Old Dog Care is a Balancing Act (+ quality of life is key)
Caring for an old dog can be hard. When you’re juggling the treatment of a number of different diseases, quality of life is always the most important consideration.
My 16-year-old Jack Russell has an ulcer on his right eye and I would like to know ways that I can treat him. The vet has prescribed medication. Just recently I have started Nubi on hemp oil, which seems to be having a positive effect. The ulceration on his eye is in addition to an ever-growing list of health issues, including idiopathic vestibular disease at the end of last year. More recently followed by an infection in his nose, sneezing, chest and losing weight. Considering he weighed 5kgs for most of his adult life, losing 400 grams is significant. We have had numerous trips to the vet. Nubi becomes extremely stressed taking tablets and generally spits them out. I have tried mixing the tablets with his food/treats and he either won't eat it at all, eats around it, or as previously stated, spits them out. Our vet recently gave Nubi a long acting antibiotic as an alternative to tablets. I don't know if there is any link but the night of the vet visit an antibiotic injection was given and Nubi's health rapidly decreased. His breathing became more difficult, he sneezed increasingly and wouldn't eat or drink. I still take him for short walks which he enjoys immensely, he wags his tail, sniffs around, cocks his leg without losing his balance and manages very well. Any advice you are willing to provide is greatly appreciated.
And my final question comes from Julie who’s wondering if there's any link to the antibiotics and her dog’s decline, and really just looking for general advice, not just about the eye ulcer but treating Nubi in general with all the challenges that he's got.
Now I'll start off by saying that this is a really challenging one to answer in a forum such as this because it's likely that there’s many different health issues all contributing to the overall health picture that we've got in this geriatric dog.
So if we start off with eye ulcers now there's a number of different causes for that. By and large, we treat them with an antibiotic ointment that will help prevent infection, while the ulcer heals. But equally, it depends on what the cause of that ulcer was.
If it’s caused by something called dry eye than we need as well as a tear replacer, we might need a specific treatment, a specific eye drop for that. There is actually an immunosuppressant that tries to encourage the production of tears. If it was due to a foreign body, so something being stuck under the eyelid then clearly that needs to be removed. If it was caused by something called an entropion, which is the rolling in of the eyelids causing the hair on the eyelids to scratch the eye, then there's specific treatments that we need for that which is typically surgery to correct that rolling in of the eyelids.
That's not necessarily going to be something that we're going to be wanting to do in a dog with an awful lot of other problems. So that's the eye ulcer issue if you'd like. Often we'll just give eye drops and we'll give painkillers at the same time because eye ulcers are sore. If you've ever even had a tiny bit of dust in your eye, you'll appreciate that it feels like a giant rock. So we want to be treating for pain as well.
Now moving on to the long acting antibiotic injection that was given and then the deterioration in health. Now antibiotics do have potential side effects, just like everything that we give. The most common side effects are gastrointestinal. So that's diarrhea and vomiting.
Allergic reactions are very rare. They tend to happen minutes to hours after administration if they're going to happen, but like I say, they're, very, very rare.
My suspicion would be that the signs that Julie saw in Nubi after that injection was given are more likely a reflection of the underlying disease. So it sounds like there's something serious going on that's resulted in that weight loss. We've got a really unwell dog and it's more likely that actually this disease is the cause of the deterioration more than anything else.
When pets get sicker
I'd always say that if a pet is not responding to treatment as expected to always reach out to your vet, even if it's only a matter of hours since they were last seen. If they're getting significantly worse, then we as vets need to know about it because it might be that there's other things that we need to do.
It might be other treatments that we need to give, other tests that we need to run, it might be that hospitalization is the best thing. The bottom line is that we seldom deal with absolute certainty when it comes to our pet’s health. Not all patients respond as expected. We're dealing with biological systems, not mechanical structures so we can't guarantee a response to treatment.
Even if we know exactly what's going on and we're giving exactly the right treatment, not every individual dog or cat will respond the way they're “supposed to”. There are variations with individuals and it's important that you keep in touch with your vet. If things aren't going to plan, let them know so that they can jump in with any other intervention and any other plan that needs to be made.
Senior Dog Care
Now as far as general advice for a senior dog who is slowly deteriorating, my advice here is that quality of life is key.
So we want to be thinking about comfort, making sure that we've got some pain management strategies in place. We want to be monitoring appetite and thirst. So keeping them eating, keeping them hydrated is very important. We also need to try and stay on top of known medical issues.
In this older dog’s case, we know there's a number of things we want to be trying to manage those as best we can and we also need to keep in close contact with your vet, especially as things change as I've just discussed.
And then finally, when we're thinking about kind of helping improve the quality of life of our senior pets, we want to just manage their environment to make life as easy as possible as we can. And that could involve things like using a ramp to get up into the car, trying to avoid steps, making sure the bedding is nice and soft and draft free, putting rugs down or runners down on a slippery floor just so that they're not falling over and exacerbating their arthritis, for example.
We just want to be making life as easy as possible, and then we need to monitor and we need to keep an eye on that. We need to always be asking the question, what is my dog's quality of life? And we want to be ready to step in if they're suffering or if their quality of life is significantly deteriorating despite doing everything that we can, and as much as possible to try and prevent a deterioration.
Ultimately there’s going to become a time when they're not happy, when they're not doing well. That the bad days are the usual picture rather than a one off and we need to start thinking about euthanasia.
So making that euthanasia decision, it's very hard, but delaying it and actually leaving your pet to suffer for too long is one of the biggest regrets that I hear from pet owners in my consult room. They are often saying, “My last dog, my last cat, we left too long and I look back and I regret leaving them in pain or leave them suffering for too long.”
We have the option to remove their suffering for them. It's a great privilege that we have in veterinary medicine. We don't want to jump in too early. We don't want to go, “Oh, they're just old, let's just put them to sleep” at the early stage when there are still treatments that can be given and they're still happy. But when things start to slide, despite giving them the best treatment and the best care possible, we want to be stepping in.
I've actually written in depth about old dog care in a previous #DrAlexAnswers post. I’ve also discussed palliative care when we know they’re on that downward slope and they're reaching the end of their days. And I've got an article discussing when the right time for euthanasia is.
So if you've got an old dog, then these are definitely things that you should be thinking about sooner rather than later, because that's going to actually mean that your dog has a better quality of life for longer, and they’re likely to live for longer as well if we're thinking about these things at an early stage rather than waiting until they're in a really bad way before thinking about them.
I definitely encourage you to check those out if you've got an older dog, even if they are healthy.
The above is a transcript taken from “The Dr Alex Answers Show”.
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