Help with our demented dog.

April 28, 2010 10:25 AM

Dog dementia - help!

Our 11-year-old yellow lab has Cushing's Disease and is suffering from dementia. He is constantly (20 hours a day) stressed and anxious. He pants a lot. He tries to crawl into small spaces. He makes a mess of the house trying to get into closets, bathtub, whatever. He is only happy when his nose/head are elevated at a 45 degree angle. He can't sleep. (Therefore we can't sleep.) (Do any of these symptoms indicate something other than Cushing's/Dementia?)

Beyond Dog's discomfort, this affects us as well. As I mentioned, one of us is up with Dog for a few hours each night. I cannot leave the house unless I absolutely must because of fear of what mess Dog will make. (I have a meeting today, so I am paying to board him at the Vet's.) Yet I can't work here because he is too needy. He is also starting to 'herd' our toddler. (He is generally great with our toddler though and Dog's worst day, anxiety-wise, is always Monday when Toddler goes back to daycare.)

I am terribly sad that Dog is unhappy and that death is on the horizon. But I also do not know how much more we can do to accomodate him - we already aren't sleeping at night, I can't go to campus to work nor can I work from home, and we're considering keeping Toddler in full-time daycare this summer because it is too hard for 1 adult to deal with both Toddler and Dog all day (and this creates a greater financial burden). No one wants to visit or babysit because of Dog. We can't go out of town anymore. These things are not really sustainable.

What we have tried: Trilostane (caused diarrhea) and Selegiline (caused diarrhea). Currently he takes Tramadol for pain, Metronidazole for killing off bugs (he has tummy issues often), and recently the vet gave us Acepromazine as a sedative so that he (we) can sleep. (This makes him have cherry eye. Gross.) Vet suggested Benadryl as a mild daily sedative recently. Yes, I keep talking with the vet. She said that there is another drug but that it is pretty dangerous. She also suggested that we might go to see a specialist (that is 2 hours away). We're going to try the Selegiline again for a few weeks and switch to a different treatment that is "riskier." We're also switching to Prescription Diet bd. I just bought an Anxiety Wrap, a dog phermone diffuser and dog phermone collar.

At this point I don't know what to do. How much do these specialists cost? Can they do much? I've read that diet can help, but does it really? What about crating him? (He can get through baby gates easily.) What about doggy daycare during the day so that I can get some work done? How can we help him keep his nose/head at a 45 degree angle? At what point do we start seriously discussing putting him down? Our goals are to make him comfortable while also making our lives less stressful. Right now he is obviously not comfortable.

posted by k8t to pets & animals (40 answers total)

At what point do we start seriously discussing putting him down?

A method I've seen is to make a list of 5 things that your doggie loves to do, and then cross them off as they're no longer able to do them. However, I suspect that you might already be past that point. Keeping the pup's head at a 45 degree angle at all times just isn't sustainable. He's making a mess, anxious almost all of the time. I'm sure all these vet visits are stressful for him, too.

I'm so sorry you're going through this. I know how hard it is to face losing a pet. But I really think the most loving thing to do, in this situation, is to help him go, peacefully, before his discomfort escalates. You might ask your vet about in-home euthanasia, to minimize the stress he feels before hand.

Sorry again. My thoughts are with you and your family, Dog included.
posted by PhoBWanKenobi at 10:37 AM on April 28, 2010 [11 favorites]

Right now he is obviously not comfortable.

This is the most important thing in your post. I think that it is the criteria for needing to put him down.

I speak from the perspective of one who waited too long to 'put down' her beloved cat. I wish I had not let him suffer that last week.

I am sorry for what you are going through.
posted by SLC Mom at 10:42 AM on April 28, 2010 [3 favorites]

If he's constantly stressed and uncomfortable despite dramatically increased efforts and medications aimed at relieving him, I think now is the time to start talking about putting him down. I think you should consider talking to another vet if yours isn't including this as an option to discuss. I don't mean to be callous, it just sounds like it's time to start talking about it. It's an awfully sad situation to be in, but when you're facing ever more risky or side-effect-heavy treatments for a condition that can't be reversed and is causing immense pain and stress to the animal, euthanasia needs to be one of the options the family and vet are discussing. I'm sorry you're going through this.
posted by Meg_Murry at 10:43 AM on April 28, 2010

I'd add, I've had mixed experiences with vets' attitudes toward quality of life for aging and ill animals. This is why I suggest talking to another vet who may have a different perspective from your current one.
posted by Meg_Murry at 10:46 AM on April 28, 2010

If it's any help, here's a list of criteria for euthanasia from about.com, and here's a slate article on the topic.
posted by PhoBWanKenobi at 10:46 AM on April 28, 2010

No definite answer, but ... We went through this with our lab for about 2 years. It really is like canine Alzeimhers. The dog slowly 'disappears.' For us it was a slow downward spiral, with the above symptoms and also meds. We decided not to do any specialist work. We had her euthanized at 14+ years; her confusion caused her to trip down some steps, she landed on her stomach, and - unknown to us - ruptured an intestine. Septicemia followed in 24 hours, she collapsed, we took her in, the vet said that it was time.

Now, several years later, we ask ourselves, should we have put her down two years earlier, when she was comfortable? I think sometimes that we wish that we had had the courage to do so. She was in pain for a while. Would we have done so at the time? I don't know. My one regret is that we had to haul her into the clinic to be put down. I would rather have done it in her favourite spot in the garden.

One of the problems is that there is so many medical interventions available for dogs these days, it's difficult to know when to stop.

As others say, you may have to fond the courage to put Dog down. It's a difficult decision, almost taboo in many ways. You have our sympathy.
posted by carter at 10:47 AM on April 28, 2010 [2 favorites]

I am so sorry you're dealing with this. We're facing many of the same issues. We have a 15-year-old beagle with Addison's disease (which we actually induced as a treatment for Cushing's disease, because it's generally easier to manage), arthritis, occasional stomach issues, and his vision is going. It also looks like he's starting to show some signs of dementia, mostly in the form of clinginess.

Because most of his health issues are manageable with medication, and he's still got a decent quality of life, we've been able to avoid seriously having the discussion about when to put him down. If he develops a terminal illness like cancer, we won't pursue treatment; we'll just keep him comfortable and let him go when that's not possible any longer. However, managing his current issues medically is not inexpensive, and we haven't even gone down the anti-anxiety treatment path.

Unfortunately, it sounds like your dog is reaching the point where he's not consolable, and isn't enjoying his life - not through ANY fault of yours, it just happens. I have to agree with PhoBWanKenobi that it might be time. Talk to your vet; I know our vet is very much on the same page as we are about this sort of decision-making, and I hope that yours is in tune with you. Absolutely ask about the vet coming to your home when the time comes.

Again, I'm sorry you're facing this. It is something I think about every day, and I don't wish that on anyone.
posted by Lulu's Pink Converse at 10:51 AM on April 28, 2010

If you do want to pursue treatment, do you have a vet school in your region where you could take him? I'm lucky to have one near me, and although it's a pain to deal with the extra level of bureaucracy there, it gives me access to people with an extreme level of expertise. Sorry to say, but most vets are great at everyday issues and not so great once things start getting complicated. I haven't found the vet school clinic to be any more expensive than a regular vet, either.

Also, is he still on acepromazine? That drug works by causing a dissociative effect and also heightens sound sensitivity. It could be making things worse, not better.
posted by HotToddy at 10:53 AM on April 28, 2010

Video of talk on acepromazine (in the context of noise phobias, but generally informative).
posted by HotToddy at 10:55 AM on April 28, 2010

I agree with PhoBWanKenobi's idea, and that it may well be time to euthanize your dog. From your initial description, I would want to be euthanized in that situation.

Please remember that dogs aren't humans. They care about quality of life far more than quantity, and don't really have the capacity to hold on by looking forward to a few good things the way that some terminally ill humans can do.

It's understandable that you're going to feel conflicted about euthanasia, especially when your dog's problems are also affecting your own life pretty severely; the temptation to think that you're doing it for yourself and against the dog's welfare is obvious. But please remember that when it's time -- and depending on what else is going on in your dog's life it might or might not be -- euthanizing your dog is the last act of lovingkindness you can perform for it.
posted by ROU_Xenophobe at 11:00 AM on April 28, 2010 [1 favorite]

The dog is suffering and the whole situation is making your lives miserable and borderline non-funcational. If there were some hope of the dog getting better and not suffering, then it would make sense to explore options to prolong his life, but he is not going to be able to get better, and at best he might suffer less in the time remaining. Meanwhile, treatment would exhaust you and drain your finances. While difficult, the sensible - and compassionate - thing to do is to put him down.
posted by Dasein at 11:03 AM on April 28, 2010

I am so sorry... that sounds like a terrible situation. Poor dog.

I have no medical or personal experience to offer regarding Cushing's disease (I'm assuming the vet has ruled out surgery) but regarding his nose/head at a 45 degree angle: have you considered a customized neck brace? Just looking at my dog (who we recently had to put an Elizabethan collar on due to an injury), I'm thinking it would be possible to keep his head up if the collar was hard and fit just below his head. Have you talked to the vet about this? It should be doable, I feel.

We rescued our dog (a tiny pup) from a very bad accident, and tried everything that seemed possible to get him treated. But after two weeks he still seemed to be getting worse (wouldn't move at all) and then we just got into the car and traveled two hours to see a possibly better but certainly more expensive doctor and finally got a treatment plan that worked. (It didn't cost all that much, in the end, and Pup is doing great.) What I'm saying is, if it seems you've come to the end of doing things this way, do go see a specialist. That way you will be better informed, and can figure out what's feasible, medically and financially.

Putting him down is a conversation for your family and your vet. You are such a devoted owner, and I am sure you will know when to start seriously considering it. There's no right point... just when you all feel that it's really the only humane thing to do. I hope the best for Dog and you. *Hugs*
posted by mondaygreens at 11:05 AM on April 28, 2010

As someone who has had to put down several beloved pets, it is best to let them go when you still have lots of good memories, and they are able to enjoy their last day. It is also one of the hardest things to do. Your dog can't understand or have explained to it what is going on, and perhaps an easy passing is the best.

The thing that has helped me the most is that the resources (and they are always limited) that would go into postponing the inevitable passing could be used to help a much larger number of animals that would be able to enjoy them more. So I almost always try to line up the next pet before I let the old one go, whether rescue, adoption or purchase, there is always a great animal looking for a loving home that can help you with the passing.
posted by bartonlong at 11:07 AM on April 28, 2010

The thought occurs to me, how does Dog's suffering affect Toddler? Perhaps you might consider putting down the Dog so Toddler is spared seeing him suffer even longer.

(I am not a parent, but I am a dog owner.)
posted by desjardins at 11:14 AM on April 28, 2010

Thanks everyone. I'm tearing up just reading this. Thank you so much for your good wishes, thoughts and ideas. It is a lot to digest.

desjardins, to answer your question, Toddler LOVES Dog so much. It is seriously impacting our decision.
posted by k8t at 11:33 AM on April 28, 2010

From the about.com link:

1. Is my pet enjoying the activities that s/he used to? Eating, walking, playing, interested when you leave or come home?

Not really.

2. Is my pet able to eat and drink? If my pet needs to be assisted, is my pet getting adequate fluid and nutrition?

Yes.

3. Is my pet able to urinate and defecate ok?

Yes, although he has some poop issues.

4. Is my pet in pain often? Is pain adequately controlled with medication?

Yes, I think that it is generally controlled.

5. Is my pet part of the family, or alone most of the time?

Part of the family.

6. Does my pet now become stressed or afraid when left alone?

Yes.

7. Does my pet continue to recognize me?

Yes.

8. Does my pet seem to enjoy interaction with other pets and family members?

Yes.
posted by k8t at 11:36 AM on April 28, 2010

@HotToddy - there is UC Davis' vet school, but it is quite far away.
posted by k8t at 11:38 AM on April 28, 2010

There is a really, really good book called Dog Heaven by Cynthia Rylant that may help when you do finally decide to put the dog down. It makes me cry every time I read it, but in a good way. I found it while I was working as a library aide in a children's library. Someone was returning it, and I checked it in. It is actually a children's book, but adults love this book too. I have given it to a few people when they have lost their dogs. I really like it so much more than any of the rainbow bridge stuff.
posted by chocolatetiara at 11:48 AM on April 28, 2010 [1 favorite]

Toddler LOVES Dog so much. It is seriously impacting our decision.

Do what is right for Dog, not what keeps Toddler happy.

Imagine having these happy vague memories of your beloved dog as a wee bairn, only to find out when you're a teen or adult that your parents were keeping the dog alive after they sort-of knew it was time to put him down because the dog made you happy. Obviously people differ, but for me the guilt would be crushing, and I would be seriously angry at my parents for dirtying what happy memories I might have had from Dog.

I don't know if things differ for pets, but if it's time to euthanize Dog, most guides to children and mourning that I've seen suggest (for people's deaths) that you don't sugar-coat or euphemize it. Dog isn't at a farm, or asleep, or anything else, Dog is dead, and will not come back (barring your own religious beliefs to the contrary, I guess).
posted by ROU_Xenophobe at 11:59 AM on April 28, 2010

If your dog's illness was manifesting in a more visibly physical way (can't walk, get up, etc.) it would be so much easier to gauge where he is at in terms of quality of life. Having mental issues/suffering is so much harder to figure out. Yet, really, the situation is still the same.

I think you have done everything you can up to this point. I think if you are up for visiting a specialist, you should do so. Mostly because then you will feel better in knowing you have had an expert opinion which will support you however you decide to go. The specialist may have some new amazing solution. Or, on the other hand, they may just be able to give you the knowledge you need to feel secure in your awareness of doing what is the best for your dog.

Lastly, when your dog DOES get into a small space, does his anxiety leave him? If so, could you create a way that he feels he is in a small space at all times? (the anxiety jacket might give him that feeling) Some dogs have a security toy that takes away their anxiety. Is there anything that might apply to your dog?
posted by Vaike at 12:03 PM on April 28, 2010

UC Davis is a great vet school and you should absolutely go seek an internal medicine specialists opinion!

A 2 hour drive may give you some answers, solutions and relief for both yourselves and your dog.

Cushing's is an overproduction of steroids in the body. If not properly controlled, then yes, it can cause his severe anxiety. If he is not responding to "normal" care with his vet, then you should go see a specialist. Would they you go to a general family doctor yourselves if you had a serious internal illness that they were having difficulty treating? I think not. Your doctor would send you to a specialist. It's no different for a dog. Costs are not difficult to obtain, all you have to do is call and ask.
posted by TheBones at 12:38 PM on April 28, 2010

@TheBones, Davis is 8 hours away. LA is 2 hours away.
posted by k8t at 1:15 PM on April 28, 2010

When my older cat was ill, one of the most helpful things for me was joining a Yahoo Group that focused on his condition, feline lymphoma. Not only did I get general information, drug experiences, vet references, and online supply sources - I got emotional support from a range of people who were all OK with me doing what I felt was in my cat's best interests. Some leaned toward putting pets down sooner rather than later, some wanted to keep fighting if there was a slim chance, but they were all supportive and non-judgemental.

No one can tell you if you should put your dog down or if you should keep fighting, only you can decide that, but it's so wonderful to have other people in the same situation to help you make that decision. Here's a group I found with a quick search - Canine Cushings/Auto-Immmune Care.

If it was me, I'd go see the specialist. In the meantime, if you're close to campus, could you have a student come in for a few hours a day and help care for the dog? It would probably be less expensive than doggy daycare, and less stressful for the dog.
posted by HopperFan at 1:17 PM on April 28, 2010 [1 favorite]

Toddler LOVES Dog so much. It is seriously impacting our decision.

This is totally understandable, but you shouldn't keep an animal in pain because it postpones the inevitable sorrow of a person. The dog will die; it can die now or it can continue to suffer; it won't be any easier for you or your toddler later. It's selfish to keep an animal alive solely to postpone the sadness of humans when its quality of life is gone.
posted by Dasein at 1:43 PM on April 28, 2010

When I was in 8th grade, my family delayed putting our cat to sleep longer than we should have. We had the best of intentions, of course, but in retrospect, I really regret it. My mom put it off because of us kids, and I actually still feel immense guilt about it when I think about it. It's a hard decision, but I think it would be better to do it too soon than too late, in terms of the animal's perspective and suffering.

I'm sorry you're having to go through this.
posted by Mavri at 1:46 PM on April 28, 2010

Look into their eyes and that will usually tell you if it is time or not. Be strong.
posted by meepmeow at 2:40 PM on April 28, 2010

I'm sorry you're having to make these painful decisions.

Since you mentioned the financial point of view and also the possibility of doggie day care, would it be less expensive to put Dog in day care and keep Toddler at home this summer, if the problem is that it's too hard for one adult to care for both? I'd imagine that doggy day care is cheaper than child day care.

If it's not possible to put the dog in day care because his problems are not something that can be dealt with in a group setting -- if he's that anxious and unable to function -- I wonder if that might also give you some insight into whether his condition has progressed to where it's really kinder to let him go.
posted by palliser at 2:42 PM on April 28, 2010

These decisions are just so incredibly painful and emotional. We all have different limits and expectations. For me, putting an incredibly anxious, sick, pained, dying dog in daycare all day wouldn't be fair. But I also wouldn't be able to keep the dog at home and send my child to daycare all summer just to make it manageable. Once the situation becomes basically unmanageable like this - people can't come over, you can't leave, it's going to get worse, there is no cure - it wouldn't be untenable for you to decide to let her go now.

Here's another rule of thumb. Out of every single person I've ever known who has put down an animal, and we're talking probably 50+ animals total, not one, not one, thinks they did it too soon. If anything, people always say "it was time," or more commonly, "we probably waited too long because we didn't want to say goodbye or do the hard thing. In the end it was worse to wait that long." Once it reaches the stage where pet lovers wonder, "Is it time?" nobody regrets ending it too soon. They only regret making their pet stay sick and get worse. You might not be there yet, and I understand. I only offer that litmus test as a way to remind you that the hard decision isn't necessarily the wrong decision.

You've already started to have the conversation with yourself and with us, and implicitly, with your vet and partner. The list of answers you've started above is a good one. Maybe you'll decide that if one more thing changes, that signals the time to let her go before it gets worse. The last few weeks or months with a dying pet are horrendous. The pet isn't happy, doesn't hope for happier times, or get kicks out of remembering happy times in the past. You can do things to keep her comfortable but you'll know when it's time.

I'm so sorry. It's incredibly difficult. The love we have for our pets, and who we are in their presence, seems impossible to artificially end. The thing is, you're not artifically ending something. You're intentionally allowing her to go, and not forcing her to stay alive and sick for your own emotional strength. It's really hard. Love to you all.
posted by barnone at 4:18 PM on April 28, 2010 [2 favorites]

I've got nothing add to the great advice above.... except... hang in there, I have no doubt you will make the right decision, you love that pup too much to do otherwise..

now, i'm going to watch your video again and go hug the dwag...

our thoughts are with you...
posted by HuronBob at 5:11 PM on April 28, 2010

Part of being a responsible owner is knowing when "it's time".
posted by 6:1 at 5:58 PM on April 28, 2010

Part of being responsible is taking your dog in and having it checked by someone who knows something about cushings.

Day vets aren't qualified to deal with this.
posted by TheBones at 6:34 PM on April 28, 2010

Call UC Davis and ask if they can recommend a private specialist closer to you.
posted by HotToddy at 6:49 PM on April 28, 2010

Cushings is extremely common in dogs and any vet who stays even remotely current with research should be pretty well-equipped to handle it. This is not a condition requiring a specialist in most cases.

It's obvious you love your dog, as others have said, dogs only care about quality of life, and you have already taken just about all the steps I would consider not just "basic" but "well above and beyond". Keeping your dog alive for as long as possible isn't what will stay with you, letting your dog go peacefully before his life becomes a living hell is. In my experience, it's the ones you let go on too long that are the ones that haunt you, not the ones you may have let go a bit too soon. I'm sorry.
posted by biscotti at 7:06 PM on April 28, 2010

Thanks all.

I've gotten into some of the Cushing's web forums and many of the members seem to think that our dog may have had too heavy of a dose of the primary Cushing's med that our vet had us give up on. They seem to think that with this med, we might have a turnaround.

I don't know why I didn't think to get involved with these forums before. And YES I realize that there are people out there that are willing to go to greater lengths than I am to help their dogs... but hey, this gives me some hope.

Knowledge is power right?

Thanks again to all the wonderful MeFites.
posted by k8t at 10:55 PM on April 28, 2010

It really ticks me off that several people have suggested that you should euthanize this dog. I'm guessing that no one here actually has any veterinary medical knowledge and do not know if all treatment options have been explored.

Advice from forums on the internet, including "speciality cushings disease forums" are not replacements for REAL doctors. I'm also really shocked that for as "put out" as you sound for the dog making a mess and keeping you up at night, that a long drive is a big deal to you. The drive may give you some answers, solutions and relief for both you and your dog.

If your dog is not responding to "normal" care with his vet, then you need to go see a specialist. It is very difficult for me to feel sorry for you when you haven't sought out the additional help from a specialists that your dog needs. I do however feel sorry for the dog.
posted by TheBones at 3:32 PM on April 29, 2010

It really ticks me off that several people have suggested that you should euthanize this dog. I'm guessing that no one here actually has any veterinary medical knowledge and do not know if all treatment options have been explored.

If I recall correctly, biscotti is (or was?) a vet tech.

I don't think OP needs a guilt trip. She's clearly gone above and beyond for this beloved family member and is clearly dedicated to doing whatever she can to make Dog comfortable and happy. When it comes down to it, an eleven-year-old lab is elderly, and, with that in mind, were I in her position, my goal would be to compassionately care for this animal in whatever capacity I can, and not to allow him to needlessly suffer. This may mean adjusting the treatment; this may mean euthanizing him. Ultimately, that's up to OP, her family, and her vet to decide.

Best of luck to you, k8t. Know that there are lots of mefites out there who are thinking of you and will support you in whatever you choose.
posted by PhoBWanKenobi at 4:07 PM on April 29, 2010

Part of being responsible is taking your dog in and having it checked by someone who knows something about cushings.

Day vets aren't qualified to deal with this."

My "day vet" is quite thoroughly qualified to deal with Cushing's, and did, and now deals with our dog's Addison's, among his other health issues. Yes, if you need to see a specialist (and CAN AFFORD IT), then you should. But outright disparaging the vets who care for pets regularly, and for years, isn't fair to anyone.

It really ticks me off that several people have suggested that you should euthanize this dog. I'm guessing that no one here actually has any veterinary medical knowledge and do not know if all treatment options have been explored.

I said it MIGHT be time. OP knows what they've done, and knows her dog, and knows her family. If OP and her family decide it is that time, I support it - sometimes exploring *all* the options isn't worth the stress on the dog or the family, and knowing when to say "enough" is the hardest and kindest thing someone can do.
posted by Lulu's Pink Converse at 6:52 PM on April 29, 2010

"Advice from forums on the internet, including "speciality cushings disease forums" are not replacements for REAL doctors."

No one suggested that they were, and in fact, I encouraged the OP to visit the specialist. I see from your previous questions that your wife is a vet, so your view of what was suggested here may be a bit negatively skewed because of things that she's mentioned/experienced.

"It is very difficult for me to feel sorry for you"

The OP didn't request that.
posted by HopperFan at 11:17 PM on April 30, 2010

As a follow up, I have since seen a specialist, TheBones. I had NO IDEA that specialists existed locally UNTIL I learned about them in the Cushing's forums. The specialist in L.A. is a "Cushings" expert, but our local internal medicine specialist has done fine.

Our local vet was going with the manufacturer's guidelines for dosing, which I learned on the forums just isn't right. UC Davis has been doing some studies of this drug and it appears that a different dosing procedure has worked (and is working for Roark, once I showed the studies to the internal medicine specialist.)

The forums help me read his results, help me with figuring out nutritional values, etc. Both my "normal" vet and the specialist are quite supportive of this. I also have found local people with whom I can "talk shop."

As a follow up, Roark is doing pretty well. I am glad that I learned about the forums on this AskMe and this led me to my specialist.
posted by k8t at 8:44 AM on June 10, 2010 [2 favorites]

Excellent! So glad to hear it.
posted by HotToddy at 10:35 AM on June 10, 2010