# Sticky  Time to say farewell?



## Ceiling Kitty

I was looking through some of my old copies of JFSM yesterday and 're-stumbled' across the AAFP Position Statement on feline hospice/palliative care, which contained information I thought might be useful on here. I've jiggled it around a bit and added some of my own thoughts - I hope others will add their own experiences or tips.










*EVERY CAT DESERVES THE BENEFIT OF A LIFE WORTH LIVING, AS OPPOSED TO A LIFE NOT WORTH LIVING.*

This may be relevant to kitties in the following situations:
- where a decision has been made not to pursue intensive treatment.
- those with chronic,progressive or terminal illnesses*.
- infirmities associated with old age.

_*possible examples include CKD (renal failure), cancer, uncontrolled diabetes, uncontrolled hyperthyroidism, liver disease, severe or uncontrollable IBD, severe arthritis, other causes of incurable pain, or a combination of the above.
_











*Some considerations if you find yourself caring for an elderly or very sick cat*

This is bound to be an emotional time. Make sure you have some support if you can. Trusted family members or friends, your vet or veterinary nurse, and even this forum can be an invaluable source of comfort and advice. There are also several other sources of support available, especially during the bereavement process (more at the end).

Try to manage your expectations. It can be useful to do this together with your vet and/or some trusted friends or family members. If your cat has a condition that cannot be cured and you are now concerned that their quality of life is decreasing, then have in mind some ideas about if and when you will consider euthanasia.

Above all, you must be aware of your responsibilities to the cat. If your cat is unwell, or seems to be struggling, or even if you are just concerned about them, you must contact your vet.

*How can I assess my cat's quality of life?*

This is quite subjective, and varies a lot between individual cats, their illnesses and their environment. The AAFP recommends the use of the *5H2M Quality of Life scale*.

This involves looking at seven aspects of your cat's life and assigning a score from 0 to 10 to each one (0 being very bad, 10 being excellent). When allocating scores, you must be honest. You owe it to your cat. If it helps, you could ask a trusted friend who knows the cat well to assign scores too so you can compare scores.

1. Hurt
Is the cat in pain? Is this managed successfully? Adequate pain control is the first and foremost consideration.
0 = severe, uncontrolled pain / 10 = completely pain-free

2. Hunger
Is the cat eating enough? Does hand-feeding help? Do they require a feeding tube to be placed to ensure they receive adequate nutrition?
0 = not eating at all (or needs a tube to survive) / 10 = eating normally

3. Hydration
Is the cat drinking enough? Do they require subcutaneous fluids?
0 = dehydrated and not drinking / 10 = drinking normally, well hydrated

4. Hygiene
Is the cat keeping themself clean? If not, are they comfortable being washed and brushed? Can they be kept clean after using the litter tray? Do they have any wounds that need to be kept clean?
0 = hygiene is a severe problem / 10 = no problem keeping clean

5. Happiness
Does the cat express joy? Are they interested in what's going on around them? Are they responsive to people, food and toys? Do they purr when cuddled? Can their bed be moved closer to the family if needs be?
0 = very unhappy, disinterested / 10 = very happy and interested

6. Mobility
Can the cat move by themselves? Do they suffer from fits, or do they stumble? If their mobility is limited, are they still alert and responsive?
0 = cannot move / 10 = normal mobility

7. More good days than bad
Are the good days still outnumbering the bad days? Is is still possible to bond with your cat?
0 = all bad days / 10 = all good days

This could give a maximum total of 70 points. Anything over 35 is considered an acceptable quality of life. If your cat scores below 35 then a review of their management is needed. There may be more you can do - see the vet for medications, make changes around the house etc. However, it is also time to start considering your cat's happiness and welfare. Euthanasia may be the fairest thing.

*Increasing comfort for your elderly or very sick cat
*
Make sure your cat has clean, soft bedding. Some cats prefer to be kept in a quiet place, but you should ensure they have access to social interaction with you and the family.

Keep them warm.

Ensure they have access to clean water and palatable foods. Soft food can be helpful for cats with sore mouths or no teeth. Warming food can make it more tempting. Some cats will take food better by hand. Never restrict water intake, even if they seem to be drinking too much. Medical conditions such as diabetes and renal disease wilk make cats thirsty, and restricting their water intake will makes things much worse. Some cats require subcutaneous fluids to keep them hydrated. This involves injecting a volume of saline under the skin - this can be done at the veterinary practice, or you can learn to do it yourself if your cat tolerates it well. Ask your vet.

Older cats may need to pee or poo more frequently. Make sure it's easy for them to reach the litter tray and that the tray has low sides so they can get in easily. Some cats may be suffering from diarrhoea and require more intensive cleaning. Clipping the fur around their bottom and on their back legs can help keep them clean.

Make sure they get all their meds on time if you can, but don't panic if something happens that prevents this. Everyone misses doses once in a while. Some meds can be crushed into food or wrapped in something tasty. Others may be available as an injectable or liquid form if you are struggling to administer tablets - ask your vet. This forum is full of tips for medicating cats - don't be afraid to ask if you need some guidance!

Be aware that they could be more at risk of accidents, especially if they are blind or they're not as agile. Evaluate your home for sharp edges, falling hazards and steps etc which might need addressing.

Keep them clean. Brush or trim out matts, trim their claws so they don't get stuck in the carpet etc. You might need to wipe their face or bottom to keep them clean and comfortable.










*TIME SPENT WITH CATS IS NEVER WASTED*

*Making 'that' decision*

There is no shame in making the decision to put your kittie to sleep if you feel that is the best thing for them. Maybe you feel like you should be doing more for them, or that you're 'giving up on them'. Stop. Many conditions are incurable and/or unmanageable. Even if there is a cure, maybe it's not an option. It may be beyond your budget, maybe your cat wouldn't tolerate it or maybe you prefer not to go down that route. Whatever the reason, there is nothing wrong with choosing to euthanase instead of treat if it means releasing your cat from suffering.

Letting go can be difficult, but it is supposed to be. This is a reflection of how deeply we love our cats. The larger the hole they leave, the more they were loved.

Ultimately, we choose to suffer - to put ourselves through the hurt of letting them go - so that they can rest peacefully. Deciding to euthanase your very old or sick cat is the last great thing you can do for them, in return for all the friendship and happiness they may have given you over the years.
_
If it should be that I grow frail and weak,
and pain should keep me from my sleep,
then you must do what must be done,
for we know this last battle can't be won.

You will be sad, I understand,
but don't let grief then stay your hand,
for this day, more than the rest,
your love and friendship must stand the test.

We've had so many happy years,
what is to come can hold no fears.
Would you want me to suffer? So,
when the time comes, please let me go.

Take me where my needs they'll tend,
only stay with me until the end,
and hold me firm and speak to me,
until my eyes no longer see.

It is a kindness that you do to me,
although my tail its last has waved,
from pain and suffering I have been saved.

Do not grieve, it should be you,
who must decide this thing to do.
We've been so close, we two these years,
Don't let your heart hold any tears._
- J. Napier

*I would prefer my cat to die peacefully at home*

We all would. Unfortunately, this rarely happens. For every cat who truly does pass peacefully at home, there are several others who suffer for too long so that this can happen. There is nothing wrong with opting for euthanasia; in fact, it is often kinder than letting a cat linger on just so we don't have to make that decision. You can always ask the vet to conduct a home visit to put your cat to sleep at home.

*Planning euthanasia*

Euthanasia means 'good death', but it can be harrowing nonetheless. As difficult as it is, I would encourage taking a little time - with a friend/family member if it helps - think about arrangements and what you would like. For example, would you prefer euthanasia to be carried out at the veterinary practice or at home? Would you like to bury your cat, or would you prefer cremation? Speak to your vet about the options and, if you can, make all of these decisions before the day comes. It will make it a little easier not to have to make all these decisions at the time.










*
The euthanasia process*

There is no 'one-size-fits-all' approach to euthanasia; it depends on the vet, the cat, the owner and the circumstances.

Traditionally, an overdose of anaesthetic is given via an intravenous injection, into a leg vein (usually the front leg). This may be done by simply injecting straight into the vein, or it may be done via a pre-placed catheter that has been bandaged into the leg. The restraint required for this injection can be uncomfortable for some cats (others don't mind at all). The vet may ask a nurse to hold your cat if they are a bit wriggly.

Sedation prior to the injection is another option, and you can request this if you'd prefer. This involves giving a sedative injection first, causing your cat to drift off to sleep; once they are asleep the final injection will be given without restraint or the knowledge of your cat. Sedation is often more peaceful, but there are two (minor downsides):
1. A small proportion of cats feel a bit sick with the sedation. Some may lick their lips before they fall alseep; a very small number actually vomit.
2. The sedative injection can sometimes sting a little bit, but it is only momentary.

Some vets will bypass the leg veins - which can often be fragile in older or unwell cats - instead choosing to give the injection into the kidney. This sounds more dramatic, but it is no more painful than injecting into the leg (especially if the cat is sedated first). I euthanased my cat Orange this way, having sedated him beforehand.

It is important to note that the body can sometimes do some rather odd things when it shuts down. These can be alarming for us, but it should be remembered that the cat will not know any of it. For example, they may empty their bladder or their bowels. They may do a big stretch, lifting their head or straightening their legs. It is not uncommon for them to do sudden deep breaths. Some cats will do nothing at all. All of these possibilities are completely normal.

Cats will not close their eyes once they have passed. They like to see where they are off to next.

*I'm worried I just can't cope! *

It's a cliche, but it's good to talk. Feelings of confusion, sadness or guilt are common in the period leading up to euthanasia, or the time afterwards, and are normal. I promise you will not be the only one to feel this way.

Speak to your vet or veterinary nurse, or understanding family and friends. If you don't feel these outlets are available to you then those on this forum will always be here for you. Many of us have been through it before, and we all understand the bond it is possible to have with a beloved cat.

There are also a number of Pet Bereavement organisations and helplines who are trained to listen and talk. Here are a few examples:
Blue Cross - Pet Bereavement Support Service
http://www.theralphsite.com/
Living with Pet Bereavement

Whatever happens, you are NOT stupid for feeling this way. A cat is never 'just a cat'. Ignore anyone who says otherwise, or who doesn't understand. Cats are remarkable animals who touch our lives in so many different ways, and once they leave us they do leave a big hole. It is normal to grieve for them in exactly the same way as we would for a person.










_Bast, Sekhmet, we give you back your child.
Noble, regal, honorable cat.
Watch over him, and guide him on his way to the spirit world.
May he be blessed in your names,
and hunt ever after beside you._

_ Do not stand at my grave and weep_
_  I am not there. I do not sleep._
_ I am a thousand winds that blow._
_ I am the diamond glints on snow._
_ I am the sunlight on ripened grain._
_ I am the gentle autumn rain._
_ When you awaken in the mornings hush_
_ I am the swift uplifting rush_
_ Of quiet birds in circled flight._
_ I am the soft stars that shine at night._
_ Do not stand at my grave and cry;_
_ I am not there. I did not die. _

Edited April 2016 to add a link to 'Compassion Understood', a new site with lots of information about planning for the end, what to tell the children, and how to cope afterwards.

https://www.compassionunderstood.com


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