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.”

13 Comments on Whose Dog Life Is It Anyway?

  1. Cheryl Koeber says:

    Marion, I read this blogpost thinking at every juncture, “been there, done that.”
    Maizie is lucky to have you and Craig, and no matter when she dies or you put her down,
    she surely knew how much you both loved her. You have given her every chance at
    enjoying her life. Also keep in mind it can’t feel good to her to be peeing inside all the time, I
    believe she must be aware of it on some level. And you need to consider YOUR quality of life, too.
    Keeping you, Craig and Maizie in my thoughts!
    Cheryl

  2. Alina says:

    Marion, when my old dog died I thought that even if I’d managed to save him in September, 2011 it would only be so that he could die when? – December, 2011, February, 2012? The truth was that he was coming to the end of his life and his death was only a matter of time. In the past 6 months or so I really did see him wind down like a clockwork toy and become more aged. I’m thankful that my dog had a good quality of life till the end and that I did’t have to face the terrible choice that you’re facing. Sincerely wishing you and your partner strength in facing what the future holds.

    • Marion says:

      Thank you, Alina and Cheryl. While no one (even dogs) comes with a definitive expiration date, we had had the conversation before the diagnosis about time, quality of life and what made sense. But there are dogs who do well on the meds, so we did want to give her the opportunity, even if, as my husband said, to give us a chance to give us a little more time to say goodbye. We didn’t anticipate the iatrogenic Addisons, and it’ really only been the last couple of weeks that she looks like what she is — a very old lady who has come to the end. We’re still not sure what the next few days will bring as she’s weaned off the pred, but we know won’t we won’t put her through any more. I think we both knew what we would do if we had been faced with a cancer diagnosis, or congestive heart failure, or something that was definitively terminal. We weren’t as prepared for something that was chronic.

  3. Karen says:

    Ah, geez, Marion. I’m so sorry. I was surprised when I didn’t hear a response from you when I was going through all this with Charlie in August, but clearly you’ve had your own album to do.

    It’s such a wrenching decision. I feel like veterinarians are a window into what our own lives would be like without health insurance. How to balance love for pet, quality of life, and economic reality?

    In the end, I had Charlie put down. I didn’t have a choice; I had no reserves on which to draw for the extended tests, much less for a treatment. He stopped eating completely, and then he stopped drinking water. He was unhappy. My vet was awesome, emphasizing Charlie’s quality of life, and the uncertainty of either a diagnosis or a successful treatment. But the questions continue to plague me. Is someone without a stash of dosh even supposed to have a pet? Are the strides in veterinarian medicine causing us to have to make choices no one had to make in the past? (Once upon a time, Charlie would simply have wasted away and died, no questions asked.) Are pets now no more than an ethical dilemma on four legs?

    I’m so sorry about Maizie. It must be horrible for all three of you. Actually, I doubt Verbal is enjoying picking his way through puddles of canine pee. I hope things take a turn for you all, one way or the other.

    • Marion says:

      Karen,

      I’m so SORRY about Charlie. I swear I never saw g your facebook on this. Either I wasn’t on much — quite possible with Maizie’s constantly peeing and my deadlines, or blame it on the mysteries of FB.

      I agree with you on the questions. Maizie seems to have rallied, but she’s very old. Had we known what the cost of her “intensive care” two days would have been, we would have at that point opted to put her down. Price aside, if we’d known it would be two days and much intervention before she’d eat again, we would have put her down.

      I don’t buy that vet training is anywhere near as demanding as that of medical doctors. With human beings, doctors have to be careful because of malpractice. In Maizie’s case, she was clearly overmedicated and while the vets followed the manufacturer’s guidelines, vets with more experience in this particular drug probably would have started her on a much lower dose, possibly preventing both crisis episodes.

      You are right bringing up the unaffordablity of vet care. I think pet ownership will go down, especially for the rescues most in need of homes. In fact, pets are already being abandoned because of evictions.Not exactly like vets have the “malpractice insurance” excuse. I know when we added our rescue-kitty last year and they quoted $600 as a base for neutering, I went to the mobile-ASPCA and got the rabies shot and microchip as well all for something like $125. (I think it was $99 without the chip.) The little guy did fine.

      We are still shopping for a less expensive vet and one who won’t attempt to guilt us when we say, “No more.” One lesson learned I learned for future reference is that if ever I decide to go the treatment route again for a chronic illness in a pet, I will thoroughly research first including dosages, signs of reaction,and not trust any vet to know. The Canine Cushings forum was very useful, but I trusted the vets more, and got the advice too late.

      • Karen says:

        Thanks, sweetie. Charlie’s illness was the last week of July and the first of August and, while I posted a lot on his progress, it sounds like that’s when your hands were especially full o’ Maizie.

        For reasons too complex to go into, I ended up taking him to three different vets over 2 days. The third vet was at the ASPCA’s Bergh Animal Hospital and she made me an ASPCA fan for life. There was absolutely NO guilting of any kind; in fact, she went out of her way to make sure I felt comfortable with my decision.

        You’re not wrong about training, though. I got very different responses from each vet (e.g., one found a heart murmur, another didn’t) and it was not designed to bolster my faith in the profession. I’m really sorry you’re going through all this.

  4. Gina says:

    Such a difficult difficult time. We went through it with our two older cats previously…and now our “young” cat is OLD, too, and dwindling. (And we have two new young ones…) It is never easy dealing with this phase of life and my thoughts are with you.

  5. Charlene says:

    I’m so sorry, Marion. It is terrible to lose a pet, especially terrible if a vets mistake is part of the reason.
    George Carlin also said “Life is a series of dogs”.
    Will you be getting another one?
    After we lost our cocker, Monty, we just did not feel that we could properly take care of another dog at the time and we rescued a cat instead…Jeffrey the rescue cat who drools. He is much less work than a dog and much more independent than a dog as well. I do still miss my Monty though.
    My heart goes out to you and your better half.

    • Marion says:

      I’ve got to update this story! First, I think can only bear to read the first couple of paragraphs so they just assume the dog dies in the end. Maizie is still NOT dead. In fact, she’s rallied. She doesn’t have Addison’s. She still has Cushings. We aren’t treating it. She’s still drinking tons of water and pee-ing. She has also learned to use wee-wee pads with about 98% accuracy, so clean up is less of an issue. The only med she’s still on is the DES which prevents her from leaking in her sleep, and melatonin which a few people suggest although there is no hard evidence it will help.

      We don’t know how much time she has, but she seems happy, and as long as that’s true (and she can still reach the wee-wee pads, we won’t kill her.

      I’m sorry for your loss. Dogs are definitely tougher to care for than cats. We already have cats. It’ll probably be a long while before we get another dog.

  6. Charlene says:

    Oh, I’m glad, then!! I mistook the statement “In the end she dies anyway”. FWIW then, I’m glad for you!!!

  7. CharlieB says:

    Marion,
    tough choices all around; we pretend we are better at the human ones but I am not so sure. A possible suggestion is to crate Mazie when you can’t watch her (put the wee pads under the open crate flooring and that way the dog won’t end up lying in it. I’ve used this method with sick dogs and puppies before and it works pretty well.
    Sending you good thoughts

    • Marion says:

      I’ve definitely got to update this. Maizie is a genius. She’s mastered the wee-wee pad. 100% accuracy, usually dead on the center. The only med she’s on now is DES, which keeps her from urinating when she’s asleep or lying down. However, because of the Cushings and maybe age, she can’t wait too long once she wakes up. We have four wee-wee pad spots in the house. All are in the hallways. It’s working well. Prior to the DES, we tried underpads under her sleeping areas but she’ll sleep where she wants and we couldn’t always crate her to sleep.

      In terms of quality of life, at this point it’s good for us and her. She doesn’t wake up in piss. We’re all happy about that. The humans don’t freak out when she goes on the pads, so she’s fine with it. She still signals when she has to have a bowel movement or when she wants to check out the buffet that is Amsterdam Avenue.

      We’re back to simply walking her 3-4 times a day, and throwing out wee-wee pads when we see them. They are the best invention ever. They don’t smell (although her urine is pretty dilute). They really do absorb 10x their weight. The house doesn’t smell of either urine or Nature’s Miracle.

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