Canine hospice...
April 5, 2015 11:20 AM Subscribe
We think our sweet mutt's days our numbered, and I need advice on how to handle the whole shebang in the best, least invasive and least financially crippling way possible.
He's a big ~70 lb mutt (american staffordshire terrier looking), and just turned 15 years old, has only started to noticeably age in the last year. Eyesight and hearing are both pretty poor at this point, and since last summer lots of skin irritation (scratching and licking constantly, cause raw patches). He's had two steroid shots for the skin issues, both of which temporarily perked him up and helped him stop licking and let his sore spots heal.
Considering his age, we talked with the vet about giving him the steroid shots as needed to keep him comfortable, we also give him fish oil and bathe him (bi) weekly, but it's the shots that make a difference. All of that is fine as it were.
But during the last couple of weeks he has been drinking a LOT more water. a LOT. It's been increasing gradually and we didn't really realize how much he was drinking till this weekend when we compared notes on bowl refills. Now we're thinking kidney failure. He's sleeping a lot but behaviorally seems in fairly good spirits. (oh, the last steroid shot was 8 weeks ago so the increased drinking/urination isn't a side effect of that)
We are going to take him to the vet this week. But I'm leery of starting down the slippery slope of testing and treatment (and $$$$), especially with a VERY old animal. The reality of our finances at the moment is that any vet bills will have to go on a cc, so I want to be careful about the money as well as the animal. And for clarity, our focus is on making his remaining time as good as possible, not on extending that time. So we're more interested in palliative care than long shot or limited return treatment. We'll put his happiness on the credit card but not a small delay in the inevitable.
So my general question is above the fold, but some more specific ones:
He's a big ~70 lb mutt (american staffordshire terrier looking), and just turned 15 years old, has only started to noticeably age in the last year. Eyesight and hearing are both pretty poor at this point, and since last summer lots of skin irritation (scratching and licking constantly, cause raw patches). He's had two steroid shots for the skin issues, both of which temporarily perked him up and helped him stop licking and let his sore spots heal.
Considering his age, we talked with the vet about giving him the steroid shots as needed to keep him comfortable, we also give him fish oil and bathe him (bi) weekly, but it's the shots that make a difference. All of that is fine as it were.
But during the last couple of weeks he has been drinking a LOT more water. a LOT. It's been increasing gradually and we didn't really realize how much he was drinking till this weekend when we compared notes on bowl refills. Now we're thinking kidney failure. He's sleeping a lot but behaviorally seems in fairly good spirits. (oh, the last steroid shot was 8 weeks ago so the increased drinking/urination isn't a side effect of that)
We are going to take him to the vet this week. But I'm leery of starting down the slippery slope of testing and treatment (and $$$$), especially with a VERY old animal. The reality of our finances at the moment is that any vet bills will have to go on a cc, so I want to be careful about the money as well as the animal. And for clarity, our focus is on making his remaining time as good as possible, not on extending that time. So we're more interested in palliative care than long shot or limited return treatment. We'll put his happiness on the credit card but not a small delay in the inevitable.
So my general question is above the fold, but some more specific ones:
- How does kidney failure progress in a very old dog? Timeline, pain...
- If we do get to advanced kidney failure, is that something that an animal can die (relatively) peacefully from, or is it a situation where euthanasia would be a kindness?
- Should we be concerned about dangerous behavioral changes as he is sick? We have two very small, but mobile children, and he is a big dog with a big strong jaw...
- What at this stage of the game should we spend money on at the vet?
- What should we do to make him as happy and comfortable as possible?
Best answer: Sorry you're going through this.
My dog is young and reasonably healthy, so I don't have advice on the kidney health/aging dog front, but my dog does have a host of skin irritations and allergies that make him an itchy licky little guy.
Two things that have helped tremendously are Trizchlor shampoo and Resicort lotion. Ask your vet if they'd be ok to use. Soothing the coat itch will help make the poor dude more comfortable and might save you the money and stress of regular steroid shots if you get a good result.
posted by phunniemee at 11:54 AM on April 5, 2015
My dog is young and reasonably healthy, so I don't have advice on the kidney health/aging dog front, but my dog does have a host of skin irritations and allergies that make him an itchy licky little guy.
Two things that have helped tremendously are Trizchlor shampoo and Resicort lotion. Ask your vet if they'd be ok to use. Soothing the coat itch will help make the poor dude more comfortable and might save you the money and stress of regular steroid shots if you get a good result.
posted by phunniemee at 11:54 AM on April 5, 2015
Best answer: I can't give advice on the main point of your question, but wanted to bring up that if the time comes for euthanasia, I highly recommend having a vet make a home visit instead of making a final drive to the vet.
It is much calmer for everyone involved.
posted by bottlebrushtree at 12:06 PM on April 5, 2015 [7 favorites]
It is much calmer for everyone involved.
posted by bottlebrushtree at 12:06 PM on April 5, 2015 [7 favorites]
Best answer: Sorry to read about your dog - it's a tough time.
We had a much loved cat with kidney failure, as you asked about animals in general, and she had three years of relatively benign decline after the initial diagnosis on a combination of one tablet a day and a renal diet.
I hear you on the costs - the initial crash cost several hundred pounds in vet bills for inpatient care and fluids as well as tests. We didn't put her through that again.
I would myself get some blood tests done - excessive drinking could also be diabetes, which in humans can come with thrush / itchy skin conditions when blood sugar is high, so maybe a link there?
Whatever you decide, it won't be the wrong thing for your friend or your family. Wishing you well.
posted by Martha My Dear Prudence at 12:27 PM on April 5, 2015 [2 favorites]
We had a much loved cat with kidney failure, as you asked about animals in general, and she had three years of relatively benign decline after the initial diagnosis on a combination of one tablet a day and a renal diet.
I hear you on the costs - the initial crash cost several hundred pounds in vet bills for inpatient care and fluids as well as tests. We didn't put her through that again.
I would myself get some blood tests done - excessive drinking could also be diabetes, which in humans can come with thrush / itchy skin conditions when blood sugar is high, so maybe a link there?
Whatever you decide, it won't be the wrong thing for your friend or your family. Wishing you well.
posted by Martha My Dear Prudence at 12:27 PM on April 5, 2015 [2 favorites]
Best answer: Cushing's disease is very common in an older dog and causes a noticeable increase in drinking. IANAV but we went through the same thing with our 11 year old girl (thinking it was a kidney problem) and it turned out to be Cushing's and she lived till we had to make the choice to end her life at 18. This is a hard place to be and I sympathize, I've been there. Maybe look for some lower cost alternatives to get a more definitive diagnosis then you can be sure your providing the right end of life care. Some things can be diagnosed with bloodwork without doing more expensive procedures or treatments, that's what we chose to do. I wish you the best in all of this and take comfort in the fact that you are giving your dog the best care you can. And want to second getting the vet to come to your house when the time is right. Much easier for everyone.
posted by pearlybob at 12:27 PM on April 5, 2015 [2 favorites]
posted by pearlybob at 12:27 PM on April 5, 2015 [2 favorites]
Best answer: IMO, the key thing to remember is that your beloved pet doesnt really have any conception of "tomorrow" and wanting to stretch things out to get more time. What he has is "right now." So it's your job, to whatever extent possible, to make sure he doesn't have any truly bad days. It's far better to pull the trigger early rather than late, because he would never blame you for missing a few future walks in the park. This is a highly personal decision, so I can't tell you when will be the right time -- except that I wouod encourage you not to take it down to the last possible moment. If you get a bad report from the vet and the vet tells you your dog is already feeling pretty poorly, it wouldn't even be inappropriate to do it then. If you make a different decision, understand that the rest is borrowed time and make peace with the fact that every day could be "the day." This thinking, for me at least, has made a lot easier for me to make the best decisions for my pets at the end of their lives. It's the last great responsibility of pet ownership and the best gift you could ever give him.
All that said, if that's what it is, kidney failure is unlikely to have any effective and affordable treatments, but there are things you can probably do to give your dog some more good days. For example, there is probably high carb "kidney diet" prescription food you can feed him, and eventually you can learn how to give subcutaneous fluids at home. When you find yourself giving subcue fluids more than once or twice a week, though, it's time to start thinking about giving him a good end.
Be upfront with the vet that you don't want to spend a zillion dollars to prolong the life of an already aged dog, and he/she should be able to advise you. It's always a good question to ask, "if I do this thing, what will that give him? Another year or more of quality life?" Anything less than that, IMO, is not likely to be worth it. On the other hand, it could be something totally treatable.
It's hard to predict behavioral changes. If he seems to get irritable or aggressive, it's probably a good sign that he doesn't feel good and you aren't doing him any favors prolonging his life.
Definitely take the time so spend time with him, take him to his favorite places, play his favorite games, give him his favorite treats. Make his "right now" as good as possible, and you'll both feel a lot better for it.
I'm sorry.
posted by slkinsey at 12:43 PM on April 5, 2015 [6 favorites]
All that said, if that's what it is, kidney failure is unlikely to have any effective and affordable treatments, but there are things you can probably do to give your dog some more good days. For example, there is probably high carb "kidney diet" prescription food you can feed him, and eventually you can learn how to give subcutaneous fluids at home. When you find yourself giving subcue fluids more than once or twice a week, though, it's time to start thinking about giving him a good end.
Be upfront with the vet that you don't want to spend a zillion dollars to prolong the life of an already aged dog, and he/she should be able to advise you. It's always a good question to ask, "if I do this thing, what will that give him? Another year or more of quality life?" Anything less than that, IMO, is not likely to be worth it. On the other hand, it could be something totally treatable.
It's hard to predict behavioral changes. If he seems to get irritable or aggressive, it's probably a good sign that he doesn't feel good and you aren't doing him any favors prolonging his life.
Definitely take the time so spend time with him, take him to his favorite places, play his favorite games, give him his favorite treats. Make his "right now" as good as possible, and you'll both feel a lot better for it.
I'm sorry.
posted by slkinsey at 12:43 PM on April 5, 2015 [6 favorites]
Best answer: So sorry you're going through this.
I don't have much to offer than anecdote, but maybe it will help a little:
Our little whippet died of kidney failure last week. We didn't know it was coming, and it seemed to happen all of a sudden- one moment she was her usual self, the next she could barely walk out the door to pee and was refusing to eat anything. We took her to the vets to be kept stable while tests were run and we decided what to do, but while she was there it became clear that there was nothing to be done, so we decided to euthanise her. She was on a drip and she was so far gone that she was settled and calm even at the vets, which she always hated, and the euthanasia was honestly incredible. They put it right into the IV, and I couldn't even tell the moment she died, it was so peaceful, gentle, and fast. I just wish all living beings could have such a death. So whatever happens with your boy, just know that euthanasia, while an awful decision to have to make, is such a wonderful choice that we can make for our beloved animals.
So my advice is to expect the worst, and to spend some quality time with him now while you can, and not to be scared of making the decision to put him to sleep when it's time. All the best.
posted by mymbleth at 1:43 PM on April 5, 2015 [2 favorites]
I don't have much to offer than anecdote, but maybe it will help a little:
Our little whippet died of kidney failure last week. We didn't know it was coming, and it seemed to happen all of a sudden- one moment she was her usual self, the next she could barely walk out the door to pee and was refusing to eat anything. We took her to the vets to be kept stable while tests were run and we decided what to do, but while she was there it became clear that there was nothing to be done, so we decided to euthanise her. She was on a drip and she was so far gone that she was settled and calm even at the vets, which she always hated, and the euthanasia was honestly incredible. They put it right into the IV, and I couldn't even tell the moment she died, it was so peaceful, gentle, and fast. I just wish all living beings could have such a death. So whatever happens with your boy, just know that euthanasia, while an awful decision to have to make, is such a wonderful choice that we can make for our beloved animals.
So my advice is to expect the worst, and to spend some quality time with him now while you can, and not to be scared of making the decision to put him to sleep when it's time. All the best.
posted by mymbleth at 1:43 PM on April 5, 2015 [2 favorites]
Best answer: Our 12 year old mutt had to be put down two weeks ago and the only thing I regret about it was not listening to my gut and taking her in sooner.
It turned out that finding the cancer earlier wouldn't have given her any extra days, but we could have made her more comfortable in the interim.
As to the cost and dealing with treatment, we ended up taking her to the emergency vet because things had progressed that far and our regular vet kept saying it was no big deal, just age. Fortunately the emergency vets were very considerate and explained what our treatment options were and the likely outcomes. So we never felt pressured into treatments that weren't likely to help.
In the end, we opted to take her in to be put to sleep rather than doing it at home because we didn't want to always have a spot in our home that reminded us "This is where Rosie died." every single day.
Be kind to yourself and remember that dogs are very present in the moment. Make sure those moments are good and know that you are doing the right thing.
posted by teleri025 at 3:01 PM on April 5, 2015 [1 favorite]
It turned out that finding the cancer earlier wouldn't have given her any extra days, but we could have made her more comfortable in the interim.
As to the cost and dealing with treatment, we ended up taking her to the emergency vet because things had progressed that far and our regular vet kept saying it was no big deal, just age. Fortunately the emergency vets were very considerate and explained what our treatment options were and the likely outcomes. So we never felt pressured into treatments that weren't likely to help.
In the end, we opted to take her in to be put to sleep rather than doing it at home because we didn't want to always have a spot in our home that reminded us "This is where Rosie died." every single day.
Be kind to yourself and remember that dogs are very present in the moment. Make sure those moments are good and know that you are doing the right thing.
posted by teleri025 at 3:01 PM on April 5, 2015 [1 favorite]
Best answer: When our aged cats were in kidney failure, our vet taught us this really low-tech version of dialysis: you get a bag of iv hydration fluid (lactated ringers - I bought it from the vet for really cheap by printing the price from an internet vet supply) and inject the animal just under the skin between the shoulder blades. We started out doing it a couple times a week - took about 5 minutes, cat had a weird water bubble that would reabsorb in a few hours and then she'd go take a monster pee, but there was no drama. Both cats lasted about another year & a half, with the injections increasing to every other day, but as I said, it was five minutes' inconvenience. There was no pain or drama at all, and our cats had a very good quality of life until, as the vet told us to expect, they "crashed." We had them put to sleep pretty much immediately then, as they went from eating/sleeping/old-cat-playing normal to really sick, all within a day or so.
Don't know if this is a solution for you and your dog, but may be worth looking into.
Re: itchy skin - when we rescued our pitt mix, she had hot spots everywhere and a neighbor recommended 1-2 capsules of fish oil in her food. Her coat is very healthy now.
posted by toodleydoodley at 6:17 PM on April 5, 2015
Don't know if this is a solution for you and your dog, but may be worth looking into.
Re: itchy skin - when we rescued our pitt mix, she had hot spots everywhere and a neighbor recommended 1-2 capsules of fish oil in her food. Her coat is very healthy now.
posted by toodleydoodley at 6:17 PM on April 5, 2015
Best answer: Our Corgi died last year of kidney failure. We sorta had a few months' notice - weird test results but no symptoms. Then all of a sudden she was having accidents and drinking a ton of water, and the vet confirmed kidney failure (similar to mymbleth). A week later we put her down.
I think the best thing you can do (once you get test results back) is to have a serious heart-to-heart with your vet. The vet is going to present any and all options to you, but they're going to understand that many of them aren't actually reasonable. No good vet is going to force you to do invasive, expensive treatments on an elderly dog if you don't want to. Talk to your vet about what your options are and what the likely outcomes are, and also how to decide when it's time to put the animal down.
Several people above have mentioned subcutaneous fluids. We did this a few times to keep her hydrated during the days that we were waiting to get test results back. Apparently some people are able to do this successfully without much stress, but I found this to be an awful experience. If it's something the vet suggests and you think you'll be able to handle it for an extended period of time, go for it, but if it's too much to handle please don't beat yourself up for wanting to invest in it.
During the week where things were going downhill I was concerned that she would die suddenly at home, so it was helpful for me to get the name of a place that would pick up the body and do cremations. I know that sounds morbid but I'm a mega-planner and I would have been stressed enough if that had happened!
I also had a discussion with my SO as to what we wanted to do with the cremains. Really glad we talked about that ahead of time. I'm very uncomfortable with death, funerals, urns, etc., and wanted nothing to do with the cremains. Turns out he wanted to scatter her ashes in a particular park. So we decided that he would pick up the cremains and do the scattering with his mom. Totally fine with me.
Putting my dog down was really hard on us but a very peaceful process for her. Honestly, I think euthanasia is the kindest gift we can give our animals. Our dog was clearly so sick and was not getting better. I was a blubbery mess (thank goodness my SO had it together because I was crying so much I couldn't even read the paperwork) but it would have been worse to let her keep going under the circumstances.
Whether you do the euthanasia at the vet or at home is a personal choice. I considered it but my SO was against it. Also our dog was not one of those who freaked out at the vet so she wasn't particularly stressed out by going there. I will say that I couldn't go into the particular treatment room where we put her down for a while after that (we have another dog so I've been back to the vet since then).
Corgis shed a *lot* so after she died we did a massive cleaning of the house and car. As soon as we left the vet I threw out the fleece I was wearing (it was really old and full of dog hair to begin with). We threw out her kennel (we could have cleaned and donated it but we were so stressed we just threw it in a dumpster) and bed. I've never seen my SO clean with such fury. But it really helped so there weren't a zillion tiny fibrous reminders of her everywhere.
posted by radioamy at 7:17 PM on April 5, 2015 [1 favorite]
I think the best thing you can do (once you get test results back) is to have a serious heart-to-heart with your vet. The vet is going to present any and all options to you, but they're going to understand that many of them aren't actually reasonable. No good vet is going to force you to do invasive, expensive treatments on an elderly dog if you don't want to. Talk to your vet about what your options are and what the likely outcomes are, and also how to decide when it's time to put the animal down.
Several people above have mentioned subcutaneous fluids. We did this a few times to keep her hydrated during the days that we were waiting to get test results back. Apparently some people are able to do this successfully without much stress, but I found this to be an awful experience. If it's something the vet suggests and you think you'll be able to handle it for an extended period of time, go for it, but if it's too much to handle please don't beat yourself up for wanting to invest in it.
During the week where things were going downhill I was concerned that she would die suddenly at home, so it was helpful for me to get the name of a place that would pick up the body and do cremations. I know that sounds morbid but I'm a mega-planner and I would have been stressed enough if that had happened!
I also had a discussion with my SO as to what we wanted to do with the cremains. Really glad we talked about that ahead of time. I'm very uncomfortable with death, funerals, urns, etc., and wanted nothing to do with the cremains. Turns out he wanted to scatter her ashes in a particular park. So we decided that he would pick up the cremains and do the scattering with his mom. Totally fine with me.
Putting my dog down was really hard on us but a very peaceful process for her. Honestly, I think euthanasia is the kindest gift we can give our animals. Our dog was clearly so sick and was not getting better. I was a blubbery mess (thank goodness my SO had it together because I was crying so much I couldn't even read the paperwork) but it would have been worse to let her keep going under the circumstances.
Whether you do the euthanasia at the vet or at home is a personal choice. I considered it but my SO was against it. Also our dog was not one of those who freaked out at the vet so she wasn't particularly stressed out by going there. I will say that I couldn't go into the particular treatment room where we put her down for a while after that (we have another dog so I've been back to the vet since then).
Corgis shed a *lot* so after she died we did a massive cleaning of the house and car. As soon as we left the vet I threw out the fleece I was wearing (it was really old and full of dog hair to begin with). We threw out her kennel (we could have cleaned and donated it but we were so stressed we just threw it in a dumpster) and bed. I've never seen my SO clean with such fury. But it really helped so there weren't a zillion tiny fibrous reminders of her everywhere.
posted by radioamy at 7:17 PM on April 5, 2015 [1 favorite]
Best answer: There is a service in SLC, Utah, that comes to the house, puts your pet down, takes your pets body away, cremates and returns the ashes to you. For a beloved big dog, that sounds sad, but easy. Sorry your dog is so sick. Best to you.
posted by Oyéah at 9:19 PM on April 5, 2015
posted by Oyéah at 9:19 PM on April 5, 2015
Response by poster: Every answer has helped me feel better equipped to go into this time. Thank you all for sharing your hard earned experience, and I'm sorry for the furry friends you have lost. And thank you all for your kindness.
posted by pennypiper at 8:55 AM on April 6, 2015
posted by pennypiper at 8:55 AM on April 6, 2015
Best answer: My childhood dog just died of kidney failure the day after thanksgiving. She dropped a lot of weight and became shaky, test results showed kidney failure. Teh vet reccommended euthanasia because they said the protracted failure is painful to the animal. WE put her to sleep that day.
One thing about dogs is they don't dwell on pain like humans, so they may momentarily be interested in treats or belly rubs or some other stimuli, but their bodies are still in pain, they're minds are just easily distracable. It is _not pleasant_ to keep and watch a dog till it dies it's natural death because by the time they are completely undestactable form the pain, it's really really elevated.
I hope you have a good and sensitive vet. Our vet is very caring and understanding of the (lack of) value of extensive testing adn treatment of animals of a certain age, and readily recommends putting them to sleep if that is best for the animals comfort, even though it is the least profitable item for them (aside from just letting the dog die at home slowly).
Sorry =(
posted by WeekendJen at 9:20 AM on April 6, 2015
One thing about dogs is they don't dwell on pain like humans, so they may momentarily be interested in treats or belly rubs or some other stimuli, but their bodies are still in pain, they're minds are just easily distracable. It is _not pleasant_ to keep and watch a dog till it dies it's natural death because by the time they are completely undestactable form the pain, it's really really elevated.
I hope you have a good and sensitive vet. Our vet is very caring and understanding of the (lack of) value of extensive testing adn treatment of animals of a certain age, and readily recommends putting them to sleep if that is best for the animals comfort, even though it is the least profitable item for them (aside from just letting the dog die at home slowly).
Sorry =(
posted by WeekendJen at 9:20 AM on April 6, 2015
I just lost my best friend this weekend from kidney failure, which was signaled by sudden weight loss. We were able to give him two good months through daily fluid injections, a diet change, and extra water bowls for impulse drinking. We used that time to shower him with love. When he stopped eating and couldn't move around much any more, we knew it was time. It hurts immensely, but I'm glad we had that extra time with each other. And thankfully we had a good vet who truly empathized.
posted by chimpsonfilm at 4:44 PM on April 6, 2015
posted by chimpsonfilm at 4:44 PM on April 6, 2015
I am so sorry. This is a heartbreaking experience, and your guy knows how much you love him and are looking out for him.
Just so that you are prepared for the potential for a different diagnosis: excessive urination and excessive drinking are symptoms associated with about 2 dozen conditions, including kidney disease. I don't know what steroid your guy got 8 weeks ago, but dogs do have varying responses to steroids, and residual effects have been seen weeks after exposure.
At this stage, a full examination and some labwork would be informative and not too expensive. The 'minimum database' is a complete blood count (CBC), serum chemistry profile, and urinalysis. If he is drinking and peeing excessively, the urinalysis is very important. It will be least stressful for everyone if you catch a sample of his urine in a clean container to bring with you (same day as your appointment, put it in the fridge) although they may want to get their own sample if they do certain tests. They may also want to check his thyroid hormone levels. The results of the minimum database may give you a better idea of what is causing his symptoms and if there is something going on that you can't see. Where I am located, this may cost anywhere from about $75-150+.
When an animal is in advanced kidney failure, they don't feel good because their kidneys can't remove nitrogenous waste and it builds up in their body. This looks like confusion, nausea, inappetance, and vomiting to us. The other functions of the kidney, like making vitamin D and signalling the marrow to make red blood cells, also slack off. They may get ulcers in their mouths and stomachs. They become dehydrated, and their electrolytes become unbalanced. This is not a peaceful way to die. =( Treatment may be time consuming, expensive, and only palliative. Fluid therapy at home may not be practical for a 70 lb dog because he may need liters of fluid every day.
If you can prevent any suffering in your dear friend, it is a kindness. I encounter more regret from waiting too long than from parting too soon. How to know when? You know his normal personality and level of activity best. Does he have more good days than bad? Can he get out and walk? Does he seem to express joy and interest? Is he able to stay clean? Is he hydrated? Is he eating? Is he feeling pain? Keep track so you can notice changes.
To maintain or improve his quality of life, do his favorite things with him. I'm sure that spending time with you is one of his favorite things. Play fetch over a short distance. Take him through the drive-through for an ice cream cone or a plain hamburger patty. Go for slow walks with plenty of sniffing. Keep him comfortable with soft beds, or let him up on the couch. Give him some quiet time away from the kids. Just sit with him and talk to him. Brush him, or give him a light massage. Take plenty of pictures. When you see your vet, ask if any osteoarthritic pain he might be experiencing could benefit from pain relief, and if there are any inexpensive medications, such as acid-reducers, that may make him more comfortable symptomatically.
Take care of yourself, too. It's OK to have limits to your emotional and financial expenses.
posted by Seppaku at 5:53 PM on April 6, 2015
Just so that you are prepared for the potential for a different diagnosis: excessive urination and excessive drinking are symptoms associated with about 2 dozen conditions, including kidney disease. I don't know what steroid your guy got 8 weeks ago, but dogs do have varying responses to steroids, and residual effects have been seen weeks after exposure.
At this stage, a full examination and some labwork would be informative and not too expensive. The 'minimum database' is a complete blood count (CBC), serum chemistry profile, and urinalysis. If he is drinking and peeing excessively, the urinalysis is very important. It will be least stressful for everyone if you catch a sample of his urine in a clean container to bring with you (same day as your appointment, put it in the fridge) although they may want to get their own sample if they do certain tests. They may also want to check his thyroid hormone levels. The results of the minimum database may give you a better idea of what is causing his symptoms and if there is something going on that you can't see. Where I am located, this may cost anywhere from about $75-150+.
When an animal is in advanced kidney failure, they don't feel good because their kidneys can't remove nitrogenous waste and it builds up in their body. This looks like confusion, nausea, inappetance, and vomiting to us. The other functions of the kidney, like making vitamin D and signalling the marrow to make red blood cells, also slack off. They may get ulcers in their mouths and stomachs. They become dehydrated, and their electrolytes become unbalanced. This is not a peaceful way to die. =( Treatment may be time consuming, expensive, and only palliative. Fluid therapy at home may not be practical for a 70 lb dog because he may need liters of fluid every day.
If you can prevent any suffering in your dear friend, it is a kindness. I encounter more regret from waiting too long than from parting too soon. How to know when? You know his normal personality and level of activity best. Does he have more good days than bad? Can he get out and walk? Does he seem to express joy and interest? Is he able to stay clean? Is he hydrated? Is he eating? Is he feeling pain? Keep track so you can notice changes.
To maintain or improve his quality of life, do his favorite things with him. I'm sure that spending time with you is one of his favorite things. Play fetch over a short distance. Take him through the drive-through for an ice cream cone or a plain hamburger patty. Go for slow walks with plenty of sniffing. Keep him comfortable with soft beds, or let him up on the couch. Give him some quiet time away from the kids. Just sit with him and talk to him. Brush him, or give him a light massage. Take plenty of pictures. When you see your vet, ask if any osteoarthritic pain he might be experiencing could benefit from pain relief, and if there are any inexpensive medications, such as acid-reducers, that may make him more comfortable symptomatically.
Take care of yourself, too. It's OK to have limits to your emotional and financial expenses.
posted by Seppaku at 5:53 PM on April 6, 2015
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The key is to communicate firmly with the vet, because they have a tendency to recommend all kinds of stuff (just as human doctors do to palliative human patients). I like to take every suggestion and ask "what action will these tests result in?". For instance, if the vet checks Mutt's kidney function, and it's up, what action will that lead to? Dialysis? Do you want that? Are there medications to effectively treat kidney failure which extend life by years? (I doubt it) If the kidney tests are off, will the vet then be recommending other tests to diagnose why the tests are up (e.g. kidney biopsy)? How much would those tests cost? Might they lead to a treatment that is affordable and will meaningfully (e.g. years) extend Mutt's life? In other words, you are playing chess: thinking a move or two ahead as to where tests lead to (because they can definitely cascade). Unless interventions stand a good chance at meaningfully prolonging his life, why embark on them? Remember you are the boss and don't be guilted by the vet into doing useless and uncomfortable procedures because they are "standard".
Drinking more likely isn't causing Mutt any discomfort now, so it's quite possible it's best just to not go any further.
Your other questions I don't have the answers to, but a good vet should be able to advise you. I think to make him as happy as possible, your care and pain medicine if needed are the best things. My vet told me if they can eat, eliminate properly and interact somewhat normally, then they aren't ready for euthanasia. When any of those things go, the time has probably come.
posted by kevinsp8 at 11:46 AM on April 5, 2015 [4 favorites]