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Is it time?
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Home2strays posted:
Ive been a vet tech for 10 yrs now, and I can't decide on the fate of my own dog. She is a 16 yr old chow mix who had heartworms about 8 yrs ago (when i was 16 and still at my firstg vet clinic) i treated her, then she developed pulmonary hypertension about 3 yrs ago and had been on vetmedin and lasix and enacard for awhile til she got better. We've known for about 2 yrs now that she has cancer (her calcium level is pretty high, as is her wbc counts) but we can't find it on xray, im assuming it lymphoma- she had an issue a few months back where under her jaw and neck ballooned out ( we biopsied it and it came back as prob. a salivary gland rupture, put her on antibiotics and pred and it mostly went away) and she had trouble breathing, she became so stressed that on the car ride to work had 3 seizures and her temp went over 106, it didnt even register on the thermometer fr over 30 minutes while we iced her. I wish I had let her go then but in the heat of the moment no one asked me and my training automatically had me popping a catheter in her leg and shooting in valium before i even thought about it.
My problem now is that I don't know what to do. Her main problem (besides cancer) is her legs. Shes always been a bit bowlegged in front but now walks on her wrists, her back legs have almost no muscle tone and she falls/cant get up most the time. She is bright alert and responsive, loves to eat, loves to be brushed. She wont allow me to pick her up to go to the bathroom outside i think because it hurts her even though shes on previcox SID and tramadol TID. She has never peed or pooped on herself but does go in the house even though I built ramps for her and my paralyzed shih tzu to go outside ( i think she doesnt trust them)
Ive always told people "you'll know when" but... what if thats not true? I liken her to my great grandma- both can't walk far, never leave the house, and dying but full of life.
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srstephanie responded:
Hi Home2strays,

My heart goes out to you, and I think all of us who have been in your position know how you feel. It is easier to be objective about other people's pets ... but when it is your own, it is very difficult to know and not get lost in second guessing and uncertainty. My beloved kitty, Macrina, died in Dec 2008 from pancreatic cancer, and memories of that struggle are still vivid for me.

I think I've posted this before ... but are you familiar with the "Quality of Life Scale" that was developed by a veterinary Oncologist a few years ago to help give some objectivity to deciding when it is time? It is sometimes called the "HHHHHMM Scale" which stands for:
Hurt
Hunger
Hydration
Hygiene
Happiness
Mobility
More Good Days Than Bad

For each area, a score is given from 1-10 (1 is worst, 10 best). If the total of the scores is greater than 35, then it suggests that the pet still has a satisfactory quality of life.

The scale is found in multiple places on the internet. Here is one which gives summaries for each area of what to look for, and there is a link to a pdf version above the scale on the webpage:
http://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/quality-of-life-scale.aspx

I wasn't aware of this scale back when my kitty was dying. But since you work at a vet clinic and hopefully have a good relationship with the vet(s) there ... I would recommend also what I did. That was to lean heavily on my kitty's vet and her Internist, both of whom had become good friends, and whom I respected and trusted. I remember well the day my kitty's pancreatic cancer was diagnosed (via aspirating lymph nodes and finding pancreatic cells, so it had already spread). I was in a state of shock and my vet promised me she (and my Internist friend said the same later) would not let my kitty suffer. They both knew my kitty well, and had years of experience recognizing the final stages and if Macrina was in pain. We used Fentanyl patches for continuous pain relief and she seemed to be pain free till the last couple days. But, I guess my point is ... that I had a great relationship with Macrina's doctors and I leaned on them to let me know if I was waiting too long. I trusted them to have the objectivity that I lacked. Of course, they left the decision to me, but I did lean on them.

In the end, on that last day, I could see it in Macrina's eyes, that she was tired and ready to go ... though my broken heart still was uncertain. But her vet agreed that it was time, and even though she made few house-calls, she agreed to come to my home (with a Vet Tech) at the end of the work day (8pm) and do the euthanasia. I think Macrina was waiting for her and died very gently and peacefully.

I know how hard this is (and I'm wiping away my tears now as the memories come back). I think the Quality of Life scale is a help in putting a little objectivity into a very subjective decision. For me, a major consideration was pain and discomfort. As long as my kitty was comfortable and attentive with an active interest and enjoyment in life, and was eating without too much coaxing ... I felt she had a right to live. I tried to wait for her to tell me she was ready to go ... and leaned on my vet friends to help me read her.

Never forget that your dog knows you love her ... and whatever decision you make is correct, because it is rooted in love.

Stephanie in Montreal
 
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Grandmaof03 responded:
I don't usually respond but after reading your post I just had to..

My heart broke when I read your words....My 12 year old beagle passed away last September from lymphomia. The oncoligist I took him to wanted to keep him overnight after his first chemo but I said "no" because I was so afraid of him dying without me holding him....Long story short...the vet said that "Mikey" looked really good he had a lot of intrest in being out doors and in the sun..he still ate and was wagging his tail..I didn't leave him but that night I had to take him in to emergency..he was admitted to ICU..at 9am his oncoligist called me and he was stable..at 9:30am he had passed away..

Needless to say, when the vet called me back to tell me he had passed..he could not say enough times how sorry he was and that he knew I didn't want to leave him because I was afraid he would die without me being with him..and that I should not feel bad about the decission to start treatment and to leave him in the hosptial...His words were comforting and compassionate...

Do we know what is best for our dogs, really they are our best friends...but do we know what is best...I think we do...I think we know when the time is right...but doing it is another story.

If I would have known that Mikey was going to die the night he did I can't honestly say I would have done anything different because he was suffering badly at home and it was harder to watch him suffer than it was to leave him with people who could care for him and make him feel at least a little better.

Good Luck to you and I will have you in my prayers. I know you are going to make the right decission for your friend.

Colleen
 
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Home2strays replied to srstephanie's response:
I appreciate your kind words : ) im in such a dilemma right now, her neck is swelling again (of course since Im going out of state next week) and my friend/vet I used to work with feels like it is probably lymphoma and not a salivary gland rupture ( would be too coincidental and coupled with her bloodworks he feels like its finally manifesting itself) last 2 times we put her on prednisone but she would have to be off her previcox for atleast a week before we can start pred again... i know shes going to be hurting worse this next week and last time she swelled quickly, I dont know if a week will be too long to start the pred. my vet friend says theres no way to tell.
Ive made arrangements with my bestfriend/ former vet tech co worker and she'll come over when the time is right, I have everything here at home that I need.
I think what ill do is print out that list (thanks so much for it, ive seen it before but forgotten) and give it to the rest of the family and maybe decide from there.
 
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AMERICAN VETERINARY MEDICAL ASSOCIATION
Bonnie Beaver, BS, DVM, MS responded:
Your advice to others is true for you too. There is no "right" answer. Most dogs will show you that they are no longer happy and you will know. For some there are issues (can't control bladder or bowels, can't move with help and don't want any either, loss of appetite, etc.) that mean we have to make a decision because we don't think that the animal can be adequately cared for. I am sorry to hear that you are even having to make this decision because it is such a hard one. Which ever way you decide, I know it is because you are making it in the best interests of the dog.


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