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About a year ago, my dog Brain (15.5yo Boston Terrier, mostly blind, mostly deaf) was diagnosed with canine dementia. For some time now, he’s been showing all the known symptoms of the condition. Caring for him has become increasingly more difficult. The more challenging traits he displays are aggressive behavior, and extreme restlessness during night time hours. Meds have helped some, but the condition is permanent, and his behaviors have been getting more worrisome over the last few months. He already takes Gabapentin, Denamarin and Trazodon. (Didn't do well with Selegiline)

I’m not sure there is anything else I can do for him, and I am in a desperate position. I am very sleep deprived (very!), and don’t know what to do. My health (and that of my family) is taking a toll. I feel like I’ve been taken hostage by my own dog, and it is quite obviously not his fault. I love him so much and want to take care of him and do right by him.

I don’t know if Brain is happy in general. He seems mostly miserable, except for when he eats, sleeps, walks outside in good weather (which isn’t often), and only very occasionally when he allows limited petting… those moments give me hope that he at least he is still capable of enjoying life to some degree. But then the barking, howling, whimpering, heavy panting, pacing, all night long, suggests he is not having a good time. Mental anguish is not as straight forward as physical pain, so it’s hard to know where the lines are drawn. There’s an inner life inside that little head, and I shudder to think that I must decide at one point when that light should go off.

This whole situation is really not sustainable, and I don’t know what to do.

Any advice is welcome and appreciated.


MORE DETAILS:

AT THE BEGINNING

Brain was never an easy dog. I understood that to be the case from the get-go when I adopted him as an already adult 9yo dog set in his ways. I accepted the challenge, even though I never had a dog before and had not experienced caring for one. I don’t think I was entirely aware of how much a pain in the ass he could be, but we were right for each other nevertheless, and I have loved him like I never imagine I could. He came with all sorts of issues, and I certainly didn’t know any better, so I gladly dived in. Brain was anxious and prone to barking fits from which it was never easy to snap him out. He was very demanding and not the kind of dog who favored snuggling or kissing. He was growly and spunky, though never malicious or threatening—he never once bit me back then. Growling was his way of expressing every single emotion in his arsenal. It was a really funny and charming aspect of his personality.

Brain had not been properly socialized, I assume, so he didn’t get along with other dogs. But he did love humans! And he loved attention, which for him meant an expectation of extreme play time. If one petted him even for a second, he immediately took that as an open invitation for him to rush and grab a toy and not give up until you played fetch and tug-o-war straight until he tired, something that could take quite a while. Even at 9, 10, 11, 12 years old, he had enviable amounts of energy. That was a challenge, but it was manageable, and I loved how into playing he was.

Even with all his quirks, complicated patterns of behavior, and medical conditions (of which he had a few), I loved looking after him and could manage it without much problem. When I traveled, which I often did for work, I had designated dogsitters who knew of all his quirks and how to handle him.


DEMENTIA CREPT IN

But of course, handling him has become an entirely different thing. He lost most of his hearing and then most of his eyesight, surely an extremely confusing thing for any dog. But then his mind has been going as well, and that has truly complicated matters much more, as anyone dealing with canine dementia will surely attest. His behavior began to show symptoms of aggression and confusion, toppled with nighttime restlessness and at times, extreme separation anxiety.

Pretty much every symptom associated with canine dementia, he has shown to varying degrees. All of them concerning in their own right, but it’s the aggressive behavior that became the most worrying. It became tough to handle him. Putting on his harness or dressing up for the cold turned into potentially unsafe situations for myself. It got so bad that at one point last year I believed the end had arrived. He bit me pretty bad. He had that evil dog look in his eye.

He was prescribed Gabapentin, and that helped a lot in calming him down. Though of course, aggressive tendencies popped up from time to time.

He was also put on Denamarin when it was confirmed he in fact was suffering from dementia. (Selegelin was prescribed before but it only made him more restless and aggressive)

Things got substantially better, though of course, a dog with dementia is a dog with dementia and I’ve had to resign myself to the idea that the disease progresses no matter what. As of the last few months, he has become very barky, confused, extremely restless at night, and sometimes a little aggressive and snappy.


CONSEQUENCES

At night, he really doesn’t let me sleep for very long before he barks, whines, howls, scratches at walls. He wants to pee probably 7-8 times a night, and I have to let him out. (It would be great if he’d just do his business on wee-wee pads, or even straight up on the floor, but he demands to go outside). He wants attention, or rather he wants something. He is confused and restless and agitated. He paces back and forth, panting heavily, and no matter how many times I let him out to pee, or try to comfort him somehow, he keeps at it.

I have been very sleep deprived the last year or so, but especially more the last few months. I have a 7 month old baby, and I am blessed that he is a good sleeper and doesn’t wake up with the barking (it’s a miracle, really), but my wife and I are truly suffering with all this. I constantly end up sleeping on the couch in the living room, with Brain leashed to the end of the couch so he doesn’t ambulate freely all night long creating havoc. If he barks or howls I will pull on the leash a little, see if that works. Or I may get up and let him outside.

He was prescribed Trazodon as a sleeping aid, but that will only knock him out for an hour or two, after which he will wake up, drugged, confused, and equally barky and howly.

I am the only one that can handle him when he’s at his worst. I know all the subtleties and nuances. I know when he will snap and when to quickly move my hand away before he chomps on it. A 20lb, 15.5yo Boston with missing teeth can still bite down hard and break skin if he catches you unguarded.

Another concern of mine is that my son is fascinated by Brain. He doesn’t even flinch when Brain has a barking fit. He is 7mo and is now showing signs he’ll start crawling any time soon. Before we know it, he will be walking/running as well. That gives me pause. Brain will not attack unprovoked, but and uninvited hand could surely be taken by him as provocation. We will always keep them apart, but walking infants and old dogs are both unpredictable and occasionally sneaky.


SOLUTIONS?

Brain sleeps most of the day, so at night he is definitely energized. I’ve tried to keep him up during the day, but work schedule doesn’t allow me to constantly monitor him. It’s also not easy to keep him up during the day, though. He is lethargic and mostly uninterested in doing anything. He is not very keen on going for walks unless it’s warm outside. But even if I did manage to keep him mostly awake and active during the day, he will still be agitated and disruptive all night.

I am looking forward to warmer weather soon so I can at least have him exercise a little more. Maybe that will help with his cognition, and hopefully it will tire him enough to maybe sleep better at night.

I don’t know if there are other drugs he can take, but it seems like we have tried everything his body can take (he has other health issues, so not every drug is on the table).


THE END?

I know his journey is coming to an end in the not so distant future. It’s a disarming thought. Mostly because dementia is not clear cut, and the decision of when to draw the line will fall on me. How do I know if he is suffering more than he is enjoying life? Mental anguish is not as straight forward as physical pain. At some point, this will not be sustainable. I don’t know when that is, though. When one can confidently draw that line. All I know at this moment is that he is not doing great, but it is also probably not his time just yet. I think that’s the case. I hope that’s the case. I can’t tell and I’m getting desperate not only for him, but for myself and my family too. I can’t stress enough how sleep deprived I am and how much it has affected my own health and well-being, and that of my wife, who maybe doesn’t deal with Brain at night, but does wake up often with the barking and the howling.

I am not going to send him away to a shelter or anything like that. I doubt he would be any happier in an unknown place, living in a crate. (I for one can’t bear the thought) And he’s most likely not the type of dog that could be rehabilitated with training at this point. Too late for that.

Sadly, I am thinking that I will wait for the weather to get warmer, maybe that will help some, and in the meantime suck it up with the limited sleep and constant stresses. Best case scenario, he will have a good spring summer and be active during the day and sleep at night. Worst case, he will enjoy some days and continue to be miserable at nights.

At the very least, I want him to enjoy a few more months of walking out in good weather (whenever that happens), smelling whichever tree and fire hydrant he desires. He genuinely does seem happy then. That makes me happy.


Please, if you have some suggestions, I would love to hear them. I am pretty bummed out about it all and anything is appreciated.
 

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Many people say it is better to let them go a week too soon than an hour too late. Is he spending more time being miserable, confused, and displaying aggression than he is happy? Has he lost interest in the things he used to enjoy? Will you be relived, in a way, when he passes and is no longer suffering? Remember, dogs live very much in the present. They are not like humans. They don't understand why their bodies are failing them, only that is it rather frightening and they don't understand why they're in pain.

It's also important to really consider whether you are keeping him alive for him, or you're keeping him alive to avoid the pain of losing him.

This is a very difficult decision that all pet owners have to face eventually, and I'm so sorry you're going through this. It sounds like you're asking permission to let him go, but nobody is going to tell you that you did the wrong thing in this situation.
 

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I was very much in this boat a little over a year ago with my sweet old girl, and my heart goes out to you and Brain. There's nothing wrong with wanting both you and him to have peace. I can't tell you whether it's time, but I can tell you that even though I missed and still do miss my girl, I know immediately after she passed in my arms that I'd done the right thing in letting her rest even if it wasn't naturally quite "her time" yet.
 
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