"Medicine should be practiced as a form of friendship." - Henry Beecher
I usually ask my clients what it is they most want for their pet as it approaches the end of life. Almost always I hear, "I just don't want him to be in pain".
It seems like a no brainer - of course none of us want to think of our animal friend being painful. Fortunately, these days there are all kinds of options from gentle, natural remedies to very effective drugs to deal with pain. Most of the time there is a way to keep our pets comfortable. But first we have to see the pain. You would be surprised how often we miss subtle signs.
Acute pain is fairly obvious. When my little dog Nudge, came home from being neutered he was painful. I knew this with certainty, because he lay on the couch, on his back, with his freshly shaved belly showing and his feet sticking straight up in the air. His legs trembled and he moaned pitifully. I realize he may have been a bit dramatic. He is not a stoic creature, but I gave him extra pain medication for a day or two until we were both convinced that nothing hurt anymore. It wasn't long before he returned to running after balls and leaping straight up in the air to express his joy of life.
Acute pain or "adaptive" pain serves a function. We quickly remove our hand from a hot stove, the cat learns to watch where her tail is when the toddler walks by and a small amount of pain warned Nudge to slow down and rest, allowing his incision to heal.
Chronic pain is another story. It is the kind of pain that lingers after an injury has healed or it may be a result of a ongoing and often incurable process like arthritis or cancer. It may be continuous or intermittent. Chronic pain doesn't serve any purpose and with time it becomes a condition in itself, robbing our pets of a good quality of life.
Chronic pain is often slow and subtle in onset. There may be a tendency for some animals to mask their pain or try to hide it. This is probably a survival instinct as a weak, injured or sick animal in the wild would be an easy target for a predator. It means we have to pay close attention. So often the behavioural changes our animal friends exhibit when they experience chronic pain are missed or attributed to just getting old and slowing down a bit.
Some signs of chronic pain to look for in your dog friend include; a reluctance to jump on the bed or sofa or into the car- actions that they that they did easily in the past. You may see a slight limp when walking or stiffness when they first get up from lying down. Dogs that love to play ball may not jump as high or seem to tire of the game sooner. Other signs that could indicate pain are a deceased appetite, sleeping longer or not being able to sleep through the night, panting excessively, licking compulsively at one area of the body or flinching when being groomed. If a normally easy going dog suddenly becomes snappy when approached by another dog or a fast moving child, he may be painful.
Chronic pain in cats may be even more subtle. Sometimes they exhibit similar signs to dogs in pain - not jumping up onto places that they used to get to easily, stiffness when getting up from lying down or even missing the litter box because old, sore hips make it hard to climb in.
But often signs of a cat with pain, perhaps because cats tend to sleep so much or are just better at masking pain, are less obvious. Watching their body language and facial expressions may give us clues. A comfortable, pain-free, resting cat's body language has been likened to a "croissant" - curled up, on her side, with tucked in legs. When awake the kitty's eyes should be wide open and her ears alert and forward. A painful cat on the other hand, may have a "humpy" posture - sitting upright with her back arched. Or watch for the "squinty" faced cat - where the eyes are partly closed, (like the cat in the picture above) with her ears droopy or flattened slightly. Some painful kitties may become "untouchable" - this would be a cuddly cat that doesn't want to be picked up anymore or hides away from the family and may even hiss and swat if touched.
So what should we do if see some of these signs but are not sure if they indicate pain? It is pretty simple. I like to ask the pet. Let's give them the benefit of the doubt and assume they are painful (not just a bit stiff) and treat for pain. A note here - please do this with the help of
your veterinarian. Pain medication for people is rarely suitable for our pets and in many cases can be deadly!
If we give a pain medication or do some acupuncture and there is an improvement in their activity or comfort level, we know we are on the right track. Some people tell me that they haven't noticed much of a difference and if this is the case then we gradually decrease the pain medication. Sometimes this is when there is a noticeable change - a change for the worse - and we realize that the medication was helping after all.
One of the most rewarding aspects of my job is when there is a favorable response to pain management and a client tells me, "Snoopy ran up the stairs and jumped on my bed last night. He hasn't done that for months." Or I hear, "I didn't think I'd ever see George leap off the
dock again! He is acting like a puppy." Sweet, words indeed!
I encourage you to be proactive when it comes detecting pain. Keeping our best friends comfortable goes a long way to ensure they enjoy an active and happy life for as long as possible.
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