Following my mother’s stroke, she sometimes knew she was in a hospital in Albany. Other times she thought she was in a library in Queens. However, when asked by the Bollywood-handsome resident whether or not she wanted the feeding tube, she replied quite coherently, “Not if it’s not going to make me better.”
She had a DNR, and her wishes were clear. Medication that might prevent more clotting in her brain would probably cause her heart to go, and the meds for her heart would have brought more clots to her brain (as would doing nothing). But even putting in the tube and waiting for nature to take its course, would have been prolonging her agony. As my sister said, “If she can’t eat ice-cream, what’s the point?”
With dogs it’s different.
Meet Maizie, a Jack Russell-mix-rescue. My better half took her in in 1999 when she was probably somewhere between two and four years old. Do the math. He was going to give her to a friend as a companion for her other dog, but when the two dogs met, Maizie attacked, and the friend got a nasty-Maizie bite while trying to break it up. After that, my future husband knew he had something “special” on his hands. When we began dating, and I brought up his possibly moving in, I had the feeling he was waiting for Maizie to die first, but oddly enough, she liked me, and there wasn’t a problem until that unfortunate incident in the elevator about which we never speak.
Maizie never had a 100% accident-in-the house-free record, but I was able to “un-paper train” her. She got the idea that the apartment was not for peeing and was pretty good about it. Then in July, that changed. Suddenly, there were puddles of clear looking pee all over the apartment. She was waking up unconcerned in her own urine, and drinking water by the bucketful.
So off to the vet, who had long suspected Cushings, quite common in older dogs and treatable. We were warned about the expense involved. Medication requires expensive monitoring and over-medication could cause the dog to slip into Addison’s disease and die. If the cortisol levels don’t go down enough, however, the symptoms will persist. So there’s a protocol that you have to commit to.
Some people choose not to treat older dogs, not only because of the monitoring, but because lowering the cortisol may bring out other conditions like arthritis which high cortisol actually alleviates.
We discussed our options, including putting her down. How long did she really have? The end was inevitable. Why wait till she was suffering? Why put her through all the vet visits? But were we being selfish? Reacting only to the cost of treatment and not really thinking about her best interest? We couldn’t live with the pee. Or could we? My husband probably could. He was at work all day, while I mostly work from home. Why do I hate her? It’s not like I’m a neat freak. Why draw the line at dog pee? Was he thinking I was being mean, wanting to kill his dog? She was his dog, before she was ours. Had I ever even liked Maizie? Hadn’t I just married him for the health insurance to begin with? Did we really even know each other? Could this marriage be saved?
Besides us, what about her? What the hell is the best interest of an animal? Does a dog contemplate her mortality? Would she be terrified of being put down because she knows what it is? Or would she be terrified because she’d read our anxiety and guilt, and because she knows that no good ever came from a vet visit?
We chose to treat. We didn’t really want to take that anniversary trip to Italy anyway. About three weeks in, her symptoms had mostly abated, but then she crashed. She could hardly move, wasn’t eating, had no sparkle in her eyes. We were ready to put her down, but the vet convinced us this was nothing more than a bump in the road, a medication management issue. With a little “pred” and a lower dose of the Cushings drug, she could go on for years.
Why was I suddenly remembering the last year of my 1973 Dodge Dart, and why was the vet suddenly reminding me of my old mechanic?
The clincher was Maizie herself. She rallied as soon as we got to the vets, a situation that probably caused her diminished cortisol to rise, and she really did seem to be saying, “Please don’t kill me.”
The second time she crashed, she was on the lower dose. She stopped eating. We couldn’t even give her the prednisone. By the time we brought her in, she needed IV fluids and critical care. Her electrolytes were messed up. After her first night, the vet asked us to visit to see if we could coax her to eat. We both left work, but we couldn’t get the normally voracious Maizie to try more than a few bites. She still had to stay over till the next evening, but finally her appetite returned and her electrolytes were good.
A few thousand dollars since her diagnosis and she’s home, tapering off the pred. They don’t want to withdraw it too quickly, lest she go into shock. She’s back to peeing clear streams and drinking constantly. Today, there was a minor victory when she finally figured out what the wee-wee pads were for. but it was probably just coincidence as she ignored them later.
Where do we go from here? Possibly she’ll be ok once we taper her, at least for while. The meds may have had the effect of screwing enough with the endocrine system to lower her cortisol for a while. However, given how rapidly her thirst and appetite have returned, we suspect that even without the pred she’ll continue to urinate in the house. I’m not talking about the occasional age-related accident by the way. I’m talking about walking her every two hours and still seeing about eight indoor accidents a day. I’m talking about the feeling of dread I now experience whenever I hear her lap up water. I’m talking about comically slipping on wet floors when we get up in the middle of the night. I’m talking about … an unsustainable situation.
Excuse me, but there she goes again.
The vet says if the symptoms remain once she’s off the pred, we could try an even smaller dose of the meds. The real experts, other dog owners who I’ve met on the forums, report that with this particular pill there’s no rhyme or reason. Sometimes big dogs do well on very little and tiny ones need a lot, and a more experienced vet might have started her on a really low dose, and worked up, which could have saved us thousands and not brought her to the brink of oblivion. I’m terrified of seeing her crash again, but beyond that, we’re going broke. The test they “need” before they can restart her will run upwards of $400 dollars. Then it’ll be around $100 for the new meds at the lower dose. After that, in another two weeks they’ll need to recheck her levels. The meds we have in the house are useless because they are capsules and not easy or safe to split. We can’t even try going rogue and splitting them because without a very expensive scale that measures milligrams we can’t measure the dose, and even if we could we’d need another refill if it worked.
My husband suggested, “You work in Washington Heights, surely you know someone with a pharmacy scale and a soft-spot for dogs.” He is considering bluntness telling the vet, “We don’t need more tests. Just give us the script or the dog dies.”
In the end, she dies anyway.
Hindsight is perfect. Surely, if we knew all this, we would have put her down weeks ago, maybe.
Update: Just adding a quick link to this video about our relationship with our animal companions via the late, great George Carlin. “Same shit, different species.”