View Full Version : Just had a tough conversation with the vet...
11-29-2011, 11:52 AM
We have a 16-year-old rat terrier. He's got some arthritis, and degenerative disk disorder, but has coped with both of these very well. He's not as spry as he used to be, and he sleeps more than he used to, but he's been getting along very nicely. He's a real sweetheart, and charms the socks off of everyone he meets.
Yesterday he started coughing, all of a sudden with no prior indication that anything was wrong. He was no better this morning, and in fact was noticeably lethargic and weak. So, off to the vet we go. After a quick exam, the vet says that he wants to keep him there for a few hours to get x-rays, blood tests, and maybe other diagnostics. Short story - looks like there's a heart issue and some fluid in his lungs. The blood test will determine what shape his kidneys are in, and what meds he might be able to tolerate. Before I left he had a couple of chest x-rays which showed a significantly enlarged heart, and fluid in one lung. No signs of tumors, and liver looked OK. Abdominal x-rays will be forthcoming.
The positive is that he is, essentially, a terrier mutt and they are tough little dogs. He's always bounced back more quickly than expected from prior acute medical problems.
The downside is that, even assuming that his kidneys can handle the recommended meds, he's going to need a lot of watching over. Doc said that even in the best-case scenario he's recommending essentially 100% bed rest. As in, I even carry him outside for elimination and carry him back in. If all goes as well as it could, he could live another year-and-a-half, although that could be as short as 6 months. If there's kidney issues, we could lose him before Christmas.
As he's gotten older, and more medical issues arose, I've been the logical, stoic, ask-all-the-appropriate-questions, rational one. I played that role again today when I took him to the vet's. Now I'm sitting here in a funk. I think the reality just hit me that he's an old dog. Sixteen years is a pretty good run.
Here's what's making this extra hard; I don't know that we're equipped to provide the kind of care he might need. My wife has to travel a lot for her job, and for personal reasons I'd rather not talk about, I am out of town periodically as well. I have a lot more flexibility in my schedule than my wife does, but not completely.
And I feel really, deeply guilty about this. This was not the situation when we got Max, nor was it as little as 2 years ago when he was showing definite signs of aging. I take dog ownership very seriously. I've never been one of those people who gets one as an accessory, or doesn't think about the long-term commitment one makes taking in a dog. But things change; things often outside of our control. So, sometime between now and the next year or two, a part of our decision-making process has to be "How much can we take on, given other factors." It feels cold, and thoughtless, and even cruel. But it's reality.
God help me, I almost hope that the vet says his kidneys are shot. The decision would be a lot easier. But, I expect we're going to hear that they're fine, and reasonable steps can be taken to nurse him back to a decent state of health. For how long? What are we going to need to do to give him as good a life as we can?
Sorry this a bit rambling and not very well-thought-out, but I'm still processing things myself. I've got some tough decisions to make in the near future, and I'm not looking forward to them.
11-29-2011, 11:59 AM
You can only do what you can do, and no-one can rightly judge you unless they've been in your shoes (and even then I don't believe they should judge you.)
If your terrier has lived a full and loving life, and the time comes to make the hard choice, you can do so with a clear mind.
It's okay to do what you must do. It is a hard world out there and you've already made it a good one for him.
11-29-2011, 12:07 PM
Decisions like this can be so difficult. Your pet can't tell you what he wants or even if or how much he's suffering. You don't know how well he'll tolerate the treatment and if it's only going to bring an extra few months or life that will be consumed by the treatments is his quality of life really what you'd want it to be?
It's a tough call. I've had two cats that I had to put to sleep and it was a very difficult decision both times but we were sure it was the right thing to do given their age, prognosis and quality of life.
11-29-2011, 12:08 PM
Thanks, I really needed that.
After I wrote the OP, I went in the other room to talk to my wife (she was on a call when I got home). I had it all together until I said the words, "heart disease," and I lost it. I guess I expected to have more warning, a little more time to process things.
11-29-2011, 12:30 PM
<snip>... but we were sure it was the right thing to do given their age, prognosis and quality of life.
And this, right here, is the tough part.
When I was 16, our then 17-year-old terrier mutt had a whole host of health problems descend all at once. The vet said that we should think seriously about putting him to sleep, and my father told me it was my decision. He was, basically, my dog. I told them to go ahead, and as much as that sucked, I was sure it was the right call.
Twenty-seven years later it's not really the same scenario, or at least it isn't right now. That's what makes it so tough.
Thanks for the sympathetic ears.
11-29-2011, 12:46 PM
A couple years back we had to have a 17 year old cat put down. And it wasn't "a he's gonna die soon because of XYZ" sorta thing. It was just a serious case of creeping old age. Probably could have milked another year or two of life there but finally decided enough was enough. When the light of life finally left his eyes it was like a brick upside the head and a punch in the gut for me. Not just his death but how I saw him. It was like I finally and for the first time saw him as he currently really was. He instantly went from an old bitchy but lovable cat with beautiful green eyes to something that looked the cat equivalent of a concentration camp victim. I felt so ill realizing I had waited just too damn long to do what needed to be done. But it was like that old frog in a slow to boil pot of water story. It just creeps up on you and you don't realize how bad it has gotten.
Don't get me wrong. Making the choice to choose to end his life still royally sucked. Probably the suckiest choice I've ever made.
Then a few months ago, we had to do the same thing for his best bud/worst enemy, our 17 year old Shitzhu dog. Again it was creeping old age, but at least this time I think we were a bit more responsible about not waiting too long. His hair would grow long and he would slowly get more and more lethargic as the hair lengthened. Then, we would cut his hair and he would spring back to life. It was like years had been taken off. But I knew the time was coming. I gave him a very short hair cut one last time and nothing changed. I knew itt was time :(
If money isnt a serious issue, you might be able to find a vet that will come to your house to do it. You might have to call around a fair bit to find one though. We did it for both the dog and the cat. I think it was much better for both. If you decide the do at home route, let me know and I can give a few pointers that might make the process a bit better.
Again, my condolences.
11-29-2011, 12:46 PM
It never gets easier. You have to do what you know, in your heart of hearts, is right - for you, for your family, AND for poochie.
11-29-2011, 12:48 PM
... you might be able to find a vet that will come to your house to do it. You might have to call around a fair bit to find one though. We did it for both the dog and the cat. I think it was much better for both. If you decide the do at home route, let me know and I can give a few pointers that might make the process a bit better.
Again, my condolences.
Eh, it doesn't seem like too much of a hijack - mind sharing your pointers here? Our older cat is the same fucking bastard delightful sprite that he's always been, but ... eventually ...
11-29-2011, 12:52 PM
I am so sorry you are going through this. It is the truly sucky part of loving and owning pets.
I lost my little Papillon boy Jay to heart failure 4 years ago. He was diagnised late into the disease and didn't respond to the medication well. He died in my arms the Saturday after Thanksgiving 2007. If I had it to do all over again I would have enthanized him. His death was not pretty.
I have another Papillon right now with the same condition, on medication, but we caught her earlier and so far she is doing well. >knocks wood< But when I see her slipping, not enjoying life any more, I will euthanize. I can't watch another go fighting like Jay did.
As hard as it is to say good-bye, I think you'll know when it's right. If he isn't enjoying life and is in discomfort, you'll know.
My heart breaks for you. (((hugs)))
11-29-2011, 12:57 PM
I know the pain you're feeling now having lost pets myself - it really is a heart wrenching decision that every pet owner has to confront at some point.
One thing that might aid your decision is to consider how very old people view the cost of medical care (not only in terms of money but also pain and reduced quality of life) versus the benefit of adding only a few more months or years to their lives. In the examples I know of (2 of my grandparents lived well into their 90's) there came a point where they no longer enjoyed life. Medicine was able to prolong life but the fact remained their bodies were shutting down from age and that added time was not comfortable nor was it pleasant. They finally decided any new medical treatments were too much to bear and simply opted for hospice to keep them comfortable while nature took its course.
A 16 year old dog will be feeling the same pains of age and you have to ask if 100% bed rest is really any sort of thing your dog will accept. I know you feel the urge to do everything you can to prolong your dogs life to get every minute he has coming to him, but remember that people rarely opt to continue medicine to that extreme once the medical care becomes too overbearing. The question then becomes, is the prolonged life for his benefit or for yours? I'm very sorry you have to face but know that you have been a good parent to him for 16 years and nothing you do now is "abandonment of duty".
11-29-2011, 01:03 PM
100% bed rest is not an optimal life for any dog I've ever met. :(
It's a sad situation, but it truly sounds like it's time.
11-29-2011, 01:36 PM
You know, I just realized my OP sounded *slightly* more dire than reality. The 100% bed rest thing would be for a week or two; after that he should be mobile.
The rest still sucks, though.
11-29-2011, 01:54 PM
Here's a veterinary quality of life scale (http://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/quality-of-life-scale.aspx) that might help you with this decision. My old lady cats (12 and almost 16) both seem pretty spry and healthy at this point, but I keep an eye on the quality of life thing because of the "frog in the boiling water" effect - like billfish said, I don't want to miss important signs that it's time.
ETA: Sorry to hear about your little buddy.
11-29-2011, 01:58 PM
Thank you for posting that Cat Whisperer... I bookmarked the site.
11-29-2011, 03:07 PM
FWIW, our mutt was diagnosed with congestive heart failure and lived for another year under treatment, until her kidneys failed and left no option but the end. We had to give her a pile of pills twice a day, and her activity level decreased as time went on. We were not obliged to put her on bed rest, though, so perhaps something can be worked out for you so that won't be necessary.
She remained alert and happy until kidney failure set in. We had to get increasingly creative to get her to eat, and eventually we were largely forcing her pills on her, but her quality of life remained good, at least as measured by tail wagging. She got a little bit leaky from time to time, but we made sure that she always had a layer of towels on her beds and other favorite spots. I did often carry her upstairs to our bedroom at the end of the day.
Best wishes during a difficult time. There's no one answer, and whatever you decide is likely to leave you beating yourself up sometimes for not choosing otherwise.
11-29-2011, 03:14 PM
I'm so sorry. It's a very hard decision to make. I have done it a number of times. I hurts, but you know it's the right thing.
11-29-2011, 05:21 PM
... and whatever you decide is likely to leave you beating yourself up sometimes for not choosing otherwise.
Oh, man ... ain't that the truth right there, honey.
11-29-2011, 06:00 PM
Max is home, and in noticeably better spirits. By the time the tests were done, the Dr. had backed off a tiny bit from, "100% bed" rest to, "as much bed rest as he'll stand." Kidney function looks fine (although one looks a bit large on the x-ray), and he responded well to an injection of Salix. His lungs are already sounding better.
The doctor's words were, "I'm very concerned, but I'm also very optimistic." I'll be taking him in tomorrow for a quick check and to remove the IV line in his leg (they kept it in just in case). He'll be in for a couple of more check-ups over the next couple of weeks, and we may get him in for a cardiac ultrasound when that vet rolls into town.
When we got Max home he drank a fair amount, really wanted some food, and didn't go straight to his kennel for a lie-down. In fact, I had to put him there and start enforcing some bed rest.
Doc sent him home with some more Salix to clean out the lungs, and Banezepril and Vetmedin for his heart. So, it's not as bad as it could have been, he seems to be bouncing back, and the doc said that, if he responds positively, within a couple of weeks he should be in pretty good shape. Maybe not 100% of what he was, but probably 90-95%.
All in all, pretty good news. We're going to lie on the couch and burn through some stuff on my Netflix queue, and see what the next few days brings.
And as an aside, I really like his doc. He's probably in his late 50s or so, a former Marine, and exactly the right combination of country doctor and still excited by advances in medicines and technology. He seems to know when to defer to those with more specific knowledge than he has. Best of all, he clearly loves the animals in his care without over-humanizing them. I always walk away from his office feeling like I got good advice, Max got good care, and when that time comes I'll get the straight story. Thanks, Dr. Maxwell. You're good people.
11-29-2011, 06:12 PM
Vetmedin is a wonder drug.
11-29-2011, 06:59 PM
Glad to hear Max is responding well to treatment! And I'm glad to hear you've got a great vet in your corner. They're worth their weight in gold.
I would not think less of you for putting Max to rest when it becomes difficult to care for him due to your schedules. Some people do rearrange their lives to care for a pet, and that's great, but I don't think it's wrong to weigh the difficulties of caring for a terminally ill pet against the other commitments in your life. (This is especially true when it comes to finances.)
Here's hoping that you'll have a good time for as long as you've got him, and that the decision will be clear when the time comes.
11-29-2011, 09:05 PM
I'm happy to hear your little guy is feeling better. Heart failure is always a tough one, and usually is one of those that takes people by surprise. It sounds like he got the right care and your vet's a keeper.
Do remember that no one will think you did the wrong thing when/if you need to make a decision. I'm an ER tech, and deal with more euthanasias on a weekly (heck, daily) basis than either regular daytime vets or even the shelter I work for. I've had to make the decision for two of my own, too, and I'm a firm believer in too early rather than too late. I see the "too late" decisions and aftermath all the time, and it's no favor to the pet for sure.
It sounds like you're truly in the right headspace for when decision time comes around, considering you were already thinking you may need to do it soon. Buying time is good, and the meds your little dude is on will probably give him many, many more good days! If you have a chance to have a specialist do a cardiac ultrasound, do it. He/she will be able to determine whether different doses or different meds will help more than what your dog is already on, and will be able to tell you exactly what's causing the heart enlargement, and give a more definitive prognosis. Those are always helpful to know when you see your guy start to have trouble again. If you know it's something that won't be helped by different meds or higher doses, it will help you make a decision even if it's another year from now.
Best to your family and your doggie!
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