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I want to share this for anyone struggling with the questions about when to say goodbye to their dog, and what to decide for a dog diagnosed with kidney failure (or anything terminal). Our 14 (almost 15) year old female pitbull passed away at home last weekend after being diagnosed with kidney failure in Feb 2020. We decided to have a vet come to our home, after about a week of seeing her good days get shorter, and she was becoming less interested in even home-cooked meals of meat and rice.

When we learned her diagnosis, we chose to provide hospice care for as long as her quality of life could be maintained. The prognosis was anything from a few weeks to 6 months. I struggled SO, so much with questions like:
1. what is 'quality of life'?
2. will I 'wait too long'?
3. will I regret spending the money to keep her going when I know she has a terminal condition?
4. is this a desperate thing to be doing? Am I way too involved or obsessing about a pet?

If you are feeling this way, my hope for you is that you can let go of those fears and worries. If you feel it's best to have a happy day and then say goodbye before the decline and the meds - that seems like a right choice too. If you want to provide palliative care and meds:

1. First of all, "quality of life" changes with age. Look at old people - they aren't running around after a soccer ball, eating big bowls of food, easily going up and down stairs, eating the same salty treats they did as younger people. They have good and bad days. But is their quality of life bad? Do they need to die now? No, of course not! When you're old you spend a lot of time sitting, sleeping, observing, eating less in general. You have comfortable days and aching days. It's ok to be old. Losing some weight or muscle mass, getting slow, being confused at times. You aren't inflicting suffering on your dog by allowing it be an elderly, tired creature. Getting very old is the normal way of things. Yes give palliative meds, or arthritis meds, CBD etc. But you aren't some god who must perfectly protect your dog from any pain. You'll know the difference between old age and decline, and when your dog is going into a stage where is suffering would become unreasonable and cannot be reversed. Which brings me to the next point...

2. It's not likely that you'll "wait too long." You're not an idiot. Have faith in yourself! I'm so happy I gave my dog hospice care. She had great days and some rough days but overall the time she had was happy and also precious. Death is forever. So it's OK to give your dog a few more days to nap in the sun, look out the window, sit with you by a pond. Life is short. No need to make it shorter.

3. I don't regret spending that money at all. And I'm not a wealthy person. Sometimes I've made up to $50,000 a year. Last year I made $35,000 being self-employed. Some of the vet care I put on a credit card. All told, for 2 months with our dog it was about $1,500 (2 sets of bloodwork, meds, fluids (kidney disease causes dehydration), urinalysis, special foods, etc.) In hindsight, I could've saved a lot if I used Chewy, or 1-800 PetMeds, Costco...point being don't keep getting meds from your vet, it's expensive. But looking back, it was such a tiny blip of spending compared to how much I'll spend and earn over the rest of my life. I'm as guilty as anyone of taking my dogs for granted. I'm thankful at the end of her life, when she most needed help, I could focus on her and comfort her.

4. No, it wasn't desperate or weird to do palliative hospice things. I see now that it was a normal and healthy thing to choose. I cooked for my dog, talked to her, wiped her eye boogies away, went on little walks around the neighborhood. I'll never wish I had spent that time in Zoom meetings instead, or building my company's social media presence, etc. We're normally all rushing around so busy - Corona virus forced us all to slow down. We can reassess what we want in our lives and how we want to spend our time.

After experiencing this, I think euthanasia IS a kindness when your pet is in intractable pain that can no longer be relieved, has had a terrible accident, is dying from rat poison or a snake bite, etc. Events where nothing can be done to alleviate or delay terrible suffering. But when it comes to elderly dogs who are terminally ill, I think sometimes people suggest euthanasia because we don't like to see things be old and feeble. It makes us uncomfortable, think about it, we don't even feel comfortable with old people! Plus, elderly pet care takes more work and time. So on that note I'd say euthanasia might be a kindness too, if you know there's no possible way you'll have time to devote to additional pet care.

I learned that whatever you choose for an elderly or terminal pet, you are the one who has to live with your decision. Not your parents, not your friends, not the vet. So make the decision YOU want to make. And you'll know if/when palliative care is no longer giving your pet enjoyable times. I'd have loved for our dog to pass away on her own. But after 2 months the meds and fluids could no longer delay things. I didn't want to do powerful meds that really knocked her out. For me, "quality of life" meant being aware. Even if that was just poking around the house, or laying out in the sun.

If you feel like your pet still wants to be here and you feel like you're trying to force yourself to choose "euthanasia is a kindness," - I want you to know, you don't have to feel pressure to choose that. You can try palliative care if you want. Or if you scheduled a euthanasia visit but then you think, "hey, seems like they actually have a string of good days left," you can cancel. It's OK. Yes, your terminally ill pet is only going in one direction - but that doesn't mean you need to rush to get there. I'm so glad I gave my dog every day she could have.

Kidney failure tips I learned as an advocate for my dog (disclaimer - I am not a vet):

signs of kidney failure: increased drinking, increased urination, vomiting, bad breath, fur dryness, incontinence, weakness, hind leg weakness, decreased interest in meals/treats, confusion or depression, dark tarry stools.

1. I do NOT recommend gabapentin for pain - she had a strong negative reaction to even a small dose. I do not at all agree it is "safe and mild" for dogs with kidney failure. Amantadine didn't seem to do anything, good or bad. Robaxin (muscle relaxant) helped when she had a stiff back. I also gave CBD which definitely helped. CBD seemed most helpful.
2. if your dog likes the prescription kidney diet food, great. If not, you can look up recipes of low phosphorus meats, rice, some hidden vegetables. In my opinion the prescription diets might contribute to a dog losing weight because they're just bland and some have crappy ingredients. Low phosphorus meats include lamb, beef, pork. Not chicken.
3. get a multivitamin to help with nutrition - my dog didn't really want the vegetables.
4. omega 3 fatty acid is good for kidney failure, from what I read. Omega 6 isn't
5. COQ10 supplement might help reduce the creatinine building up in dog's body
6. sub q fluids are your friend!
7. protein isn't exactly the problem for kidney failure, it's the high phosphorus levels in meats and some legumes. Phos-Bind powder is your friend (can get from vet med websites).
8. your vet will prescribe antacid and probably anti-nausea med, these are great meds!
9. your dog is immune-compromised which means they are more susceptible to things like giardia, kennel cough. Watch out for those kinds of things.
10. iron supplement or "blood support" supplement from vet meds sites might help delay onset of anemia due to kidney failure.
11. bloodwork is a useful tool
12. urinalysis can help as well since dogs with kidney failure are at risk for UTI

Take care. If you have a dog diagnosed with kidney failure I feel your pain, truly.
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