WHEN YOU CAN'T "CATCH" YOUR BREATH
MANAGING RESPIRATORY DISEASE IN AN OLDER PET
As an end-of-life care veterinarian, in my experience no disease condition necessitates as much careful planning to manage a good, lasting quality of life, culminating in a peaceful passing, as respiratory disease when it is severe or end-stage (with progression of diseases such as heart failure, lung cancer, collapsing trachea, nasal cancer, etc). It should make sense to all of us as living beings that WHEN YOU CANNOT BREATHE, NOTHING ELSE MATTERS. Because no oxygen-dependent species can survive long without adequate respiratory function and oxygen delivery to tissues, respiratory conditions have potential to turn into a crisis so quickly that there may not even be time to get your pet to an emergency clinic for help if you wait too long to make end-of-life decisions. Shortness of breath and inability to get enough oxygen is one of the most frightening experiences for anyone, human or animal. The purpose of this blog is to share some information that may help caregivers be better prepared for when intervention may be needed to help their pet, BEFORE they enter a crisis.
At every in home assessment for our hospice & palliative care program, our resource packet includes information on taking vital signs for a dog or cat, including resting respiratory rate, as well as what signs you might notice visually that indicate your pet is having a difficult time. If your pet has respiratory disease (diagnosed, or clinical symptoms evident), we also discuss what values indicate distress or crisis in your pet so you know when to reach out to a veterinarian (and potentially intervene by modifying the treatment plan if possible). Resting respiratory rate is one of the single MOST important things you as a caregiver can monitor at home if your pet has or may be predisposed to heart or respiratory disease, as this rate will increase once these systems start to be compromised, usually before other symptoms appear. Boehringer Ingelheim offers a free app, My Pet’s Heart2Heart (ref 1), that makes it easy for you to record these rates as well potentially as input the values that are normal, concerning, or indicate emergency for your pet.
WHAT IS NORMAL AND WHEN SHOULD YOU REACH OUT TO YOUR VET
Resting respiratory rate (ref 2) (taken when your pet is resting quietly) – a single breath includes both inhalation & exhalation:
Dogs: Normal = 18-24 breaths/min (smaller dogs tend to have higher rates than larger dogs)
Cats: Normal = 20-30 breaths/min
Any significant, consistent elevation from your pet’s normal “baseline” is reason for concern and means you should reach out to your pet’s veterinarian for workup or if needed, referral. And that is exactly why you should start monitoring now, to at least know normal for YOUR pet! In pets with known disease, anywhere from 40-60+ breaths/minute at rest can indicate your pet is in or close to a crisis state depending on their species, size, etc.
Other signs that can indicate your pet is not respirating effectively include cyanosis (check for gum color turning from pink to blue/purple-tinged if gums are not pigmented), reluctance to eat or drink, unwillingness to lay down, nostrils flaring, open mouth breathing in cats, and orthopnea (standing with their elbows pointed sideways to create more space for their chest to expand). These symptoms indicate your pet may need to be seen promptly by their primary or an emergency veterinarian.
HOW CAN I HELP MY PET IF THEY ARE IN DISTRESS
Since pets rely on a functional respiratory system for cooling themselves, a very real sequela to respiratory distress is overheating, or hyperthermia. A cooling mat or placing a fan near them may help bring their temperature down to a safer level and help them rest easier. If congestion is an issue (nasal, bronchiolar, etc), sitting with your pet in a bathroom with a hot shower to create steam can help break up blockages, especially if your pet lets you perform coupage (striking the chest gently but firmly with cupped hands) afterwards. But, if your pet is in clear respiratory distress my #1 recommendation is to get them into the car and head to your closest ER for immediate assistance.
WHAT CAN HOSPICE CARE PROVIDE FOR MY PET WITH A RESPIRATORY CONDITION
Unfortunately, unlike many diseases such as osteoarthritis, with respiratory disease our focus shifts towards crisis prevention & management rather than a robust treatment plan (although anti-anxiety, anti-pain, as well as other medications, supplements, and treatments may be part of the plan for your pet). This crisis prevention is done through educating the pet’s family/caregivers about what the disease process may look like, educated guesstimates of timelines (but just like most fragile geriatric patients, this is unpredictable), and being accessible throughout the pet’s journey to help modify plans when needed, help decide if and when humane euthanasia should be considered, and information such as what’s in this blog about what caregivers should be monitoring and watching for. Crisis management can include emergency injections for caregivers to give (and we will teach them how), oxygen supplementation, and sedation to help manage anxiety.
1. Boehringer Ingelheim Pharma GmbH & Co.KG, My Pet’s Heart2Heart:
2. Cox, Shea. PetHospice.com. 2018. How To Take and Monitor Vital Signs.