Spirit and the dreaded quality of life decision

[LBass]

Spirit will be 14 on January 8th.  He has become increasingly frail over the last year.  The diagnosis is degenerative myelopathy--progressive disease of the spinal cord resulting in rear end weakness and ataxia.  There is no direct treatment other than symptom management and encouraging exercise.  

Spirit has been doing reasonably well until the last month or so.  He's increasingly weak and wobbly.  Having a hard time managing the stairs into the back yard and now even struggling with the "easier" steps out the front door.  His appetite is still mostly OK but I often need to hand feed him--I think he finds it tiring to stand at his feeder.  Fecal incontinence is an issue--he deposits "turdles" unexpectedly here and there.  The last 2 weeks have found him far more whiny and doing a lot of panting that appears to be discomfort and/or anxiety to me.  

He had his annual physical about 6 weeks ago and his senior blood panel and general exam results were great.  Yay!  The vet and I did talk about how I might approach making the dreaded "decision" for Spirit.  The thing the vet said that has lingered with me is that making the call for dogs with Spirit's diagnosis can be particularly hard because they are often still enjoying their lives and remain engaged, but that their bodies are just not capable any longer. 

I made an appointment for him at the vet's office this Wednesday afternoon (12/16).  We won't be seeing our usual vet but a locum covering for him instead.  This locum vet is someone I've seen often over the years and like and trust, so seeing him is not a bad thing at all--another set of eyes and another opinion and perspective.  I wanted to talk about maybe getting Gabapentin for him.  He was taking that for a couple of weeks recently while an open wound on his rear was healing.  I noticed that he seemed somewhat more comfortable in himself while on that med.  He's gotten worse--more struggling to get up and to manage the stairs and more whining and panting--since I made that appointment.  

All of this is by way of asking for some input from those of you who have been down this road.  The light of engagement and interest is still present for my boy, but everything physical is getting harder and harder for him.  He is a difficult dog to help because anything new and unfamiliar freaks him out.  For instance:  "OMG!! Why is she beside me on the steps?!  Touching my collar??! She doesn't usually do that!  ACK!  I better run back to the door and go in.  Maybe if I emit a GSOD she'll STOP the WEIRDNESS!"  Everything is harder for him and, as you can imagine, it's also harder for me.  I don't want to make the decision about me but I worry that I'll mistake "hard for me" as being "hard for him" and make the wrong decision for him.  It all feeling overwhelming right now and I'd appreciate your perspectives.

TIA
Lucy

[organistswife]

Hand on shoulder, very difficult time.

You will make the right decision.

 

You love your dogs.

[MerseyGrey]

Fortunately I haven’t had to make a difficult decision like this, but if I were in your shoes now, I would probably be thinking give it a few weeks on the gabapentin and see if he improves with it. If not, I would start asking myself ‘what would I want if I was making this decision for myself?’. I think it’s very personal, and very dependent on your dog, who you know better than anyone else. But ditto as above, you will make the right decision. Although it will never feel as though you’ve had enough time with Spirit, 14 is such a good age, and you’ve given him many happy years. Sending you and Spirit love.

[FiveRoooooers]

{{Lucy}} All things weighed re: quality of life, perhaps a short trial of Gabapentin could be worth trying because you'll know rather quickly if it is going to help or not. If Spirit is already wobbly, our vets start with a low dose since higher doses can further that, but there is a high threshold of where you can go if it helps.

I've told Pagliaccio's story before, but he was 14.1 when it was clear about the road where we were headed. His LS was progressing, he was very frail and we had run the courses of acupuncture, chiro, Depo, Adequan, while toward the end he was still on several meds. While he was still sharp mentally, Pal's body was simply wearing out and so, he and I had a heart-to-heart chat. I so wanted to avoid a crisis and have that be our final memory together. His last day was planned and grand - all his favorite noms, a short walk to Seamie's Lane, games with the campers, *time with mom*. That night, our vet called when she was ~20' away, giving Pal and me the heads up about remaining snuggle time. I will always remember how while I was holding him he lifted his head and licked my nose, as if to say "It's ok mom, I'm ready."  It may have been a day too soon rather than a day late, but I really believe that it was right.

Whatever you and Spirit decide, it will be right. 

[Jerilyn]

Lucy, as you know, I was just in this exact situation with Lila. And as you also know, it’s not easy. The signs are not as clear as we would like them to be, especially when the body is failing but the spirit  is still engaged. Spirit doesn’t seem to be as stoic as Lila was, but his personality adds an additional challenge too. Is he screaming because he’s in pain or because it’s a change to the routine? Then add in trying to figure out if you’re making the decision for your own needs or his – it’s a very difficult time.

Hindsight being what it is, I think that if you are wondering if it is time, it probably is time. I don’t think I waited too long for Lila but if I had made the decision a few days or even a week earlier, it would not have been too soon. As hard as it is to think of, he’s not going to get better, only worse.

The one thing  can suggest is to have a plan. It sounds like you have a good relationship with you vet and can get Spirit to the office. But what if something happens in the middle of the night or on the weekend? My vet gave me some injectable sedatives to have on hand so Lila could be calm and relaxed until she could get here. I did use one, but just knowing I had it available was a great relief to me. Working with a palliative care vet was a great experience.

Hugs to you and the venerable Spirit! 

[Remolacha]

I think the hardest part is when the spirit  is still willing but the body just can’t anymore. Add in someone who doesn’t like a change in routine, or to be helped, and you do have the perfect storm 

this is where I remind myself about “a day too soon is better than a day too late”, because I waited too long with a cat who was still very much present, but whose body was giving out. Whenever I start worrying about it being too soon, I remember Richard, and remember it is my job to be the adult.

The gabapentin is worth a try, it might help for awhile, can’t hurt. Jan and Jerilyn have it right, make a plan, so you aren’t faced with a crisis. Conner had his episode (still not really sure what it was) on a Friday night, and being able to talk to my vet that evening and over the weekend before she came to let him go on Monday was a huge help. If you can, letting him go at home is such a blessing for you and him.

Whatever you decide, it will be right for him.

[greysmom]

My 

If you have some Gabpentin left from his wound treatment, I would just give it to him, and see if it does help.  You alreafy know he can handle the dosage and it's worked before for him.  I wouldn't wait until Wednesday, since 4 days is an eternity for a senior, and if it does work you can discuss another refill, or perhaps adding another rx (pain med? nsaid?) which might give him a few more quality days.

As Jerilyn said, you know he's not going to get "better."  This is about making him comfortable and able to work around his body limitations for a period of time.

Also, I would encourage a little more toughness regarding his freak-outs around your helping him.  If he needs aid on the stairs, just do it, tell him he's being silly, and be matter of fact about it - he needs the help for his own safety, so he needs to get used to it.  He doesn't have to like it, but he does have to allow it. 

{{{hugs}}} for you and sweet Spirit.  We love you!

[palmettobug]

Lucy, I just want to say how lucky I am to have met Spirit. He is a sweet, silly, Chicken-Little that I'll always remember fondly. 

[macoduck]

Our first mutt girlie, Rosie, was one that I will forever regret not letting her go sooner. We've had many dogs since then and I have hated making *that* decision every time.

[LBass]

Thanks to each of you for your thoughtful posts.  I can't tell you how helpful it is to talk to and hear from others who do understand.

I do want to give him a try on Gabapentin again.  How I wish the vet had an opening sooner, or that I'd called sooner, or that I had some leftover meds.  Chris, I used all of them while Spirit was recovering from his recent Chupacabra bite.    The vet's father died recently and I think they're trying to catch up on appointments. This practice usually doesn't ask me to wait in situations like this.

Jan, what a lovely day you and Pagliaccio had.  I had that kind of planned farewell when MoMo was dealing with osteo.  We spent a blissful afternoon snuggling in the backyard on a blanket in the sunshine.  The vet came to the house with one of the techs and Mo greeted them with delight--ever the perfect hostess--rather than the anxiety vets' offices always caused her.  I don't want to wait for Spirit to be in crisis.  I need to keep that in mind.  A planful approach is better than trying to eek out the last possible moment and letting him end up in a crisis.

Jerilyn, you and Lila have been in my thoughts so often in the last few days.  " I don’t think I waited too long for Lila but if I had made the decision a few days or even a week earlier, it would not have been too soon."  That is oddly comforting.  I need to stop thinking that there is only one right day.  He really is not going to get better, only worse.   

I was hunting for one of the harnesses to put on him full time today, thinking that would make it easier to help him and make it easier for him to accept help.  I found the lift harness I'd used for MoMo--soft and comfy for wearing all the time and made to distribute my lifting across chest and tummy.  He's wearing that now and we've had 3 successful outings with it.  I feel better about being able to assist him.

You all have helped me calm down and think about how to make this decision.

Because everything goes better with hound pictures:

 

 

[boopieface]

hugs from Clarkie and Mammaa.

[RaineysMom]

having been down this road myself this past August, I can feel your pain.  Our Larry was on 500mg Gabapentin 3 x day, 100 mg Tramadol 3 x day (which some vets now thing doesn't really do anything for canines but?), 3.75mg Meloxicam 1 x day, a Chinese herb called Sore Body (or Body Sore) 2 x day -- but in February his back end really went out and we tried one last med -- Amantadine.  It took a couple days to start working but it turned him around.  We got almost 5.5 more months with him (he turned 13 in Feb).  It's $$ and made him vomit a LOT but gave us more time, and good quality time.  The amantadine boosts the Gaba and Meloxicam effects (I would recommend putting yours on the same if possible).

in the end, his back out went out on August 2nd and while not as full out (yet) as in Feb, we let him go that afternoon also thinking a day too early was better than a day too late.

sending tons of hugs to you  

[Time4ANap]

I'm so sorry you are facing this.  We had pretty much the same situation with Rocket.  We tried an assist harness and he wouldn't even let me put it on him.  We got to a point where we knew that even if there was something that would make him feel better or walk better for a short time, I didn't want to risk having him get injured and have to leave unexpectedly.  We decided not to put him through any more "fixes" and his pain was under control, but he was struggling.  He would only get up to go out once or twice a day and had to be told it was a walk to get him to get up.  Upping his Gabapentin made him loopy.  We made the decision on a Saturday to spend the weekend spoiling him and having his hound friends over to visit.  His friends brought French Fries. We spent the weekend with him snuggling up against me and holding paws (this was the boy who had major space issues). The vet came on Monday afternoon and he left us without being injured or having something catastrophic happen. Probably a day too soon or maybe not, but no pain or injury. 

Is that a "Miss Donna Pimp Hat" that Spirit is wearing? Rocket was also a member of the Pimp Hat Club. 

All the best to you and Spirit as you work through this. 

[Mercsmom]

Lucy,  I see my own journey with my beloved Liberty, so similar.  Yes, do try the Gabapetnin as it may give him some relief.

Now, know that what I'm going to say next may sound cold and heartless and it's the exact opposite. It's said with love and deepest support.  

Consider the time of year. I had planned my Liberty's departure for December 16 (2013) carefully.  The semester was over so I didn't have to hold myself together to get work done.  But it wasn't so close to Christmas as to make very successive yuletide "that time".

A kiss on the nose of Spirit's lomg smoot.

[BatterseaBrindl]

 

[Potomacpupsmom]

Lucy, I think your plan to trial the Gabapentin is a good one.   You need to be comfortable with any decision and it is never an easy one.   I hope Spirit will be comfortable and you will have many opportunities to snuggle and spoil him.   Sending {{{hugs}}}.

Kathy

 

[Hubcitypam]

I'm so sorry.  Will say that in roughly 20 years on this forum the best advice I received is the one Jan quoted  "Better a day too early than a day too late.". 
I watched my sister's dog suffer intolerably.  You are in my thoughts.

[EllenEveBaz]

Spirit is so fricking beautiful.  

Dear Nutmeg had lumbosacral stenosis, with most of the same symptoms as Spirit.  I'm so glad you got a harness on Spirit and he's ok with  it -- I wish I'd done that earlier for Meggy and made help easier for both of us.

Echoing most of the thoughts expressed above.  I felt better when I  settled on a plan.  Every plan is individual -- mine was that when the depo-medrol injections didn't help anymore, it would be time.  Here's a link to an oldie but as far as I know still a goodie -- Dr Suzanne Stack's brief explanation of the injection of the coricosteroid depo-medrol -- Stack on Depo-Medrol.  Our vet had no knowledge of it, but after reading up on it was willing to try.  Stack says the worst thing that can happen is that it won't help the symptoms.  Meggy started improving within 24 hours and it kept on helping for 3-4 months each for 2 injections.  She was still wobbly and frail and fecally incontinent (what's a little doo-doo between friends?) but could stand to eat and just enjoyed life more.  I will always remember those terrifying old-lady-zoomies in the backyard and how much she loved them.  There was no improvement on the third injection and that's when I let her go.  

 

[ramonaghan]

You have received great advice from people far more experienced than I am, so I just want to say that I'm sorry you're facing this. Sending hugs to you and your handsome boy. You will do right by him. 

[Hubcitypam]

Rex 's last diagnosis was GME but the specialist vet ($$$$$) said he was just guessing,   The  depo helped him enormously but many vets won't prescribe  it.  I followed a vet's advice and sought out and older vet.

Somehow I breathe a sigh of relief that  I have two sturdy muttleys.  

Edited December 14, 2020 by Hubcitypam

[Banjoman]

Lucy, I know people think I am hard but as far as my animals are concerned making and taking that decision can never be too early but can so easily be too late. I don’t want my pets to have to tell me they have had enough, I want them to go while still enjoying their life, not struggling with it. Whenever I have been thinking it is coming up to that time I have usually taken the snap decision and contacted the vet, asking them to come to the house that day. It is easy to double think things and put them off but you have the Christmas period to contend with too and possible difficulties with access to a vet urgently if needed. I think that says it all from my point of view.

Posted with a loving heart.

Carol.

[racindog]

16 hours ago, LBass said:

Thanks to each of you for your thoughtful posts.  I can't tell you how helpful it is to talk to and hear from others who do understand.

I do want to give him a try on Gabapentin again.  How I wish the vet had an opening sooner, or that I'd called sooner, or that I had some leftover meds.  Chris, I used all of them while Spirit was recovering from his recent Chupacabra bite.    The vet's father died recently and I think they're trying to catch up on appointments. This practice usually doesn't ask me to wait in situations like this.

Jan, what a lovely day you and Pagliaccio had.  I had that kind of planned farewell when MoMo was dealing with osteo.  We spent a blissful afternoon snuggling in the backyard on a blanket in the sunshine.  The vet came to the house with one of the techs and Mo greeted them with delight--ever the perfect hostess--rather than the anxiety vets' offices always caused her.  I don't want to wait for Spirit to be in crisis.  I need to keep that in mind.  A planful approach is better than trying to eek out the last possible moment and letting him end up in a crisis.

Jerilyn, you and Lila have been in my thoughts so often in the last few days.  " I don’t think I waited too long for Lila but if I had made the decision a few days or even a week earlier, it would not have been too soon."  That is oddly comforting.  I need to stop thinking that there is only one right day.  He really is not going to get better, only worse.   

I was hunting for one of the harnesses to put on him full time today, thinking that would make it easier to help him and make it easier for him to accept help.  I found the lift harness I'd used for MoMo--soft and comfy for wearing all the time and made to distribute my lifting across chest and tummy.  He's wearing that now and we've had 3 successful outings with it.  I feel better about being able to assist him.

You all have helped me calm down and think about how to make this decision.

Because everything goes better with hound pictures:

 

 

I have found a great deal of help and comfort by just talking to the dog about their situation. Sometimes they even initiate this although I have a tendency to try and ignore it at first when they do because I don't want to believe what is happening.  Sometimes words are not even necessary.  If you are unsure a professional reputable animal communicator can facilitate things. I have done that as well quite successfully. Regardless, sending positive thoughts and tons of love.

[LBass]

I am so grateful to each of you for your kindness, firmness, and words of wisdom.  He had a rough day yesterday.  I have a plan that I'm as comfortable with as possible.  I called the vet this morning to ask that he refill the Gabapentin today.  I haven't heard back yet but I'm sure he'll do that.  I'll  see whether that helps Spirit feel more comfortable.   If not, then the vet visit Wednesday afternoon will be our farewell.  

He's wearing the harness and I can steady and help him some.  We'll spend the next 3 days enjoying things that he still gets excited about.  I don't feel happiness at this decision but I do feel peace and that has always been my signal that I've made the right decision.  I'm so grateful that I've been able to work from home these last months giving me more time with him.

Time4ANap, that is indeed a Miss Donna Pimp Hat!  Spirit won it in one of the Miss Nellie Auctions.  He has always fancied himself a ladies man hound.    Too shy to put his moves into practice, but proud of them just the same.

Lucy

[dante2zoe]

Lucy, 

I am late to this thread but am also one who has dealt with knowing when is enough.  I got it right most of the time, but we were 24 hours late with Sherman and it was not fun.  But, you have a plan and it is solid and feeling peaceful about it is wonderful.  Indy's body failed him completely but when I let him go, he was still so pissed and my last look from him was so damning lol.  But, that was Boo.  Anyway, I have had good luck with gabapentin and with Adequan injections but I think you are past that point for Spirit.  He is such a love and will stay here with you as long as he thinks you need.  So, letting him know that it is OK that he go, may be helpful to you both.

Lots and lots of hugs. 

Cindy

[Fostr_Mom]

I can't add anything to the awesome advise you've received. You are a loving, smart, intuitive mom to Spirit and your plan sounds perfect for the two of you. We will so miss sweet Spirit when it is his time to go. We had to make a similar decision with Kyle. His body was just failing him although his spirit was still bright.  When he suddenly stopped wanted his favorite apples, not wanting to do anything except sleep in the grass, I knew it was time.   Will keep you both in my heart & prayers.