End Stage

[Jaybay]

Our old Dalmatian, Doc, is in end stage kidney failure. Typical Dal, he had bladder stone surgery in February 2015, recovered well but continued to drink excessively.  We kept up with labs every few months, and they were fine until the lst check on May 5.  BUN 112 CREA 5.5.   OK.  This isn't our first rodeo with kidney failure, so we got the Azodyl and aluminum hydroxide on board and went on the kidney diet.  Within a few days Doc was vomiting and it was obvious he was going down fast.  Less than 3 weeks later, his BUN was over 130; CREA 7.7 and phosphorus 11.4.  Obviously, the End is near.

Oddly enough, cerenia not only didn't work for Doc's nausea, it made him much worse.  He was a shaking, drooling, gagging mess, so I put him on my Phenergan at 25 mg every 8 hours.  He did much better within a couple hours, ate well and even joined the other 2 dogs in a couple of squirrel chases.  That ended in a few short days and I don't think he has much time left.  The other dogs know Doc is failing.  They've attacked him twice.  I know it's normal dog behavior, and I've seen it before, but it's still difficult to experience.

Last night he started having what I think are some kind of seizures from the toxins beginning to cross the blood/brain barrier.  It wasn't a generalized grand mal type of seizure, but his pupils blow out, his teeth gnash uncontrollably and he's just not "there" for several minutes.  It's going to fall to me to make the final decision.  My husband has never been able to make that call, so I want to understand what I'm seeing.  Our last dog had so much more fight in her than Doc did, and even when I finally had to say enough, she wasn't ready to give it up.  In one respect, Doc will make the decision a bit easier on us and on himself.  He won't have to suffer as long.

On top of all this, we lost our home to another flood in April, this time with 3 feet of sewage- and hydrocarbon-contaminated water.  Poor Doc had to experience the first flood in 2009 and it's somehow completely unfair that he had to endure another one at the end of his life.  I had hoped he could hang on until we could move back in, but that is not to be.  We spent 3 weeks at my sister's house while a bay of our garage got converted to an apartment. It's comfortable enough, but we'll be here for probably another 3 months.  Doc is as comfortable as we can make him, and I know he may be down to days if not hours now.  Just when I think it's time, he gets up and acts like nothing is wrong.  Hollywood actors have nothing on a terminally ill dog.

[Jaybay]

Doc had a terrific day Thursday, which I knew couldn't last, but made it all the more difficult to make the decision. My husband saw that and determined Doc had more good days in store than bad ones and refused to talk about euthanasia anymore. He went off to work Friday leaving me to watch Doc's final descent. He refused food, which he hadn't done thanks to Phenergan, and the twitches and tremors crept in during the day. The ammonia breath was overwhelming. He only wanted to be by my side.

I made the call for the end of the clinic day, Husband came home from work, and I gave Doc his final meds. Lots of Valium  and phenobarbital that should have completely knocked Doc flat. I knew it was the right thing, but it all went pear shaped. The meds didn't sedate Doc nearly enough, and I don't understand how. The dose was massive. He felt so great that he ate a big last meal, stole some from one of our other dogs just as he used to do, and proceeded to party. The plan was to have him unaware of leaving, but he charged out the door to the truck under his own steam.

Two hours after the meds, we tried to calm him down enough at the vet to administer IV sedation. Doc was having none of it. He ran all over the room, wouldn't let our very patient and kind vet near him, and tried to hide behind me. It's horrific to convince a beloved dog to trust you to end his life when he's fighting so hard against it.

It came down to plan C. The vet dashed in with a shot of succynol choline to the neck almost immediately followed by the euthanasia meds. It was over in less than a minute. Not the smooth, peaceful transition we wanted for Doc.

We're traumatized by the whole rodeo, and all I can tell myself over and over is that Doc will suffer no more. Bad enough to watch him die slowly, but this? That poor dog deserved so much better. It wasn't the vet's fault or anyone else's. Just one of those awful things that nobody can see coming. My eyes are so swollen from crying I look like a freaking garden gnome. There has to be a way through this, but I have a feeling it's going to be a very long road.

[tonyb286]

Hi. I sympathise with you, even from such a distance. It is never an easy call to make, but in this case, I believe it was the right call. Things may not have gone how you would have liked, but just remember that was just one moment in time - one moment in a long life rich with love, adventure, security and kindness. In the days and weeks that follow, I hope you come to a place where you can remember happier times. The grief of losing a beloved family member is hard and long lasting, but it does ease over time. You are among friends that understand here and you are very welcome to chat any time you feel the need or desire.

Run free Doc.

Tony

[tonyb286]

Hello. I don't often say this to owners, but I think you already know Doc's illness has possibly gone too far for any kind of management to have much effect. You really have only two choices remaining ... you could decide the time has come, and help bring his suffering to an end. Or you could try intensive fluid therapy to see if it helps bring the numbers down.

There are problems and risks with both approaches and I honestly don't envy you having to make this decision.

The fluid therapy may not work, in which case you will be putting Doc under additional stress (going to the vet, etc) without any benefit. On the other hand, euthanising him when he still has "good days" is not an easy thing to contemplate.

I think the symptoms you have seen (particularly the seizure-like tremors) and the blood values are very telling of end-stages, usually when less than 20% of the kidney organ tissues remain. It is unlikely there is any turning back from such a cliff-edge, but only by trying fluid therapy will you find out.

Regards

Tony

[Jaybay]

Tomorrow is the day. Thanks everyone for your help.