Quality of Life & End of Life Conversations
I frequently say about pets, “Their only fault in life is that they don’t live longer…otherwise they are pretty much perfect.” As pets begin to decline due to terminal illness or organ dysfunction from old age, it can be very difficult to know when “it is time.” It’s a conversation that many of us actively try to avoid, as if ignoring it will make the problem go away. I know…I’ve been there, too. But unfortunately ignoring that conversation does not make the reality of our pets’ decline disappear. Addressing these conversations early and as often as needed in states of health decline make an overwhelming process just a little bit more manageable when the time to let them go finally does come.
The most important question during these conversations is, “What is my pet’s quality of life like?” Although we want to preserve the quantity of our pets’ days, we do not want to do this at the expense of the quality of their days. Are they living and enjoying it, or are they just existing? When quality of life starts to slip towards more bad days than good days, it is important to ask, “Is there anything that can be done to shift the balance back towards more good days?” If the answer is “yes,” then we implement those changes to help our pets be more comfortable and happier. If the answer is “no,” then we approach a conversation about what it looks like to consider putting a pet to sleep to prevent their suffering from being prolonged. At this point, the question no longer is, “Can my pet keep going?”, but rather, the question becomes, “Should my pet keep going?” We shift our focus from how long they are living to how well they are living.
If quality of life is so important, how do we as pet owners monitor this at home? There are many ways to monitor quality of life. Below are a few examples of the things we should be evaluating:
~Appetite: when a pet stops eating normally or stops eating altogether, this can be a sign that their quality of life is suffering
~Pain level: if a pet is demonstrating clear signs of pain and discomfort and medications are no longer effective to control this pain, we are concerned about a poor quality of life
~Energy and Excitement: if a pet no longer has the energy or excitement to do the things that used to make them happy, this can be a sign that their quality of life is declining
~Ability to carry out daily functions: if a pet starts to lose the ability to perform basic daily functions, like going to the bathroom, eating and drinking normally, and being able to move around comfortably, we are concerned about poor quality of life.
When pet owners are noticing these signs, I encourage them to start keeping a journal of “good days” and “bad days.” It does not have to be fancy or very in depth! At the end of each day, review that day’s events for your pet and decide if it was an overall good day or an overall bad day, and write that in the journal. You can add any specific details if you would like, as this helps some people track what denotes a good or bad day. At the end of each week, tally the “goods” and the “bads.” If your pet gets to the point where the bad weeks are starting to outweigh the good weeks, please call your veterinarian to discuss your pet’s quality of life. This can be a hard conversation, but our goal is to avoid a prolonged period of suffering for our pets. They spend their whole lives brining us so much joy and love; I think it is a kind and noble act to allow them a peaceful passing when the time is right for them. The time will never be right for us, and it is okay to acknowledge that with tears and mourning. However, we cannot let that grief deter us from honoring our pets by doing what is best for them. We consider it a somber privilege to help you navigate these quality of life and end of life discussions and decisions for your pet.
“If having a soul means being able to feel love and loyalty and gratitude, then animals are better off than a lot of humans.” ~James Harriott
Have you ever noticed a cat going to the bathroom outside? If you have, you’ll note that they aren’t in a private area or hiding under anything. They are out in the opened so that they can be alert for predators or other dangers which may cause harm to them, nor do they back themselves into a corner or readily go into a covered box to become easy prey. Cats use their urine/feces to mark their territory, sometimes covering and sometimes not. While this may be difficult for us to understand, marking is an important aspect for our feline friends.
When we bring a cat inside, they are actually doing us a huge favor by eliminating in a single designated area we have given them called a “litter box”. We are imposing our demands for minimal mess onto them and suddenly their freedom to go wherever they chose has been greatly restricted and in turn, we need to also compromise with them. While we should not greatly decrease our zone of comfort and convenience, meeting in the middle or as close to it as possible, will help with the cat’s comfort level as well.
If you know me, you know that I have eight inside cats. With over 20 years of experience with not only cats in my home, but also at veterinary hospitals, I have had my fair share of litterbox issues. I have had cats urinate and defecate on and under my bed, inside closets, on clean laundry and many other areas all throughout my home. I understand, fully, the frustrations that are felt when cats do not use their designated litterbox area.
Having said that, when a cat does do these types of unsavory behaviors, pay attention! They are usually trying to let us know that something is wrong. Urinary tract infections, kidney disease, diabetes, hyperthyroidism, bladder stones, cancer, constipation/diarrhea, stress, behavioral and so many more issues could be the root cause of this inappropriate behavior. The most important first step, is to schedule an appointment for your cat with their veterinarian to rule out a medical problem. A cat which is urinating/defecating outside of its litterbox is the number one reason they will be abandoned or relinquished to an animal shelter. Sometimes this is not an easy road, but we owe it to them to try and figure out the root cause of the problem.
Litterbox habits are the best indicator of your cat’s health. With dogs, we generally walk them and immediately note if there is an issue – blood in their urine/stool, diarrhea/constipation and frequency of elimination. But with cats, we may not always notice an issue until it has been going on for several days. Feline are masters at hiding health issues and illnesses so we must be detectives when trying to determine if there is in fact an issue occurring. If at any time your cat begins to hide or act differently, that is a direct indicator that something just isn’t right with them. The litterbox is a great tool that can be used to monitor your cat.
Sometimes, the problem can be a simple one. Do you like using a dirty bathroom? Neither do they. I recommend to scoop all litterboxes as least once per day. If you have over five cats, twice daily scooping may be more realistic. If one of your cats is urinating larger than normal amounts or having diarrhea, this may deter the other cats from using that particular litterbox and they will need to be cleaned more frequently to keep them in usable condition. There are many felines that prefer to use one litterbox for urine and the second for feces. If he or she is the only cat, they may not want to use the litterbox during this time, so having one litterbox per cat, plus as additional one, is always a good rule of thumb to follow.
Once the litter within the box is at a minimal level or is no longer clumping, it is time to dump and clean the box then refill it with fresh litter. The boxes should be cleaned with soap and water at least once per month and refilled with new and fresh litter. If you have a very scratched up box, odors can and will permeate into the box which can be offensive to your cat(s). If you ever have issues with this, the best thing to do is to purchase a new litterbox or boxes.
Having the appropriate amount of litter in every box is also a very important thing to be attentive to. Cats like to dig and bury so maintaining about 2-3 inches of litter should be sufficient for the average cat. For cats that like to dig and scratch deeper, you may want to keep 3-4 inches of litter in the box. I recommend doing a trial and error to see what your cat(s) prefer.
Size is also important and the litterbox(es) should be 1 ½ times the length of your cat. Too small a box may inadvertently cause them to go outside of it if their rear end if hanging out. There should be plenty of room for them to stretch and scratch around. Another rule should be to have one litterbox on each level of your home. This will save you a lot of trouble in the long run and accidents will be less likely. This is especially important if you have young kittens as their urge to go will be sudden and they will need immediate access to a litterbox. Their bladder control develops as they age, same with people, and will take time for them to make to the potty on time. This may also be the case with some adult and senior cats which may suffer from mobility issues, therefore having a litterbox on every level of your home is a must-have. Overtime as your cats age, you may need to switch to a lower sided litterbox to assist your cat’s ability to climb into the box should they suffer from arthritis which prevents them from stepping over higher sides or squatting/positioning appropriately when urinating or defecating.
Litterboxes, location and litter types are all very important. Personally, I am not a fan of liners or covered boxes. While the fancy covered boxes, cabinets, and designer boxes are great for our décor, it is not what a cat would ideally choose for themselves. These are more for our comfort and convenience as most people do not want to look at or smell the litterbox in their home. Trying to toilet train your cat is also not a natural behavior for them. Many toilet-trained cats have health issues related to their elimination habits which can go unnoticed for longer periods of time, as we pay even less attention to their bathroom behavior. Cats are programmed to bury their waste, not go into water. Liners may deter cats from using the boxes as it is a foreign material and covers can make them feel like they are trapped, especially if a small child or dog is looking into the hole while they are inside the box trying to use it. Self-cleaning litterboxes may also hide health issues as you are not readily cleaning the box yourself and simply emptying the waste as needed. If you have a problematic cat, try removing the liners and/or cover to see if their litterbox behavior improves.
As for location, try placing the litterboxes in a quiet place, away from the washing machine, loud noises, vibrations, bright lights, furnace, etc. You should also keep the litterboxes away from the cat’s food/water supply and try not to place the boxes against a wall, especially if they have lower sides. The was one of the many mistakes that I have made over the years and if there is not enough space between the wall and litterbox, cats may mistake it as one big box. Spreading the litterboxes throughout one big room is better than lining them up, side by side. Sometimes a cat will tell you where they want to eliminate as well. Try putting the litterboxes where they may be inappropriately eliminating and this may solve the issue.
Bullying between cats may also cause elimination issues by one cat chasing the others away from a particular litterbox or room. If this occurs, you should place a litterbox in the middle of the room, or add an additional box in another part of your home. This way the cat being “attacked” will not feel cornered.
Observing their “environment” is another key aspect to comfortable litterbox locations. If the litterboxes are on a cold concrete floor in the basement, this might not be as appealing as perhaps a bathroom mat. Try to put yourself in your cat’s shoes and see if you can figure out what they want and need. A cat that eliminates in the bed may be insecure and urinating/defecating on the bed may make them feel safer. We sometimes think this is an act of spite, but really that is not the case. Stress can be the only factor in this equation. Having new people in the home, moving furniture or adding new furniture, plants and even a new baby can all be stressors for your cat. Although stress might not seem like much, this can be a very big deal for your cat(s).
Finally, the type of litter you use is very important. Heavily scented litter is more for our sense of smell than our cats, and is designed to cover up what a cat eliminates in the box. A cat’s sense of smell is 1,000 times more sensitive than ours, so it could be just as offensive to them as an extremely dirty box. Premium scoopable litters have been my favorite for the past 20 years. The litter should be nice, soft, smooth and not too heavily scented – ideally a non-scented litter should be used. I would stay away from the fancy “crystal” litters as most cats are not a fan of the consistency. Again, this is a human convenience, not a feline preference. If you have a cat which is unhappy with their litter, you may have to do some trial and error to find their preferred type and brand.
Sometimes, medications may be required and necessary to help decrease a cat’s level of stress and also help them become more confident. Punishment is never the way to stop the unfavorable behavior and generally tends to in-fact increase the stress level in an already afraid cat. Rewarding your cat with treats and praise when they use the box is the best way to approach issues.
Feliway spray and diffusers are always good tools to have in place if you are having issues with inappropriate litterbox behavior. If one of your cats has an accident, it should be cleaned immediately and completely. Enzymatic cleaners specially designed to remove the smell of urine and pet waste and will greatly decrease the changes the cat will revisit this area for elimination in the future. Ensuring every cat in the house has their own feeding/water station, perch, scratching post, and toys as well as at least 15 minutes of individual, one on one play with you will also greatly reduce their stress and help build confidence. Rotating toys in and out of sight stimulates their minds and frequent interaction is just as good for their health as it is for our own and will help strengthen the bond you share.
If you every have any questions about your cats and their litterbox behavior or any other health concerns, feel free to contact us as needed. The staff here at Ruckersville Animal Hospital are always happy to be at your service for all your feline needs!
Spring is here! The weather is getting warmer. Flowers are blooming. The grass is getting green and tall….and ticks are everywhere looking for their next meal and ride. Did you know that 1 in 5 dogs in our area gets infected with Borrelia, the organism that causes Lyme Disease? Ehrlichia canis is another very common canine tick-borne infection in this area. Less commonly we see infections with Anaplasma and Rocky Mountain Spotted fever. Cytauxzoonosis is a fatal feline tick-borne disease that is also seen in our area. These diseases not only make your pet sick but can also be fatal.
Preventing the attachment of ticks is essential to avoiding tick borne illnesses in you and your pets. Always check yourself and your pets for ticks after walking in the woods, tall grass, or brush, especially in the spring and fall months. Be sure your pet is on a monthly tick preventative medicine like Simparica in dogs and Revolution Plus in cats. Since 2013, we have had the new class of flea and tick preventatives known as Isoxalines for which Simparica is one brand. These new preventatives are highly effective for up to 30 days and very safe. Many of the older flea and tick preventatives are now starting to show some resistance so it is important to have your pet on an Isoxaline.
Every year we test dogs for Heartworm disease, Lyme, Ehrlichia and Anaplasma. If your pet is positive for one of the tick-borne diseases and is not sick, we may elect to not treat the infection believing the immune system is actively and adequately fighting the infection. We will always recommend treating the pet if there is a co-infection with two or more diseases or if the pet is actively ill from the infection.
Enjoy the spring and please work at keeping the ticks off you and your pet.
Let's talk dental health! How often should your pet's teeth be professionally cleaned? Is there anything that you can do at home to help slow the build-up of plaque and tartar? And what can you do about bad breath?!
Dental hygiene is important not only for the gums and teeth and underlying bone, but also for the whole body. Bacteria in the mouth create a plaque that covers the surface of the teeth. This plaque starts to build up again within several hours after the teeth have been cleaned. This is true in people too, and it is the reason that dentists recommend brushing your teeth twice daily. But brushing your pets’ teeth twice daily?! In an ideal world, that would be lovely, and it would go a long way towards reducing bad breath and keeping the teeth pearly white. Nevertheless, we need to balance idealism with realism. Few pets will tolerate twice daily tooth brushings and few pet owners have time to fit this into their schedules. But don't despair! There are many products that can help kill mouth bacteria and slow the build-up of plaque. These products come in many forms, including enzymatic water additives and dental chews. Call your veterinary hospital to discuss options that might work well for you and your pet.
Even with these products, many pets often need a professional comprehensive oral health assessment and treatment (COHAT) several times throughout their life. Eventually, the plaque lays a foundation for tartar to cement to the teeth. This rough and porous tartar harbors bacteria that contributes to bad breath and allows infection to set in along the gum line and at the roots of the teeth. An infection at the root of the tooth can cause significant local damage, including deterioration of the surrounding jawbone or a very painful tooth root abscess (trapped pocket of pus). The infection often leads to weakening of the structures that hold the tooth in its socket, and the tooth becomes loose. Wiggly teeth are ineffective, irritating, and often painful for pets, and they need to be removed.
Because pets don't do a great job of sitting in a dental chair and saying "Ahhhhh", the COHAT exams need to be performed under general anesthesia (drug-controlled unconsciousness that prevents movement and blocks the perception of pain). This allows for a thorough exam of the whole oral cavity as well as humane treatment of any identified problems. Once the pet is sleeping under anesthesia, the assessment portion of the COHAT begins with dental radiographs (x-rays) of all the tooth roots. Dental radiographs give valuable information about the portion of the teeth and bony anchor that cannot be seen by the naked eye. The gum lines are probed to search for any problem spots, and the mouth is assessed for oral masses and broken teeth. During the treatment phase of the COHAT, the teeth are cleaned with an ultrasonic scaler which safely and effectively removes the cemented tartar. The teeth are then polished with a paste that helps delay the build-up of plaque on the teeth. If any problems were identified during the assessment portion of the exam, these teeth are extracted (removed) after the surrounding nerves are numbed. Some extractions may only need leverage and traction to be removed, while others may require the aid of a dental drill. If there is a large socket after a tooth is removed, the overlying gum is sutured together over the socket to prevent food and debris from getting stuck in it while the mouth is healing. If teeth are removed, the pet is sent home with a medication to reduce pain and inflammation and may also be prescribed an antibiotic to prevent infection.
COHATs are important for a healthy mouth, but they also contribute to a healthy body by reducing the amount of bacteria that enter the blood stream through the gums and circulate through the rest of the body. Different pets will need COHATs at varying frequencies. Some factors that contribute to this are species (cat vs dog), breed, mouth size, and genetics. As part of your pet's annual wellness exam, the mouth is inspected and a COHAT may be recommended depending on the amount of dental disease that can be seen. Appropriately timed COHATs increase the comfort, health, and longevity of your pet. If you have questions about this, we encourage you to speak with your veterinarian about when your pet would benefit from a COHAT.
April Darnell, LVT graduated from Blue Ridge Community College in 2002 with a Veterinary Technology Associate of Applied Science degree. She joined our team in 2016 and has 20 years of experience in the veterinary field.