What Would You Do?

[JulesP]

I don't know how to make the decision either way.

Whenever I've felt like that it hasn't been time. That is just me though. Whenever it has been time everything has become clear and doubts have gone.

[kelpiecuddles]

Peronsally I sit down, hug my dog and look in to their eyes for a while, for me things become clear when I can see whether their eyes are pained

[dragonwoman]

You have a large breed dog who has hip and elbow dysplasia- both elbows, both hips, one side worse than the other. Dog was initially diagnosed by specialist at around 6 months, had x rays since then as an adult to confirm- dog is nearly 6 years old now. Earlier this year the dog snaps one cruciate ligament, goes has surgery (TPLO) and a long recovery which although went well was slow and difficult and put alot of pressure on his other already messed up joints.

Dog is put on ongoing, long term Tramadol (opiate pain relief) and carprieve (non steroidal anti inflammatory) to try to reduce the pain/ discomfort in his hips and elbows- the cruciate seems to have healed well and the pain doesn't come from there. Dog can no longer run/ swim at the beach or park without being in pain afterwards even on the maximum dose of medication. Can do short walks and very gentle, short runs and experiences less pain but still struggles to get up on to couches etc without assistance- ie, it's not a pain free existence.

Is starting to look almost bow legged- like his conformation is changing to compensate for the pain. Dog is very boisterous and active and loves to run and play- lives with two other dogs- also VERY stoic so can be difficult to gage his pain level.

Then dog snaps the other cruciate ligament.. What would you do?

I would do what I had to do some years back in a very similar situation, euthanasia is a blessing sometimes. To have kept my beloved friend alive any longer would have been for me and not for him, I have never regretted it. I still miss him very much, we achieved a lot together, but I have my beautiful memories forever

[ness]

Tramadol and carprieve will do very little if the cruciate is fully ruptured . I presume the knee has been assessed as being unstable, is there any meniscus damage?

Is it the cruciate rupture that has caused you to reassess his comfort level? If it wasn't for that would you be asking the same question?

Not trying to push you one way or the other sometimes its really hard to know what to do. What about looking at the option of a brace?

Edited October 20, 2013 by ness

[Cosmolo]

I haven't confirmed the cruciate rupture yet Ness- was late yesterday afternoon when he pulled up lame and i didn't think it was cruciate till this morning when he wasn't weight bearing and he was moving suspiciously like he did last time.

In saying that he has just gotten up after lying down for hours and is weight bearing a bit on the bad leg- maybe not a complete rupture? He will see our vet in the morning, hopefully they will be able to tell us what's actually going on. If it wasn't for the suspect cruciate i would probably just be limiting activity further but not thinking about anything else. I do find it hard to assess his pain level though unless it's obvious- he's really stoic.

That's a good point Jules, i hadn't thought about it like that.

[ness]

Weight bearing is promising. Work out if its stable or not and go from there. If its stable you might get away with resting and restricting exercise. Fingers crossed. Certainly don't envy the position.

[Cosmolo]

Hopefully that will be the case Ness.

He is lying on the couch now with his head on OH's lap, wagging his tail. He does look happy alot of the time, especially when he is lounging around or in our lap having a cuddle. That's what makes it so confusing.

[RuralPug]

It's all about his quality of life and prospects.

If he has more good days than bad days (I am not talking whether or not he can run, but whether or not he has been miserable most of the day) then it is not yet time. I kept a calendar, and marked off any 'bad days' for my seniors. When the bad days come thick and fast and your vet says that there is nothing more that can be done, then that is the time.

I'm sorry to say that when weighing these things up, you should not place your own needs and desires in the scale at all - except for your desire to make the best decision for your pal. Hugs.

[Summersaint]

thats a very hard choice to make...my thoughts are with you

[Airedaler]

I'm sorry, this post is long but I recently included this article in in our Club magazine, little knowing that within weeks I would be referring to it time and time again in deciding what to do with one of my dogs. I found it an excellent resource but you do need to be sure you are being honest in answering the questions. I hope it can help others as it helped me to make "that decision".

How to Know When It's Time to Euthanize Your Pet

By Dr. Andy Roark | vetstreet.com

Just last week, while I was performing euthanasia for a critically ill patient, the pet's owner looked at me and said, "I bet this is the hardest part of your job." That gave me pause.

For me, putting animals to sleep is not one of the hardest parts of being a veterinarian. That's because euthanasia is often a blessing and gift to a suffering animal. In my experience, the hardest part of being a veterinarian is telling owners that their beloved pet has a terminal illness and will soon be leaving this world. The emotions that pass across their faces, even if they have suspected the worst for some time, are heart-wrenching.

I still remember the first person I had to share this terrible news with. He was a nice, middle-aged man with two small children and an 8-year-old Rottweiler named Stone. Stone was a member of the family, and when he started to limp, his owner brought him straight in to be checked out. Stone was a wonderful dog at home, but he was not a fan of the veterinary clinic. My best dog treats did nothing to warm his heart, and when I manipulated his painful left shoulder, well… that ended our chances of being best friends.

Even though Stone was not an admirer of mine, I liked him, and I really liked his owner. That made it so much harder to discuss his diagnosis: osteosarcoma. Osteosarcoma is a painful bone tumor that responds poorly to treatment. In some cases, treatments involving limb amputation and/or radiation therapy can be beneficial. In Stone's case, these options were not feasible.

Together, Stone's owner and I decided to provide him with the best palliative care we could, and we promised each other that we would not let Stone suffer. When the time came, we would do the right - if tough - thing and put him to sleep rather than allow him to live in increasing pain.

Stone's owner was the first person I ever had an end-of-life discussion with, and he was also the first person to ask me a question I have heard hundreds of times since: "How will I know when it's time?"

The most recent person to ask me this question was my own mother. Her Miniature Schnauzer has battled long-term health problems and was recently diagnosed with diabetes. Unfortunately, she initially responded poorly to treatment. She lost her love of food, began soiling her bed and was generally acting pitiful.

How to Decide

Over the past few years, I've heard a lot of veterinarians give wonderful advice to people who are wondering when it is time to give their pets the gift of a peaceful passing. Here are four of the best pieces of advice I've heard, and they are the same ones I passed on to my own mother for her consideration.

Every pet, illness and situation is different. There is no single rule that can be followed for when it is time to help your best friend "cross the rainbow bridge." Getting input from your veterinarian on the specific medical conditions that your loved one may face is vital for doing what is best for your pet. You may also benefit from having a caring friend who is not as emotionally involved in the situation as you are to help you gain perspective and really "see" what is happening with your pet.

Remember that pets live in the moment. One of the most wonderful things about animals is how they embrace the present. Every time I walk into my house, my faithful Viszla throws a one-dog ticker tape parade. The fact that I have entered the house thousands of times before, or that I will leave again in a few hours, means nothing. All that matters to him is the joy that he feels right now.

When our pets are suffering, they don't reflect on all the great days they have had before, or ponder what the future will bring. All they know is how they feel today. By considering this perspective, we can see the world more clearly through their eyes. And their eyes are what matter.

Ask yourself important questions. Sometimes, articulating or writing down your thoughts can make the right path more apparent. Some questions that help pet owners struggling with this decision include:

• Why do I think it might be time to euthanize?

• What are my fears and concerns about euthanizing?

• Whose interests, besides those of my pet, am I taking into account?

• What are the concerns of the people around me?

• Am I making this decision because it is best for my pet, or because it is best for me because I'm not ready to let go?

Measure their quality of life. This is no more than trying to determine how good or bad our pet's life is at this moment. Trying to assess this can be difficult, but there are some ways you can try and evaluate it. Let's take a look at a few of my favorites in the next section.

Is Life a Joy or a Drag?

Our pets may not be able to talk to us and tell us how they are doing, but if we pay close attention, there are many clues that can help us answer that question.

The Rule of "Five Good Things": Pick the top five things that your pet loves to do. Write them down. When he or she can no longer do three or more of them, quality of life has been impacted to a level where many veterinarians would recommend euthanasia.

Good Days vs. Bad: When pets have "good days and bad days," it can be difficult to see how their condition is progressing over time. Actually tracking the days when your pet is feeling good as well as the days when he or she is not feeling well can be helpful. A check mark for good days and an X for bad days on your calendar can help you determine when a loved one is having more bad days than good.

HHHHHMM: Doctor Alice Villalobos is a well-known veterinary oncologist. Her "HHHHHMM" Quality of Life Scale is another useful tool. The five H's and two M's are: Hurt, Hunger, Hydration, Happiness, Hygiene (the ability to keep the pet clean from bodily waste), Mobility and More (as in, more good days than bad). Dr. Villalobos recommends grading each category on a scale of 1-10 (with 1 being poorest quality of life and 10 being best). If the majority of categories are ranked as 5 or above, continuing with supportive care is acceptable.

Pet Hospice Journal: Keeping a journal of your pet's condition, behavior, appetite, etc., can be

extremely valuable in evaluating quality of life over time.

A Tale of Two "Endings"

Thankfully, my mother's Schnauzer, Zoe, eventually responded to her therapy. As a perpetual optimist, I like to think that she may be with us for some time to come. Still, the reality of having older pets is that we must be vigilant in their care and aware that every day is a gift.

In the case of my long-ago patient, Stone, with whom I first walked this path, I am glad to say that he did not suffer unnecessarily with osteosarcoma. His owner made a good decision, and Stone crossed the rainbow bridge while in the loving arms of his people. He was remembered by them as a strong, loving protector of the children in his family, and I will always remember his owner for having the strength and wisdom I hope we'll all have when the time comes to say that final goodbye.

Dr. Andy Roark is a practicing veterinarian at Cleveland Park Animal Hospital in Greenville, S.C., where he lives out his dream of caring for animals and educating their owners on optimal pet health. Dr. Roark is also the founder and managing director of a veterinary consulting firm, Tall Oaks Enterprises, LLC, as well as a member of the VetPartners consulting group. While in veterinary school at the University of Florida, Dr. Roark served as one of the first national presidents of the Veterinary Business Management Association (VBMA). He currently serves on the NAVC Program Committee, the Veterinary Team Brief Advisory Board and the National VBMA Advisory Board.

A nationally recognized veterinary writer, speaker and thought leader, Dr. Roark pens regular columns for DVM Newsmagazine and Veterinary Team Brief.

Dr. Roark is also a dedicated concierge, chauffeur, storyteller, dress-up fashion consultant and diaper changer for two young daughters.

[OSoSwift]

What an awful situation to be in.

Personally if the dog were mine I would euthanise. It would be a quality of life issue for me. It is not something that can be fixed, it will deteriorate and from the sounds of it the dog can no longer do basic fun things he would normally enjoy.

I have made a decision similar to this before but the dog was not affected in as many joints.

It is a very difficult decision to make and I feel very much for you. Hugs to you all

[Simply Grand]

Hugs Cos I'm fortunate not to have had to go through this very much so I can't add to any of the good advice already given but just wanted to send my sympathies.

[RuralPug]

Airedaler. thank you so much for sharing that article. It is a wonderful and valuable resource.

[*kirty*]

You have been through so much already, don't rush into any decision. Hugs xx

[Cosmolo]

Thank you very much Airedaler- that is a great article.

Part of what is influencing my thoughts right now is that i can't bear to think about going from a family of 5 to a family of 2 in only a couple of months. I won't let this stop us from making a right decision and i know we have to be unselfish but the thought is just horrendous.

[OSoSwift]

Sorry Cos I didn't realise that had happened as well. SO sorry to hear that. Your heart will be shattered

[Blackdogs]

Better a minute to soon than a moment too late.

Dogs don't consider life and death, and unlike humans, they aren't particularly concerned with squeezing every last second out of life. All dogs know is what they are feeling at the time. When dogs are gone, they are gone. They're not regretting or pining or, most importantly, existing in pain.

We hold on to them because of us, not because of them.

I think it's important to consider these points when making this difficult decision.

[corrie]

Cosmolo, I am so sorry to hear about the loss of your other two dogs. Your guys have always been some of my DOL favourites.

Sorry I don't have any good advise except to trust in yourself. It has always been very evident how special your boy is to you. I remember you posting when he first wormed his way in to your hearts.

You have been through so much already, don't rush into any decision. Hugs xx

I agree with kirty's post above.

[labadore]

Quality of life, not quantity and putting the dogs needs before my own are the two guiding principles I try to abide by when it comes to making that extremely difficult decision. It's not easy letting our beloved dogs go, but we have to do what is right for them. Thinking of you during this difficult time

[Cosmolo]