How to know when it's time? Stoic dogs.

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How to know when it's time? Stoic dogs.

Postby Tigerbeck » Sun Jan 05, 2014 6:02 pm

My dog was recently diagnosed with osteosarcoma in her rear leg almost at the hip joint. My vet misdiagnosed it for two months as a torn knee with strict bed rest and I have seen her condition get noticeably worse over the last month or so. She is stiff and limping, but I really can't tell how much pain she is in. She has never been a whiner and even when she has been hurt in the past she allows me to touch it and do things that were painful to her. For now she mostly stays on her bed or walks around a little and when on Deramaxx seems a little more comfortable and wants to eat.

So the question is, how can a really gauge how much pain she is in and ultimately the right time for her to go when she never shows it.

Becky
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Re: How to know when it's time? Stoic dogs.

Postby Misskiwi67 » Sun Jan 05, 2014 8:39 pm

Give her more pain medications and see if she is more comfortable.

I won't recommend euthanasia until the dog is on an NSAID, tramadol and gabapentin and not comfortable. There are a lot more options for pain control, and both the other drugs have low side effects.
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Re: How to know when it's time? Stoic dogs.

Postby Misskiwi67 » Sun Jan 05, 2014 8:45 pm

Here is a page on osteosarcoma from a veterinary hospice site. The whole website has a lot of great resources.

http://www.lapoflove.com/diseases/Osteosarcoma.pdf
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Re: How to know when it's time? Stoic dogs.

Postby Tigerbeck » Mon Jan 06, 2014 12:12 am

Thank you for the information. She is switching from Deramaxx to Truprofin for cost reasons so we will see how she does then. It is just hard to know when she isn't comfortable or how much pain she is in because even though I know she is in pain she does basically the same things. For example she isn't too playful anymore, but that could be because she is bored around the house when it's snowing or because she doesn't feel like getting out of bed because of pain. I just want to be sure I can recognize the signs she isn't comfortable and know when to increase/change meds or do something else since she doesn't fuss and whine or ever act in pain. She shouldn't have to suffer because she is a trooper.

Becky
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Re: How to know when it's time? Stoic dogs.

Postby Tigerbeck » Mon Jan 06, 2014 12:16 am

One other question:

She does exhibit quite a few of the signs of pain from the link provided. Is the goal to eliminate all of those signs or minimize them to what degree? She tucks her tail when she lays down, licks, pants and of course some lameness. I have never been in this position so I apologize if these seem like silly questions. I just don't know what magnitude of symptoms equates to unreasonably uncomfortable.

Becky
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Re: How to know when it's time? Stoic dogs.

Postby Misskiwi67 » Mon Jan 06, 2014 12:59 am

Did your vet approve the change and did you do a washout period? There should be 7-10 days between the two drugs to prevent interactions, and that's a long time without pain meds for a dog with her diagnosis.
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Re: How to know when it's time? Stoic dogs.

Postby Misskiwi67 » Mon Jan 06, 2014 1:03 am

Tigerbeck wrote:One other question:

She does exhibit quite a few of the signs of pain from the link provided. Is the goal to eliminate all of those signs or minimize them to what degree? She tucks her tail when she lays down, licks, pants and of course some lameness. I have never been in this position so I apologize if these seem like silly questions. I just don't know what magnitude of symptoms equates to unreasonably uncomfortable.

Becky


If you are seeing symptoms, you should be working to minimize them. Based on your description, I would put your dog at a level 4-5 out of 9 on the pain scale, and that's a considerable amount of pain. If drugs don't help, then it may very we'll be time, but you haven't tried even half your pain control options. In my care, your dog would already be on tramadol and I would have told you to call at the first sign that wasn't enough to upgrade the pain control plan.
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Re: How to know when it's time? Stoic dogs.

Postby Tigerbeck » Mon Jan 06, 2014 11:12 am

Until Saturday we thought she had a torn knee. 2 months ago the vet ordered 1 month of bed rest and one week of deramaxx to see if it helped and return, I returned in one month said the Deramaxx was great and I wanted more but her knee was getting worse. She gave me only one week more of Deramaxx and a referral to a larger vet clinic. She wouldn't give me a prescription for more than one week despite bloodwork that looked good.

So she has been on Deramaxx for only one week at a time and the newest and more capable vet said give her 2 days off everything before switching to the Truprofen, but I gave her 3 days off just to be sure. Everything I am doing is with the guidance of the vet. I am not really sure what more I could do because she did have a little fall that I thought caused her limping and I have been following the vet's instructions. At this pt. I have an appointment with a cancer vet on weds to go over x-rays.

If anything I am upset with my initial vet who gave me a poor diagnosis that caused me to lock up my dog for two months while cancer ate her up.
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Re: How to know when it's time? Stoic dogs.

Postby Misskiwi67 » Mon Jan 06, 2014 11:28 am

I'm glad you have the appointment with the oncologist tomorrow. They will help you with everything you need - more medications, detailed instructions. They will possibly repeat the x-rays to see how much things have progressed. This is by far the best thing you could have done at this point.

Some vets are more aggressive than others. Osteosarcoma is commonly misdiagnosed - they can absolutely act exactly the same, and early x-rays can miss it sometimes too. Its a crummy disease in more ways than one. I'm so sorry it took so long to get the right diagnosis.

Keep an eye out for signs of GI upset with the medication change. A few days between is much much better than none, and the 3 days is a good compromise between risk of interactions and pain control.
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Re: How to know when it's time? Stoic dogs.

Postby dogs4jen » Mon Jan 06, 2014 12:34 pm

Is it too late to amputate the limb? I guess you can discuss that with the oncologist. I'm awfully sorry you and your dog are going through this.
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Re: How to know when it's time? Stoic dogs.

Postby Tigerbeck » Mon Jan 06, 2014 12:58 pm

Thank you for the well wishes. It has been hard, but I am trying to stay logical and reasonable about what our options are and how I should proceed since I am the only one seeing her on a regular basis.

According to the x-ray from Saturday the cancer is actually high, almost in the upper hip joint on her rear leg. I will talk with the vet on Weds, but the general surgeon did not think amputation would be possible. We did not get chest x-rays, but my guess would be it is already there based on the sound of her breathing. She isn't exactly labored but she snores when she isn't asleep and sounds raspy. We've lived closely for 7 years so it just sounds different to me the last couple weeks.

It's my understanding that even with amputation a dog will only last a year and often times not even finish healing from the amputation before the cancer gets them. The most important thing now is just keeping her comfortable any happy. I just want to be sure I recognize the signs that it is time. As it is she was happy to go play in the snow yesterday and resting now.

Becky
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Re: How to know when it's time? Stoic dogs.

Postby jamielvsaustin » Mon Jan 06, 2014 9:51 pm

I don't have any advice but wanted to send well wishes. I, too, wondered about amputation when first reading this. I hope the oncologist gives you some helpful/direct information/instructions.

FWIW, most times when I talk to people who have had to euthanize pets, they say "you just know". Very rarely do I hear someone say they waited too long or that they should have done it sooner.

If you've been very close with her for the last 7 years I have to believe she'll let you know when she's ready. The fact that you're concerned about this and the timing of everything shows that you aren't being selfish in this...you'll do what's best for her even if it tears you up. :teardrops: :hug:
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