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If you're worried about your pet's health, please speak to a vet or qualified professional.

Hve you ever had to PTS when it wasn't a clear cut decision?

18 replies

Principality · 08/08/2012 09:42

Have you ever been in a situation where having your Ddog PTS was not a clear cut decison?

I know that it is never an easy decision, but what I mean is have you been in a situation where you are really torn as to what to do, when weighing up quality of life?

My first ever childhood dog was PTS, but in my mind it was always the right decision- she had lukemia and suddenly took a turn for the worse, so we spent one last special day together where she was totally spoilt rotten and then said goodbye with all her family and friends around her. :( As awful as it was I knew even then that it was 100% the right choice for her. (Doesn't stop me crying my eyes out just writing about it now!!)

Ddog1 is 4.5 and has had problems most of his life, although they weren't picked up upon during his first year. He has anterior facet dysplasia in his back and damaged nerves leading to his legs. This was discovered during an MRI scan. He previously blew both cruciate ligaments (which post MRI they said were probably caused by the abnormalities in his back, but they didn't know this in advance).

So to some up, he has had both cruicates done by TTA, one after the other, 2 x 6weeks of crate rest, masses of hydrotherapy, physiotherapy, was still not quite right so referred to MRI by the ortho specialist, which showed the above problem, referred to neurologist, then another neurologist, a European specialist as NDR who operated to try and fix the anterior facet dysplasia and create more room for the damaged squashed nerve in late 2010. 10 weeks of STRICT crate rest followed by controlled lead walks for months. He was never quite right in his movement after but seemed happy enough.

Then over the past 8 months he has started having problems again. Episodes of screaming pain that last a few min, followed by 12-36 hours of him obviously being in a lot of pain, reluctant to get out of bed, squeaking when he moves. Of course during these episodes he is given strong painkillers, but he is very sensitive to opiate based drugs, so we have to use them sensitively. (he drools, is sick, cries and whinges and refuses to get up- i think he feels dizzy)

On a day to day basis he is on metacam, with tramadol when he has an episode. Because of the above he has very limited excercise or he gets sore and lame. He has maybe three short lead walks per week, which he enjoys and manages happily. Anything more than that and he becomes very stiff and sore at best, having a squeaking painful episode at worst.

All of the above sounds awful I am sure, and it is, but the rest of the time, at home, you would barely know there was anything wrong with him. He is loving and happy. He bumbles about the house, following me or the children around. He mooches about the garden, he enjoys playing with the children, he LOVES his food and it is clear he still enjoys his life.

I always said that after the big back op I would not put him thorugh anymore surgery as I didn't feel it was fair on him. He didn't deal with the recovery well- particularly the crate rest and had to be sedated for large chunks of it. I was very lucky in that over 3 years, m+s insurance policy paid out approx 13.5k for his operations, rehab and medications. However, when the policy renewal came in for the 4th time it was £90pcm, which was understandable, but unaffordable, particularly as I already felt it was not fair to put him through anymore surgery if anthing went wrong. So he is no longer insured (well he is, but all of the above is excluded as with a dif company). At one of his recent vet appointments about 3/4 weeks ago, after his worst episode yet, our vet was doing some tests on him and said she felt he now had nerve damage in the leg hind too. The original MRI had shown that it was abnormal but wasn't causing problems then (2010).

Sorry for rambing... but there is quite a lot of history there to get the picture!

I feel so lost as to what to do. On one hand, most of the time, when he is at home, he is a happy, loving, normal dog. Until it goes wrong, like it has again today. I have a doped up boy off his trolley on tramadol. I woke up this morning and he was crying out everytime he tried to get up from his bed. Yesterday he was fine.

If you has asked me 3 years ago what I thoguth about people who have an active working breed like mine and only walk the poor animal a few times a week I would have had some choice words and told you it wasn't fair on the dog. I was asking my vet her opinion and she said it was necessary that PTS was on my radar, but that you had to inidividually assess your dogs needs for quality of life. The way she explained it was that her checklist for QOL was different for each of her dogs. She said she has one that lives for cuddles with her husband, and wouldn't be distressed by a reduced exercise routine, despite being a collie, and so would be happy just to stay and home, so long as she could come to work and sit under his desk, whereas at the other end of the scale she said her other bitch would be desperately unhappy in the same situation and she would therefore think it kindest to PTS.

I really do not know what to do. It is compunded by the fact that we are moving house at the end of the month and I am so worried how he will cope with that too, as he gets so stressy and tense about things and I am sure it will make it worse. I don't know what is best for him. These "episodes" are awful at the time, but aren't all the time. They are getting closer together now tho, about one every 3/4 weeks.

I was just wondering if anyone else had been in a similar situation, where most of the time they are ok- but just ok, and then occasionally awful. How to you make the decision?

OP posts:
bumpybecky · 08/08/2012 14:00

I'm so sorry you're in this position :( we had our dog pts due to cancer and other health problems, she was almost 14 so although difficult, the decision sounds easier than yours.

I can completely understand the decision not to put him through further surgery. It does sound as though the condition is deteriorating though so I think it's a good idea to have think about how bad it needs to be for you decide enough is enough.

You say the episodes are happening every 3/4 weeks and last 12-36 hours at a time, so that's approx 1-2 days a month he's in pain. Assuming the pain can be controlled when it happens, it sounds as though he's ok much more than he's not ok :) I can understand that it must be very stressful not knowing how each day is going to go though.

Have you considered using one of those plug in things to calm him down about the move?

FiveHoursCommute · 08/08/2012 14:55

Have you had a look at a quality of life scale like this one
We've just had to put our old dog down earlier than I would have like to because of circumstances; it's not easy, I sympathise.

Lucyellensmum99 · 08/08/2012 23:18

I used to be a vet nurse and my boss used to have a very good peice of advice for people. Listen to your Gut.

Don't listen to your heart - it will never let them go

Don't listen to your brain - it will try and rationalise "he had a good day today"

Your gut will tell you, you'll get that feeling in the pit of your stomach, then its time :(

Ive been in a similar position. My dog had kidney failure, i knew i could buy him a few more weeks? months? but maybe it would have been days - he rallied after a drip but ive seen it so many times, they rally, then they are back for PTS really soon. So i told myself if he doesn't manage 24 hours without the drip thats it - bless his heart, he tried so hard, but within the morning, he was just so flat and i knew it was time. I just knew. It was so heart wrenching. I had to make the decision - i stayed, i wanted to scream at the vet to stop when he gave him the injection - maybe another chance, but it woudlnt have been fair to him - he just looked so tired.

If im very honest with you OP, i think hes had enough - im so sorry xxxx

fuzzysnout · 09/08/2012 00:29

Only you know the answer OP, but as you are asking it may suggest that it is nearly time. There is a saying among dog folk ' better a week too early, than a day too late'. I'm sorry you have to make the decision and hope you work out the best thing for your dog.

Toughasoldboots · 09/08/2012 00:54

This reply has been deleted

Message withdrawn at poster's request.

AllOverIt · 09/08/2012 07:21

So sorry that you're all going through this. I agree with others, I think he might have had enough. SadSadSad

MonsPubis · 09/08/2012 07:24

Same as the others. I think you know that he has probably had enough, and I am very sorry to see you ar going through this.

Lizcat · 09/08/2012 08:28

As a vet I think you are entering the sone of no wrong time. There will be the time that is right for you and your family. No two people are the same in this as it is a bit more of an arbitary decision.
What you do get to do is to have it done on the day of your choosing in the location of your choosing with the people who want to be there there.

MonsPubis · 09/08/2012 08:33

oh lizcat, what do you think of greenlipped mussel and salmon oil for arthritis?
Sorry to hijack.

Principality · 09/08/2012 10:40

Thanks everyone for your kind words.

See this morning he is back to his usual baseline.... which is stiff and being careful with himself and his movement, but not anywhere near as bad as a bad day.. He is currently sat at my feet looking at me like I have lost the plot because I am crying again... and because I haven't yet shared my apple with him

I know he is in a lot of pain on his bad days, and I think uncomfortable most of the time, but our vet says his response to the pain seems to have improved. She was saying something about how the body responds to chronic pain by wither becoming more sensitive or less sensitive to it... i think, does that ring bells lizcat?

My regular vet spoke to his specialist who said he would like to see him again and would only charge a nominal consult fee of £75 yes that is nominal compared to usual eeek! rather than usual consult fee because he is no longer insured and the vet is interested in outcomes because the op is so rare- i think he said less than 100 done. I am nervous that he will suggest more surgery... My regular vet said if it was her dog she wouldn't have more surgery but prob would have another MRI because she would want to know what was going on inside. But his last MRI was about £1k... either just over or under I can't remember. The ortho specialist didn't have one so he was seen at a mobile MRI that visits the practice once a month or so. Anyway I don't have 1k to spend on an MRI, especially as it doesn't matter what it says as we will not proceed with surgery regardless, and would only treat pallatively with painkillers...

I've looked at the QOL scale... and it really differs depending on if we are having a bad or good day...

On a good day:

Walking - 1

Arising- 3

Eating- 0 (nothing wrong with his appetite! Grin )

Affection- Very affectionate to people and dogs he knows- but is now grizzly when dogs he doesn't know go anywhere near him, I think he is worried they will hurt him.

Playfulness - sometimes he will play so 1

Toiletting is fine- 0

ALP- not really sure what counts as artificial life rolonger- just the drugs which make him more comfortable? He's just on daily metacam at the mo, unless he is very sore.

Giving him a score of 5- so reassess in 30 days

But on a bad day:

Walking - When he first does it, and for the first few hours he won't get up at all, no matter what, so that is an 8. But after a few hours he will get up if you encourage him to go for a wee. As an example, he didn't do his morning wee until 2pm yesterday. So it could be a 3, he will get up to toilet.

Arising- again for the first few hours he won't get up and I don't push it as everytime he tries to move it hurts. When he is ready he gets up but is of course very stiff and cautious with his movement. So for a few hours it is an 8, but then back down to 3.

Eating and drinking- Even during a bad day when he can't get up, so long as you bring it to him he always eats everything and drinks well. 0

Playfulness- 3 does not play

Affection- Well he won't get up, but is obvioulsy please you are there with him, he rests his head on your knee when you sit with him.

Drugs- Not good, not sure of the score but he has to have opiate drugs which keep him spaced out...

So I am not sure exactly what his score would be on a bad day as it changes hour to hour, but it would definitely be over the 8 that says it is time now.

But these bad days are not all the time which makes it so much harder...

I don't want to feel I am giving up on him. I don't want the vet to think I am a bad owner by not proceeding with more tests/scans and assumably more drugs if I refuse surgery. He is always so much more upbeat when he is at the surgery as he LOVES her to bits (she used to do home visits for puppies and so up until he was 6m old she would come out to see him and make a big fuss with treats and playing- it worked he adores her and thinks going to the vets to see her is a treat in itself. He even cries if he sees another dog go into her room before him Hmm) He is so overexcited to see her that he always looks more cheerful than at home, and whilst obviolusy he does come up sore on examination it never seems to be as bad as at home. Of course I have explained this, but I dont know if that is why she suggests more investigations?

This has taken me ages to write because in the middle of it naughty dog has gone into the garden and is barking his head off at next doors cat who is sitting on the fence taunting him. He behaves like an older dog who is finding old age is catching up with him but not yet caught him on his good days.

Thank you for your kind words and for listening to my rambling.

I think it maybe worth going back to the specialist vet who did his op and ask his opinion but make it clear I am not happy doing anything invasive, in terms of tests or treatment. I feel if I don't go then I am giving up on him too soon and that I have failed to give him a fair chance. I think I would also be fair to say to him that I really feel we are coming to the end and that unless he has some super wonder drug that we will take him home to make sure he enjoys his last few days/weeks.

Thank you for all your kind words and thoughts.

OP posts:
bumpybecky · 09/08/2012 11:00

I know it's not supposed to be Mumsnetty, but (((Principality)))

I think your final summary is very reasonable. Glad to hear he'd feeling a bit better today :)

Principality · 09/08/2012 11:27

Thank you for non mumsnetty hugs Grin

I am awaiting a phone call to say if he is going in tomorrow pm or early next week. Depends on time as it is a 4 hour round trip to get to specialist.

I will come back and update

OP posts:
Lizcat · 09/08/2012 13:16

Principality please please please don't think at all about any vets judging you for not choosing further tests etc you have already travelled a million miles beyond the average owner. With tests I always talk to owners about is the result of the test going to change our treatment of the pet. As a scientist yes it is really lovely to know exactly what is going on, but are we going to do anything thing different.
Going to see the specialist is a great idea there are lots of funky things referral practices are doing for pain control with drugs like GABA and fentanyl patches.
I hope you find a way forward that suits you and your family.

GetOrfMoiRing · 09/08/2012 13:21

I am so sorry, that all sounds so heart wrenching. You have done your very best for him and nobody can say that you have not tried your best for the poor animal. It must be so heartbreaking for you to see him in so much pain.

Principality · 09/08/2012 15:33

Thank you all.

He is back to see Rudolpho Capello on Monday afternoon, so everything crossed that he has something helpful to suggest.

He is currently sat next to DS2 who is ill with a tummy bug, giving each other mutual sympathy and cuddles whilst watching Shrek. Love him.

OP posts:
Principality · 16/08/2012 11:45

UPDATE

Just for anyone who may have been curious.

We went to see Rudolpho on Monday. He said his movement was pretty good and that he certainly had a lust for life polite way of saying your dog is hyper excited and dragging you about like a loon

On manipulation he haid he did have some pain in his back end, worse on the left side. He said he thought it was sciatic nerve compression on the left hand side and possible lumbrosacral disease. He recommended CT scan to investigate further. If we wanted to we could then operate or treat with more appropriate painkillers that focus on nerve pain.

I said i didn't want any more invasive investigations or surgery and he was very understanding. He did explain all the options including recovery time and costs but I said I still didn't want to go ahead.

He talked about a drug called Gabapentin that is particularly helpful in dealing with nerve root pain. I asked if we could start this drug without the ct scan to confirm the nerve compression. He agreed.

So after ordering it from our vet he started it yesterday. We were told that it would make him incredibly dopey at first and maybe we would need to build the dose up slowly to the recomended 3 x daily. However, he seems fine thus far without any side affects from the doses he had last night and this morning.

We discussed George's welfare. He feels it is "currently acceptable to continue managing the pain conservatively". He said he is obvioulsy still enjoying his life, even tho it is not the sort of life one would hope to be able to provide for their dogs. Hopefully the gabapentin will help to make him more comfortable and stop the painful episodes. We will just have to wait and see.

I took himout on a ten min lead walk with my toddler this morning to feed the ducks. He seemed to really enjoy himself and several bits of duckbread, so I am feeling much more positive and less tearful. I really really hope the gabapentin helps him.

Thank you for all of your kind words and support, i really was at rock bottom over the past week with him.

OP posts:
kilmuir · 16/08/2012 11:53

we have recently had one of our lovely dogs PTs.
day before I looked in his eyes when we were having a cuddle and I knew it was right thing to do.
Op was right , my heart wanted to keep going but I know that was not kindest thing to do.
Sure vet would not judge you. Our vet suggested morphine for our old boy but we said no, as quality of life was poor and only prolonging the outcome.
wish you and your lovely dog well

1MitchellMum · 16/08/2012 14:12

I do feel for you ...just a quick note to say that our boy (now 10) has had two TPLO ops, a meniscal repair and a back op. His pain meds have now increased so he's on 4 x 50mg Tramadol, 1 x 40mg Onsior and 3 x 300mg Tramadol per day. He was put on the meds by Noel Fitzpatrick, who did the ops. We know he needs to be on them for life, with possible increases (recently increased from 3 - 4 Tram per day). His QOL is good. Quite high doseage I think, but it does help. Good luck with your dog ... as you say it's very hard when it's not clear cut. x

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