Recent studies show that most people can be very poor at recognizing the subtle signs of pain that animals display. Discussions and resources about quality of life (QOL) and signs of suffering are very helpful tools for families facing end-of-life.
Help For Recognizing Hidden Signs of Suffering
Our pets display very subtle signs of pain that can be quite difficult to recognize and identify. They often don’t show obvious signs of pain like crying, yelping, whining, and vocalizing. This makes it challenging to determine…are they really suffering? When it comes to assessing quality of life and discussing options, it can help to look at changes over time: days, weeks, months.
Here is a list of the most common signs of pain in animals:
panting, falling, stumbling, hesitating, slow, licking wrists, biting, restless, shifting positions, anxious, unsettled, can’t get comfortable, can’t sleep fully on side for long periods, abdominal effort to breathe (side “sucks in” with each breath), wanting to be upright all the time, tense or flinch with touch, stiff, eliminating in the house, dilated pupils, wide-eyed look, hiding, less time spent grooming, sleeping all the time, not interacting with the family, drooling, wet lips, chomping/licking lips, head hanging down, pale pink or white or blue tongue/gums, large belly, not eating, not moving, not walking, can’t get up, difficulty laying down, not using one leg or limping a lot on one leg, vomiting, third eyelids up and visible
Signs of Debilitating Arthritis: panting, falling, stumbling, hesitating, slow, licking wrists, biting, tense or flinch with touch, stiff, eliminating in the house, dilated pupils (pain), wide-eyed look (pain), old age weight loss and lack of muscle mass, skinny, bony, can’t get up, difficulty laying down, dragging toes, knuckled over, too thin, laying in urine or feces
Signs of Unstable Chest/Lungs/Breathing: can’t sleep fully on side for long periods, wanting to be upright all the time, not laying flat out on side, laying on chin/sternum/elbows/upright, unable to sleep well or deeply, unable to sleep for long periods, panting, blue tongue, exhausted, coughing, restless, shifting positions, anxious, unsettled, can’t get comfortable, abdominal effort or side sucking in with each breath
Signs a Cat May Not Be Feeling Well: hiding, less time spent grooming, unkept fur, sleeping all the time, not interacting with the family, 3rd eyelids elevated/visible, skinny, bony, weight loss, attracted to heat, finding warm places to rest/sleep, head hanging down, wet lips, drooling, chomping/licking lips, not eating, vomiting, twitching, can’t jump up on things, some cats use purring to comfort themselves when they are in pain
Signs of Bone Cancer/Osteosarcoma: classic moth-eaten appearance on bone x-rays, not using one leg or limping a lot on one leg, head-bobbing limp, very large and very firm lump or tumor on leg, skin breaking open/splitting/oozing, pain may be manageable when still using the leg yet limping, pain often too great once not using the leg/holding leg up, don’t confuse it with torn ACL which is much less serious, much more manageable (younger dog, back leg, holding leg up, no lysis on bone x-rays)
Signs of Old Dog Vestibular Syndrome: head tilted or cocked to one side, eyeballs jiggly/darting back and forth repeatedly, vomiting, drooling, nauseated, unbalanced, can’t walk, falling down, dizzy, doesn’t want to get up, (mild cases can recover hopefully quickly, some take a few weeks to recover, symptoms may be too severe to let it go on that long so euthanasia is humane option to relieve suffering)
PAIN? – Is your pet’s pain well managed? Can they breathe properly? Is there abdominal effort to breathe (bad)? Is there panting all the time or often (bad)? Can your pet sleep well for long periods (good)? Do they need to be upright (bad) to breathe, wanting to be on the elbows and chest and NOT on it’s side? Can they lay on their side (good) for long periods? Are the gums and tongue pale? Is the belly enlarged? Hemangiosarcoma is a very common fatal bleeding cancer of the spleen that can affect the liver and heart as well. It’s a ticking time-bomb that can bleed without stopping. Don’t wait too long and get into a period where dog cannot breathe well. Drooling? Wet lips? Chomping/licking lips? Hanging head down? Cats in end-stage kidney failure feel like they are hung over or have to vomit constantly along with weakness. They definitely need relief once they stop eating or drinking, maybe even before that. Once dogs with osteosarcoma stop using the leg and hold it up all the time, the level of pain is too much. They are probably more painful than we think, even when they are still limping around on the leg.
NOT EATING/DRINKING? – Eating enough? Does hand feeding help? People food or canned food? Still eating may not mean all is well. Some pets are suffering/painful inside, yet still eat very well. (Debilitating arthritis is a good example.) Is your pet drinking too much or not enough?
CAN’T URINATE/DEFECATE IN THE APPROPRIATE PLACE? – Fall when getting outside? Fall or shake when getting into position to urinate or defecate? Eliminating in the house because it’s too painful to go outside? Laying in urine or feces? Leaking urine often? Is there too frequent urination or not enough? Is the skin red, raw, and painful where continuous urine leakage has caused irritation like a sunburn? Do meds help with leaking urine? Would a large flat container with low sides work better as a litterbox? (The Container Store)
DEPRESSED/WEAK? – Expresses joy and interest? Responsive to family, toys, other pets? Depressed, lonely, anxious, frustrated, bored or afraid? Can your pet’s bed be moved to be close to family activities? Does your pet seem trapped in a body that doesn’t work or is painful? Some pets are suffering when their mobility is difficult and painful. Some pets are suffering even though they are still eating. Pale tongue/ gums? Periods of weakness that come and go?
CAN’T WALK/GET UP? – Get up without assistance? Would a cart or sling help? Feel like going for a walk? Stumbling, shaking, falling? Do pain meds help (early arthritis) or make no difference (advanced arthritis)? Does it help to place rugs all over the house so pet can gain good traction and stability? Panting? Stiffness? Muscle mass gone? Skinny? Bony? Head, shoulders, spine/back, hip bones visible? Lost a lot of weight? Significant weight loss can mean serious cancer or organ failure that may not be fixable.
BEHAVIORAL ISSUES? – Vicious dogs or mentally unstable dogs may pose a serious and ongoing danger to humans and other pets. Costly damage can be done to a home by destructive behaviors. Unhealthy hygiene damage can occur from pets with inappropriate elimination issues. It can be very stressful to live with some of these problems. An animal behavior expert may be able to work with you towards a solution. Click here for a list of veterinary behavior experts nationwide who can help. (or visit this website: www.dacvb.org/resources/find/)
TOO MANY PROBLEMS? NO EASY FIX? – Can more be done to help? Have you explored hospice options (www.IAAHPC.org)? When bad days outnumber good days, or when your pet’s list of problems is long, quality of life may be too compromised. Euthanasia is a very important opportunity to give our cherished pet relief from terrible pain and suffering. Take yourself and the family into consideration as well. Are you constantly worried that your pet will die alone while you are at work? Are you cleaning up diarrhea or leaking urine every day? So many of us lead busy lives and have limited funds. You may want to meet with each of the following people to help you discuss the many factors involved in the euthanasia decision: your regular veterinarian, a home euthanasia/hospice veterinarian, an animal chaplain or human hospice chaplain, and a pet loss counselor who can help with anticipatory grief. Click your state on the colorful map in the upper right of this website for a list of pet loss therapists.