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  1. #1
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    Default Old dogs: How much treatment?

    I'm not sure if this is just a vent or if I'm looking for advice or encouragement so bear with me

    I have a 14yr old Boston Terrier that I posted about a while back. Back story is that she was taken to the NCSU College of Vet Med for liver failure and after much testing, we determined that she had a liver infection and possible pancreatitis. She was very sick when she got there and spent 5 days in the hospital. For the past 6 weeks, she has been on antibiotics (Clavamox and Baytril) to treat the infection as well as Denamarin and Ursodiol for liver/bile support. She is eating and drinking well and she definitely feels better than she has in a long while. She plays with her toys and wrestles her beds around. Based on her recheck at 4 weeks and her bloodwork done on Monday, she is showing great signs of improvement. Her liver enzyme levels are MUCH lower (ALT went from 1800ish to 400ish!) although still considered elevated, and her CBC on Monday showed that her infection seemed to be basically resolved.

    She's due back for another recheck on the 29th at which time they'll run a full CBC/chem panel to check her liver enzymes again as well as possible urinalysis and ultrasound if necessary. DH has been very supportive thus far and is a real softie for all of our animals. He is starting to push back at the idea of going back to the CVM for our recheck though due to the costs involved. That same re-check was $500-600 last time not counting antibiotics (which I hope we won't need this time!). We have already spent $4k on her initial stay, rechecks, diagnostics, and medications to this point. I have chosen to make the long drive back to the CVM for our follow-up work because our local vet doesn't have ultrasound capabilities and their equipment is not as sensitive/accurate for running the bloodwork. (When we went to them initially, their ALT results were actually higher than what the CVM found at her initial eval there.). The regular vet is still going to cost ballpark $200 by the time we get all the bloodwork run there. I feel like we're better off going to where we can get the best answers and most accurate information... at least until we can get a firm handle on this.

    It's possible that there's no real "cure" here... her infection is resolving but it's not out of the question that she has liver disease. They've also been watching her platelet counts in her bloodwork and wondering in the back of their minds if she doesn't also have some endocrine issues. Although we haven't found it anywhere yet, it's not out of the question that the "C" word could rear its ugly head. With a dog of her age, you're going to find SOMETHING that is going to end up being their demise. I really don't intend to allow her to undergo any invasive diagnostics or treatments at this point just because we have that ability. It's not fair to her at her age. I do intent to make her as comfortable as possible while we still have her. My feeling is that the infection is something we know is there and that we can treat and the liver disease is something we could manage. I don't feel like there's really going to be an "end" to treatment of some sort for her... at some point we'll have to dial back to our regular vet and treat her symptoms to the best of our ability. DH seems to think we've done all we should at this point and that we should skip the recheck. I feel like if we stop now and don't fully pursue this route of treatment then all of the money we've spent on her treatment to this point was in vain.

    It's a lot of money to spend but I feel like with the results we've received thus far, it has been money well spent. I don't intend to lose our house trying to keep an old dog alive forever though. I feel like DH thinks I am. We have two other dogs and 2 horses to consider vet care for also. Am I doing the right thing? If I'm not prepared to fully explore and treat all of our possible diagnoses have I already wasted our time/money? Or am I doing the right thing by treating the obvious using the best resources available and then just accepting the fact that she's old and is not going to live forever?
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!



  2. #2
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    Sep. 10, 2009
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    I think you are doing the correct thing. You have already invested a lot both financially and emotionally. It makes sense to finish treatment for this problem. I would talk to the internist/resident and just let them know your feelings. Lots of clients decide to treat for the treatable. You could finish up treatment for this problem and decide not to pursue further diagnostics down the road. You have already provided her a better quality of life.



  3. #3
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    Oct. 12, 2001
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    if the dog seems ok and just needs a basic liver enzyme measurement done, surely your local vet can draw blood and send the blood out to an accurate lab, or even to the "cmv" that you used before for analysis? that shouldn't be more than $100.



  4. #4
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    wendy - Our local vet does their bloodwork in house and although it was in the ballpark, it was not the same as what the CVM found the next day when they ran the same tests there. The CVM only processes their own bloodwork from the vet hospital. My total cost at the local vet for our exam, a CBC/chem panel, and an abdominal xray was ~$225. I think the xray was only $60. So the cost difference isn't that much to drive to Raleigh instead and get more clear bloodwork results.

    Thanks anel. I appreciate that
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!



  5. #5
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    I would say, as you've already gone 3/4 of the way down this road finish it with the recheck.

    I have to agree with DH though, at some stage you have to say 'when' which is never easy.
    I have horse to sell to you. Horse good for riding. Can pull cart. Horse good size. Eats carrots and apples. Likes attention. Move head to music. No like opera! You like you buy.



  6. #6
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    Jul. 13, 2008
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    Quote Originally Posted by SkipHiLad4me View Post
    If I'm not prepared to fully explore and treat all of our possible diagnoses have I already wasted our time/money? Or am I doing the right thing by treating the obvious using the best resources available and then just accepting the fact that she's old and is not going to live forever?
    If it improved the dog's life, even for a brief time, it was obviously worth the time/money spent to date. I don't think it's a waste to gather medical information and then make an informed decision that means not using that information in further treatment. At the end of the day, part of having a beloved animal treated is about us, our perceptions of our own morality as well as our affection for the animal. If it will always bother you to think "I should have...", you need to examine whether you should just "waste" the money and buy yourself some peace.



  7. #7
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    Thanks for your input I feel like I need to go to the recheck as planned and at that point I'll be able to make a better decision as to what to do next for her. It's so hard to know what's best for them as they get older. You don't want to go overboard trying to prolong their lives but you want to make sure that they have the best quality of life possible while they're here.
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!



  8. #8
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    Go for your scheduled recheck - and during that recheck, ask if its fiesable to have the monthly (or however frequent) blood checks done at your RDVM (regular place), then have the results sent to CVM.

    I work at a referral hospital, and this is what we do all the time. We have clients come from an 8 hour plane ride to have their pets seen - do we expect them to come back for rechecks? No, but we do expect compiance with followups through their regular vets. Any cients within an 8 hour drive we do expect to see back for at least 1 recheck - then give them and their vet the protocol of what bloods are required, wich labs to send to etc. There is (or shouldnt be) any charge from CVM to assess followup bloodwork, but they are probably the best ones to track it and make further recommendations.

    If recommended by CVM,you would likely just take your dog into your regular vet for the blood test ( full liver pannels here run about $75-150), and have them submit it to a lab with quality control. While in house machines are wonderful, the quality control can be a little off sometimes.

    Glad to hear your dog is doing well! Liver disease sucks but usually can be comfortably managed for a long time.



  9. #9
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    Thanks Squish I'll ask them about doing that.
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!



  10. #10
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    Mar. 5, 2009
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    No advice really - I guess I'd go for the recheck too since you've gone this far into it.

    I really just want to say WOW, a 14 year-old Boston! I grew up with Boston Terriers - wonderful dogs! Ours never had the health issues that 'today's Bostons' seem to have, but the oldest one we had only lived to be 14 - we thought that was very rare back in the 80's. Off the shelf dog food, no supplements, no dentals, maybe a Rabies shot once a year (and a spay of course, but that's it.

    I hope your Boston continues to feel good!



  11. #11
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    Thanks TBM!! I got her through the Boston rescue (foster failure!) when she was 9yrs old and I had no clue that she'd be with us as long as she has. My grandmother always had Bostons and her oldest one only lived to be 11 or 12. With the exception of a couple of eye ulcers, my girl has been very healthy up until this point. She's a real trooper
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!



  12. #12
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    Apr. 28, 2008
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    OP, you are a saint to spend $4k on a 14 year old dog.

    Before you go have the conversation with your husband about what you are willing to do if it comes up not as expected. It is easier to have these conversations before you have the blood test results in hand and emotion gets wrapped up in it.



  13. #13
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    I have an old geriatric dog. I get liver enzymes done on her every 6 months due to her taking Previcox for arthritis and joint pain. It only costs a fraction of your price. However it does not matter what those results are because my prime directive is only about her quality of life. But I do it because the vet requires it for a 'script.

    So if it were my dog I would first ask myself will the results change my protocol or does it even matter at this point in the dogs life stage. (She also has mammary cancer but I don't need to know if its malignant. If she can't walk what difference does it make?)



  14. #14
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    It is a personal choice. For me no, once I have issues with vital organs and the age indicates that things will go downhill I just cannot justify the medical bills in the thousands. I have had many shelter dogs and cats and that is where I go to adopt my animals and I don't want to force an animal to live beyond what is comfortable. I will provide my dogs with joint injections and such but major organ failure is a different problem.

    Hope all goes well for you, and your animals.



  15. #15
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    It is a personal choice. For me no, once I have issues with vital organs and the age indicates that things will go downhill I just cannot justify the medical bills in the thousands. I have had many shelter dogs and cats and that is where I go to adopt my animals and I don't want to force an animal to live beyond what is comfortable. I will provide my dogs with joint injections and such but major organ failure is a different problem.

    Hope all goes well for you, and your animals.



  16. #16
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    f it improved the dog's life, even for a brief time, it was obviously worth the time/money spent to date. I don't think it's a waste to gather medical information and then make an informed decision that means not using that information in further treatment.
    This is a GREAT point and I just wanted highlight and applaud it. It is never a 'waste' to get diagnostics done so the ultimate decision you make, even if it is euthanasia (this doesn't apply specifically to your Boston, just with medical work in general) isn't one you regret making. We all know the feeling of having one foot on the other side of the fence and having already spent $$$$ and all you have is decisions to make. If nothing else, you have absolutely stacked the deck in your favor, and made sure there's never a hindsight worry. Well mentioned.



  17. #17
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    When we made the choice to take her to the Vet School for an evaluation (mainly for the ultrasound since our local vet didn't have the capability), I knew that we were potentially going to sink a bunch of money into the diagnostics and that there was a strong possibility of getting a poor prognosis. I decided that it was worth it to spend the money to find out what "it" was that was causing these liver issues. I felt like if I didn't explore all of the options, then I would always question whether I'd really done all I could for her. It's easier to put a dog down knowing that you've exhausted your options and knowing that was the best choice for them. It's a lot harder when you question whether there was something else you could have done for them. I know we'll have to put her down eventually but I don't want to do it while wondering "what if".
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!



  18. #18
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    We are going through the same thing right now with our 13 year old Newfie. My husband, vet and I came to the agreement that if the front end is doing ok (he's eating) and the back end is doing ok (tail is wagging), we'd pay for whatever treatment was needed. My main concern is the dog's quality of life.

    Good luck with your Boston!
    It's 2014. Do you know where your old horse is?



  19. #19
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    Quote Originally Posted by SkipHiLad4me View Post
    When we made the choice to take her to the Vet School for an evaluation (mainly for the ultrasound since our local vet didn't have the capability), I knew that we were potentially going to sink a bunch of money into the diagnostics and that there was a strong possibility of getting a poor prognosis. I decided that it was worth it to spend the money to find out what "it" was that was causing these liver issues. I felt like if I didn't explore all of the options, then I would always question whether I'd really done all I could for her. It's easier to put a dog down knowing that you've exhausted your options and knowing that was the best choice for them. It's a lot harder when you question whether there was something else you could have done for them. I know we'll have to put her down eventually but I don't want to do it while wondering "what if".
    That is exactly what we did. It is too hard not to know.



  20. #20
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    Pet insurance can be a wonderful thing



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