When to let go?

dcaton

I know there's no easy answer to that question, but I'd welcome some advice.

I have 7 dogs, 6 living with me and 1 with my ex-wife. Most were rescues that we couldn't find homes for and decided to keep. The ex comes over periodically to visit them, but I've been caring for the other 6 by myself for the past 6-7 years. Fortunately I work at home so I'm with them pretty much 24/7.

Our oldest is a boxer, Jesse. He's almost 13 and in October, was diagnosed with a tumor on his heart at the base of the aorta. Tumors of this sort do not respond well to chemotherapy, and removing it is not an option. Things were pretty bad for a few weeks, and he was having near-syncopal episodes every few days. But the cardiologist came up with the right combination of drugs and his heart is now beating normally and he hasn't had an episode in three months. The condition is terminal however, as there is nothing that can be done to stop the tumor from growing.

A few weeks ago, we noticed some blood around one of Jesse's teeth. Our primary vet thought it was a gum infection probably near the root of the tooth. Normally he would pull the tooth but given Jesse's heart condition anesthesia was not recommended, so he prescribed antibiotics. It didn't improve, so he told us to consult the cardiologist to see if he had any other options.

We took him to the cardiologist yesterday, and it turns out that he has squamous cell carcinoma in the lymph nodes near his throat, and probably in the gums too. There are no treatment options. So now Jesse has two terminal conditions.

Our vet has three criteria for determining quality of life: is he eating and drinking normally, is he peeing and pooping normally, and does he still show affection.

Jesse still meets all three of these criteria. He has no trouble eating and he never defecates in the house. His heart rate, blood pressure and respiration are all normal, and his last blood test showed normal kidney and liver function.

So here's my dilemma: the oncologist said that he is probably in pain because of the oral cancer; the regular vet said that if he's still eating and doing all those things, he may not be in pain. The oncologist strongly suggested euthanasia, the regular vet said to take it day by day, but he doesn't think Jesse is at the point where immediate action needs to be taken.

My ex wanted to put Jesse down immediately, and I refused. He just doesn't seem ready to go yet, and she thinks I'm being cruel by allowing him to suffer. But how does anyone really know whether he is in pain or not? The cardiologist gave us some Tramadol for pain, but only enough for 4-5 days.

Jesse ate this morning, probably would have eaten two bowls if I gave it to him. He doesn't have the energy he used to because of the reduced blood flow and he can't go on long walks but he doesn't seem like a dog who needs to be put to sleep.

My primary concern is for Jesse and I don't really care if my ex thinks I'm being cruel. But I also realize that sometimes we see what we want to see. I know I have to let go sooner or later, and I'm hoping the good Lord will just take him peacefully in his sleep one night. But euthanasia is an irreversible decision and I just don't think it's time yet. But how do you really know if a dog is in pain or not, and even if he's in pain, is it at a level that's intolerable?

Don

cjac&mac

First of all I am sorry for your troubles. I have a boxer my self with health issues so I understand. However I don't think mine will live past eight.

My fiance thinks i'm the cruel one because of the way I think. To me, I fully believe in the power of the pack theory. Meaning that your dog may now he's not well, but the last thing he wants to do is show that. In the dog world if he shows weakness, he is cast out of the pack, he would be considered a hindrance and a weak link. So to him, he is going to put on a healthy attitude so you don't kick him out of the house.

Because we have the technology to test and exam our pets for lethal diseases and problems, you have the advantage to recognize and acknowledge serious issues going on with him.

Most people keep their pets alive too long, for selfish reasons. Of course he is still going to show affection towards you, and he will continue to eat and drink, which in turn he will also continue to eliminate. Because if he didn't continue theses things he would be cast out, or he would die. The moment your dog falters, is the moment he can't fight any longer. Take it as a cry for help. Only you can know when that moment is.

As for the clinical aspect of it, if you know he only has a short time left, then why would you, as a caring pet owner, allow your dog to get to the moment of failure, and suffering? To the dog, the end of his life ended on a bad note, he would go out not fighting, not surviving. Give him his dignity, let him go out fighting!

It's all easier said then done. But I have lost many a pet in my lifetime, and I have lived by this motto for all the deaths. It definitely will be sad, but you will feel a lot better in the end, because you know your dog felt like he was worthy of your pack, right up to the very end!

I wish you the best of luck. And my best wishes to you and your loved one.

dcaton

I have several friends who have had sick pets recently, and all of them refused to eat. Sure, if a pet eats he will continue to eliminate, but there's a big difference between eliminating outside in a normal manner, and losing control and eliminating in inappropriate areas. Not eating or eliminating properly would be clear signs of a deteriorating quality of life.


I know his remaining time is limited (and who's time isn't?) but I don't know if it's days or weeks or months, and neither does the vet.

Do I put him down now and deprive him of a few more months of life, at the possible expense of a few hours of suffering when things take a turn for the worse? If the signs were there, I would not hesitate to put him down, but there are no outward signs of suffering or distress. And that's the problem. Even the vets don't agree whether he's in pain or not, and even if he was, will the Tramadol control it? And if he is in pain, it is a slight discomfort or intolerable. There's really no way to know, but I have to think there would be some sign of discomfort.

Thank you very much.

dakotajo

I really feel for you I wouldn't rush into things just yet. I think when it's time he will definately let you know. When my dog had kidney failure we tried fluids and where just desperate but... she was doing okay for a few days but on the day we decided I just knew, she kept panting and was very stressed and kept looking at me like she was trying to tell me she didn't want to feel this way anymore and when we did take her in to be put down, I swear she knew and was very relaxed. Don't worry, you and your dog will know when it's time

GeorgeGlass

I think I agree with you and your vet. Those three signs seem like good indicators. I'd say just be aware of those three signs and look for problems in those areas. When one or more start happening a few days in a row, then it's probably time. In the meantime, enjoy the days/weeks/months you have left.

Kathyy

Those signs are a good start but what about the rest of the time? My 15.5 year old sick dog shows discomfort by staring into space, not hearing well, tongue sticks out a bit, funny looking stretching. third eyelid covering part of the eye, barking softly without much force, less counter surfing and tissue shredding, trouble jumping on the furniture, not being able to wag her tail. Strange little things but when she isn't shredding tissues she isn't feeling well. Not hearing and staring when in her bed are definitely signs of discomfort. She is in kidney failure which poisons the blood, not painful but a very miserable way to feel.

dakotajo, sorry you lost your dog. It is nice to know she will let us know it is time. Her good times far out number the bad right now but every hesitation before eating scares me a little.

dcaton

Kathyy - I don't think my vet's three criteria were meant as hard and fast rules, more like guidelines or perhaps a minimum set of conditions. Certainly there are be other factors that can indicate a good or poor quality of life.

I had a little sheltie mix that was diagnosed with kidney failure at 17. The vet suggested that we try daily subcutaneous fluid injections, and she lived to be 18 1/2. I took her in for a checkup every few months and the vet was amazed at how well she did. Her quality of life was very good up until the last couple of days, and she let me know that it was time.

spotted nikes

Ask your vet if the type of tumor your dog has, can rupture. I found a dog a couple of yrs ago, that was skinny, had a bloated belly and coughing. After cking neg for HW/Erlichia, I had X-rays done, and it turned out that she had a tumor around her heart and some in her lungs. I opted to have her PTS because the vet said that the tumor could rupture at any time and make her bleed internally until she died. Said it was a painful way to go.

I didn't want to risk that so I bought her some chicken mcnuggets, and a cheeseburger and let her go peacefully with a full belly.

I believe the saying that "Better a week early than a day too late".

dcaton

I don't believe it can rupture. We've been to the cardiologist 5 or 6 times now and he has never mentioned anything like that. He is very thorough and takes a lot of time to explain everything, and he also prints out a very detailed report for us each time.

It is a slow growing tumor, which apparently is why chemo is not a viable option. The problem is that it is pressing against one of the heart chambers and causing reduced circulation. He hasn't had a fainting spell in three months and his blood pressure and heart rate are normal, so for the time being the condition is being managed with medication.

I think the oral cancer is more of a concern at this point. Fortunately I work at home so I can keep a very close eye on him. Right now he's sleeping on his bed and dreaming - hopefully pleasant dreams.