The HHHHHMM Scale
Dr. Alice Villalobos, a veterinary oncologist, developed the HHHHHMM scale to give owners and veterinarians an objective way to evaluate the success of palliative or hospice care for a cat. Using this scale, pet parents and veterinarians can work together to assess a pet's well-being and make adjustments to palliative or hospice care when appropriate.
The scale uses seven parameters to measure your cat's quality of life. Each parameter is scored on a scale of 1 to 10, with 1 being the worst and 10 being the best.
Hurt: Does your cat have adequate pain control? This can be so hard to assess as cats are so good at hiding their pain.
Some signs that your cat is in pain include:
- Limping.
- Licking one spot on his body repeatedly. A cat with cancer experiencing pain may lick his tumor repeatedly.
- Your kitty's posture is different or unusual.
- Your kitty spends more time resting and interacts with you less than usual.
- Your cat sometimes trembles or shakes while resting.
- Your kitty's breathing is labored, exaggerated, or abnormal. Your cat's ability to breathe comfortably is essential.
- Your companion protects or guards one part of her body and will snap if you try to touch it.
- Your cat rests with his eyes open all the time and seems uncomfortable.
I could always tell when Jewel's arthritis was really hurting her despite the pain management program we had her on. She would sit with her back feet right by her front feet so that she wasn't putting any weight on her back legs. It was absolutely heartbreaking for me to see her in pain, and it was definitely a major factor in my decision to help her to the Rainbow Bridge.
If you think your cat is in pain, please talk to your veterinarian about what options are available to treat it. Oral and injectable medications are available to help control pain.
Refusing to eat is one of the most obvious signs that your cat isn't doing so well. Fortunately, there are several options to help your cat eat. Talk with your veterinarian about the various options. Is your cat nauseous? Many cats with chronic renal failure also suffer from acid reflux. Kitties taking antibiotics sometimes feel nauseous. If your veterinarian rules out nausea or acid reflux, you might want to consider trying an appetite stimulant, such as Mirtazapine or Cyproheptadine.
You can also try hand-feeding your cat. If that doesn't work, syringe feeding or getting your kitty a feeding tube may be an option.
Hydration: Hydration is as important as eating is for cats. Sick cats are at risk of becoming dehydrated, especially if they are vomiting or have diarrhea. Cat dehydration can be serious and should be treated right away.
There are several things you can do to encourage your cat to drink. For instance, place several water bowls around the house so he doesn't have to walk far to drink water. Get a pet fountain; many kitties enjoy fresh flowing water. Try adding an ice cube to the water bowl. You can read more about how to encourage your cat to drink in my post, "Eight Ways to Get Your Cat to Drink More Water." Subcutaneous fluids (fluids under the skin) and intravenous fluids are treatment options if your cat becomes dehydrated.
Hygiene: Can your kitty keep herself clean? Cats are very sensitive about cleanliness, but if they are in pain, they may not be able to groom themselves. You can help your cat stay clean by brushing her regularly and using cat bath wipes or waterless shampoo made specially for cats. For the last several months of her life, I helped Jewel stay clean by giving her baths with cat wipes. She didn't mind it too much, and I'm sure she felt better after a little grooming assistance.
Happiness: Is your companion still interacting with you and other family members? Is he experiencing any joy in life?
When Jewel began to decline, I sat down and thought about the things that made her the happiest in life - eating treats, getting to eat a bit of people food with us at dinnertime, and curling up for a comfortable snooze in one of our kitty kubes. Another major factor in my decision to help Jewel over the Rainbow Bridge was that she was no longer enjoying the things that made her the happiest. Likewise, determining what makes your cat the happiest and assessing whether he is still enjoying these things may help you with your decision.
Mobility: Is your kitty able to move around on her own? If she can't, there are various interventions you can try depending on what is causing her immobility. For instance, if your companion is having trouble walking due to arthritis, you can talk with your veterinarian about pain management. Using pet stairs, low-sided litter boxes, and raised feeders can also help arthritic cats. Mobility devices are very helpful to some kitties as well - as long as their pain is being managed well.
When using the HHHHHMM Quality of Life Scale, rate each parameter on a scale of 1 to 10, with 1 being the worst and 10 being the best. A total score of 35 or more constitutes an acceptable quality of life.
While this scale may help you measure your companion's quality of life objectively, you will ultimately need to do what you think is best for your beloved friend. He will let you know when he is ready to go to the Rainbow Bridge. As difficult as it may be, try to keep your heart open to receiving his message. Helping your kitty cross the Rainbow Bridge is the last gift of love you can give him.
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