Palliative Care, Until Tomorrow - Cancer and Most Recently Kidney Failure

[Aedrah]

Hello - I stumbled across this website while searching for help with palliative care with my 12 and a half year old greyhound, Pedro.  We have booked at home euthanasia for tomorrow at noon (the earliest we could book) - I'm hoping in the meantime for any tips that can be useful to keep him out of distress until that time comes. We want to keep him comfortable. It's important to us that we don't cause him any stress or discomfort, and that he's as happy as possible until we can help him along.

Right now he's suffering from kidney failure - he's not urinating at all. This is a new problem, and somewhat sudden but complicated by a host of other health issues.

Here's our story: About a month ago we brought him to the vet for a checkup/blood-work and prescription refill. The bloodwork came back normal, for him (his creatine levels have always been off which vets attribute to his being a greyhound - they weren't any more off than normal).

A few days after the visit we noticed he was having difficulty standing on his own, and found a lump along his ribs - it seemed to grow overnight - back to the vets - they prescribed Rimadyl (which he's had success before with, for pain management) and the vet did a fine needle aspirate - it came back strongly suggesting cancer - specifically:

"Microscopic Description: Four (4) direct smears of a FNA from a
subcutaneous mass over upper right ribs of a 13-year-old dog are
examined. This sample is mildly to moderately cellular, consisting
of a population of pleomorphic spindle cells, individually and in
clusters, on a markedly hemodiluted background with leukocytes that
appear in proportion to blood contamination. Spindle cells show
indistinct cellular borders and contain deeply basophilic cytoplasm
with mild punctate vacuolation. There is evidence of anisokaryosis,
and nuclei are oval, with coarse chromatin pattern and single to
multiple prominent distinct nucleoli. Binucleated, multinucleated
and large karyomegalic cells are noted. Mitotic figures are also
identified. There is no evidence of inflammation."

Since then, he's had bouts of weakness, being "out of it" and collapsing.

The poor guy has had a number of other medical issues in his life that he's overcome/managed - he has SLO (Symmetrical Lupoid Onychodystrophy) which is an autoimmune disease.  He hasn't lost a nail in a few years now, thanks to pentoxifylline, omega 3s and vitamin E regimen. He's also had malignant hyperthermia,and has been prone to injury/scrapes and trips as he got older, losing muscle mass in his hind end.

Knowing he's older, and not wanting to see him suffer anymore, we made the decision to keep him comfortable and happy, and choose home euthanasia when the time came where he was no longer happy/comfortable.

That time just seemed to come too soon.  Yesterday morning he woke us up early - needing to go out. We got him bundled up, made it to the hallway and he urinated and defecated in the hallway - unlike him. Not in distress, but having a hard time standing and obviously weak. As the day went on he was still weak, but not in distress. Happy to accept cookies, food - looking for tonnes of water.  But he didn't urinate as the day went on - didn't want to go outside, no accidents. Maybe a few dribbles when he stood up. Not straining. Just not urinating. Defecated overnight on his bed (formed, not diarrhea). He's also been coughing a bit.  Just a little while ago I noticed on the floor what I think is blood and mucus mixed together.  He's not straining to go. He's not vomiting or nauseous (yet), his BM's are formed. Reading some of the postings here, it would seem he's lucky, so far - I can't imagine what each of you have gone through.

But I can't help but feel I'm waiting for the worst of it to come, but hoping that doesn't. It's now more than 24 hours since his last urination.  He's still not in distress, and still eating/drinking but we can't bear to let things get worse for him. We don't want him to suffer.  

We want to keep him comfortable until the vet comes tomorrow - what can we do?  Is there anything else we can do to help avoid distress and keep him comfortable in your experience?

The vet has just said to keep feeding/watering him and of course offer him whatever he likes provided it doesn't upset his stomach.

I'm sorry if I'm rambling - having a hard time putting this into written words. Hoping for some help - thanks for reading.

[TwoBitsMom]

God Bless your Beautiful Spirit and soul Pedro....
You are much loved.

[ginger899]

Rest in peace Pedro. You were well loved.

[tonyb286]

My heart goes out to you from across the pond ... rest in peace Pedro, no more suffering. What a fantastic dog and friend you were. Aedrah, you did the right thing, even though it was hard. It was done out of love and compassion. Big hugs, Tony

[Margot49]

Such a sad day, I know but you need to know that you made the right decision.
Run free, Pedro.  Wait at the Bridge with our Ranger and all the other beloved Greys until we can walk together once again.
Hugs

[Aedrah]

Hi everyone - just a quick note to say thanks for the support and kind words.  Today has been really hard for my SO and I, though Pedro passed peacefully earlier, with as little stress as possible with the help of our vet at home.

Relieved that he won't suffer anymore, but so very sad. Knowing we did the best we could for him, it just doesn't seem enough.

Thanks again.

[Misfits4Me]

I woke up thinking about you & Pedro....I'm praying for a Peaceful passing for you both......Please know you have done a wonderful job with/for your companion....I commend you for his care.....

I know today is especially hard, I have been in your shoes.....I still cry thinking about it.  I'm sending "Good Vibes" your way, so you can get through it....It will be tough, but because you love him so, you will be able to do it....

Please come back and let us know how your doing.....We have some very well spoken members on this forum and we understand what your feeling....

Again, I will be praying for comfort for you both......Sincerely, Karla

[TwoBitsMom]

Aedrah..
Give Pedro lots of hugs and kisses...Tell him how proud you are that he is part of your family and how much the past 12 years have meant to you. Tell him he is the best dog in the world and the best friend anyone could ask for. Tell him how much you love him, and will love him forever.
My thoughts and prayers are with you both.
Connie

[mikefertuza]

Interesting thing to really read in this one. I just hoped that things would really be okay when it comes to this one. All is well in the end.

[tonyb286]

Hi Aedrah. I have no words of wisdom for you, but I'm pleased others above have shared with you their excellent knowledge and experience. My heart truly goes out to you. I lost my lurcher BB to kidney disease a couple of weeks ago, so I empathise totally with what you are going through. I can only make the suggestion that you sit with him, talk to him, comfort him as best you can - and reassure him that everything is going to be ok. When the vet comes, stay with Pedro. Let him lie in his own favourite place and stroke him gently, keep talking to him if you can until he falls asleep. This is so very hard, but we do what we do out of love. My thoughts are with you. Be brave. Big hugs from the UK, Tony x

[Aedrah]

Hi Connie,  thank you also for your reply. advice and kind words. I'll definitely check his gums.

I woke up early this morning to him coughing - sounds wetter than yesterday - I assume either more blood, or water, in his lungs.  Not in distress, thankfully, and breathing good. But a bit restless. He also peed a bit in his bed. Was a fair amount that he made, clear, not as yellow as the dribbles were yesterday. I'd guess a cup or two. Wasn't the normal amount for him nor for the amount of water he drank all day yesterday, but a fair amount compared to what the dribbles he made yesterday. This makes me worry a bit less about his kidneys, for the short-term (at least until the vet comes in 8 hours)

[Aedrah]

Hi Ginger - thanks for your reply and kind words.
I'm really sorry to hear about your beloved dog as well - poor guy. I can't imagine what that must have been like, for him and for you.

It's definitely a hard decision - I wondered when we got the diagnosis "when would be the right time" - actually more worried about it. We didn't want too early, but of course not too late, especially with limited options for travelling vets. We also have limited options for treating him without causing stress/being invasive, and are up against his auto-immune disease which could flare up again. We want his last bit of his life to be comfortable - it's important to us. Our biggest fear is finding him in distress - how scared he would be. I hope the right time is now, I feel it is but it's hard to ever know that. Just taking comfort in the fact that he won't be suffering after and that we've given him the best home and care that we could.

[TwoBitsMom]

I am so sorry to hear about your dog...It sounds like you have made the best decision for him.
I know you are worried about the amount of water he is drinking...so, normally a dog will drink about 1 ounce of water for every pound of body weight he has.  So if your dog is 80 lbs...you could reasonably expect him to drink 80 ounces...( 10 cups )   If he is 50 lbs...expect about 6 cups.
A dog who is dehydrated will drink more...and as Ginger said..some will find its way to the dehydrated tissue and cells..some to the feces...some will be lost through expiration..and so forth.  Now if your dog is not drinking at least the normal amount for his weight, I would not worry too much about him not urinating.  However, if he is drinking huge amounts, and you are worried,but still want to keep him comfortable..then you can offer him ice chips..given to him by hand, or Freeze a bowl of water to make him a big ice cube...dump it out of the bowl on to a plate, and let him lick it.  
I know you are also wondering whether he is dehydrated or not, and you are checking the skin on the back of his neck..but you can also check his gums...if they are dull and or sticky....he is dehydrated.
You can also try to keep your dog comfortable by playing some soft background music..staying close to him...and keeping the room dimly lit.
You and your dog will be in my thoughts and prayers...
Connie

[ginger899]

I am so very sorry.
And Margot, I am also sorry you had your beloved dog put to sleep recently. It's the first I'd heard of it.

I had a dog a few years back who had an inoperable cancer (prostate) He was more or less not too bad on and off the last 2 weeks of his life, but weaker, and had to be carried back when on a walk sometimes (though he had been raring to go) Then the time came when he simply couldn't pee. It happened really suddenly and was causing him great distress. We fought to the end, with muscle relaxants and Rimadyl, but that last night nothing worked. On the phone the vet suggested catheterization, but I knew that would only be a temporary option. He would need that every day! I called out the vet in the middle of the night and had him put to sleep. There was at that stage, nothing else I could do, but give him peace.

If drinking, even though he's not urinating, doesn't seem to be causing him distress it could be that his kidneys have more or less shut down, and aren't producing much urine. Where's the water going? Some will come out via the feces, and there could be gradual fluid retention going on in his body cells.
I think you have maybe made the right decision. I cannot suggest anything, or any other treatment options, beyond possibly catheterizing him. But I am not a vet, and there's a lot I don't know. However, considering his diagnosis of cancer, it's not a simple issue of course. Even if his kidney problem could be further treated, and a little more time bought (?) -there would still be the cancer to contend with.
It sounds to me as though it is the right time. I know -there really is no "right time" to let go of a beloved friend and companion. But it seems to me his body has started to shut down.

I do know what you are going through. I am thinking of you. God bless.

[Aedrah]

Hi Margot,

Thanks so much for the response and advice as well, and I'm so sorry to hear about your grey. It sounds like you did your very best, which is I guess all we can do, despite wanting to do more.

Pedro is a retired racer, and retired he certainly is - he adopted us when he was 5 and has been a large part of our family ever since. Looking back, we chose his breed for a number of reasons, one of which was their longer life-span (and of course that he needed a home). We were looking at great danes and irish wolfhounds originally, but were heartbroken when we found out they only live 6-8 years. With greys, we thought 12-14 years was a great life-span for a large dog, longer until the inevitable heartbreak - but it's funny because no matter what, it's not enough years - they still go by in the blink of an eye.

[Margot49]

So sorry to read this story and, actually, it is very similar to mine. We had to put our 12 1/2 year old Greyhound to sleep about 3 weeks ago.  He had started some kidney issues a while back but then I noticed a lump last May and took him and had my Vet aspirate it.  It was Lymphoma.  Prognosis was 30-55 days with no treatment.  I did some research, talked to 4 Vets and did some serious soul searching. Due to his age, possible side effects from treatments and the cost, I decided to do palliative care also with diet and supplements.  He was with us for just short of 6 months and I knew when it was time that his quality of life was just not there any longer.  After reading what you have written, I think you have made the right decision.  Our Grey hated the Vet's office also and I had planned to do home euthanasia.  The way things turned out, I took him into the office in the evening and my Vet, whom I've worked with for many years, made sure it was a peaceful passing for both of us.  To tell you the truth, our Grey really didn't seem stressed out that evening in the office.  

As for the blood work, Greys have different blood values then other breeds.  I made sure our Vet had all that information in his file when we first got him.

As for the not peeing, I would be a bit concerned too if he is drinking that much. However, you've informed your Vet and the dog doesn't seem to be uncomfortable.  Not sure where you are located but, if the dog didn't go much during the day today, I would give the Vet a call about an hour before they close and run that past him in case they think the bladder needs to be emptied.  

As for keeping him comfortable, this breed really gets used to their *routines* and hate to fluctuate from that.  Our Grey and many I've had here are definitely creatures of routine.  Actually, as bad as our dog was feeling toward the end, he got up and went to my husband to take him for a walk, which they did together one last time.  

It certainly sounds like you are doing the best you can for this dog.  I know how hard it is to watch them decline.  Sometimes, this is the last act of *love* we can offer our beloved pets.

It will all work out.

Is this a retired racer?  

hugs.  we are hear for you.

[Aedrah]

Hi Karla,

Thanks so much for the response. I should have mentioned in my post that he gets extremely stressed out when visiting the vets. Like shaking, collapsing and major panting. Takes him hours after the visit to calm down.  This stems from when his SLO was being treated - was a bit traumatic for the poor guy. This was one of the major reasons we are opting for home euthanasia - I just couldn't imagine his last moments being that stressful for him.

I considered a home vet, but unfortunately no reliable ones in my area that I would trust.

I did find now that he's now dripping a tiny bit , and smells like urine. So I guess he's creating a little bit now, whereas before there was nothing. By no means puddles, but there's some coming out it would seem. Very yellow.

I spoke with the vet again, and they think the reason he's not urinating is because he's dehydrated. I guess it's possible - but with how much water he's been drinking the last few days (and still wanting more) and his skin elasticity around his neck being mostly normal when gently pinched and twisted, I'm not confident of that. But the cause doesn't really matter I guess at this point.  Poor guy. Thanks again for responding -  I really appreciate it.

[Misfits4Me]

Hello & welcome...I'm sorry you found us under these circumstances....It sounds as if your doing an "Excellent" job with him....The only thing you might think about doing before your Vet closes is to take him over to have his bladder expressed (Manually)...The would release the pressure he is probably feeling from not being able to urinate....You may not be able to get him there, but I did want to offer the suggestion....

I'm sorry, I have to be somewhere shortly, but I wanted to respond to your post.....You are in my thoughts.....I will check in tonight when I get back.....Karla