Rescue Journal

raymond (and iky)

Carol  ·  Jul. 10, 2008

firstly iky cuz she is easy...bloodwork is good except she is hypothyroid (ah ha, i knew she was cranky for a reason!)...she is on meds now and should be feeling more like herself soon, so that is very good news for ms. iky.

raymond is not so easy...i don't know if you are interested or not in how i approach my decision making. but for those that are, i thought i would walk slowly thru this one so you can see where i am coming from.

i have a fair amount of discussions about what i call "vetting them to death" and i am not sure people really understand where i am coming from so i thought raymond was a good way to explain.

where ever, however, raymond lived most of his life...there are consequences now that he bears. his hearing is impaired, his vision is impaired, he is cognitively impaired. while the actual reasons, or actions that led to this are hidden somewhere in his past, we do see the actual results.

raymond can't hear worth a shit, raymond can't see worth a shit and raymond is mostly out to lunch and has great difficulty in processing what is going on around him...we suspect that these consequences are from either a single profound, or multiple less profound, but repeated head injuries...ie, some asshole probably beat the crap out of that poor, sweet, innocent dog.
over the past couple of weeks, he has been declining a bit. he has lost bowel control when he is sleeping and despite regular pain and anti-inflammatory meds, his back end is still causing him discomfort.

vetting a geriatric or palliative animal "to death" does NOT mean NOT taking them to the vet when they feel unwell. it means realistically understanding what is going on and what benefits and costs (not financial, but traumatic costs to the animal) and weighing them against each other. it means understanding what is the absolute goal...quality of life, consisitent daily comfort or extending life.

and it means you absolutely have to recognise what you are doing for and to them and what are you personally are hoping to gain. because anyone who truly loves an animal is not going to want to sit passively and watch them die without knowing all of the answers and fighting the fight against death...my point is that with geriatric and palliative animals, sometimes that is what you actually are committed to do.

raymond is not feeling well so step one is we go to the vet. at the vet we discover two facts.... one he has absolutely no tone or contractibility in his rectal sphincter muscle and two.... he is reacting to alot of pain during the examination of his sacral spine.

given his age and history, the most likely causes are...a ruptured sacral disc or an underlying tumour pressing or encapsulating his sacral spine. we look at the history of onset...slow, insideously gradual over time. probably not a ruptured disc because the onset is usually quite acute and rapid so the underlying tumour is probably the cause.

so what are my goals here?....

maintaining raymond's quality of life

ensuring that raymond is happy and living stress free for the remainder of his life.
maintaining good pain control and physical and emotional feelings of wellbeing, maintaining or increasing his ability to mobilize freely by reducing inflammation, reducing pressure on his spinal nerves.... be it from tumour or ruptured disc.

i know he is not a surgical candidate...not physically and especially not emotionally either...so we are looking at managing him medically and non-invasively (ie with medication.)

the treatment is the same whichever disease process has afflicted him...reduce inflammation and control any pain (it is all about general principals that i talked about earlier...pressure on the spinal nerves from whatever cause leads to the same kind of expected symptoms....pain, weakness, loss of bladder and bowel control, and reduced mobility)

i don't need to know if it is an underlying tumour or a ruptured disc...while it might satisfy my curiosity, it won't make any difference to symptom control and ensuring his continuing comfort and independance. raymond is the one who has to go thru the diagnostics and i know raymond does not want to do that and raymond doesn't have to worry that i will make him either.

so end result...

raymond is on melixacam to reduce inflammation and to help with any pain.

raymond is on tramadol now too to make sure we actually do control his pain.

raymond is now on elavil because we know it is good for blocking and reducing neuropathic pain and we know that raymonds spine has a million spinal nerves sending out neuropathic pain signals.

raymond will not be running back and forth to the vet unless we hit a pain crises...raymond does not like the vets, it scares him and upsets him and i want him free from both. if he hits a pain crises, any trip to the vet will have immediate benefit to him...either his pain will be immediately controlled or we will euthanize to end his suffering if we can't make his pain go away.
that is how i make decisions regarding whatever diagnostic or treatment options we intend to explore..with raymond's needs and wants at the forefront of any decision i make.

it is all about raymond and his need to feel good, the rest of it would be about my feeling better.

Comments

Heidi

Thanks Carol for that! Be comfortable Raymond. I understand your rational and it makes sense. Just like some people choose to do whatever is available to prolong life and other choose not to as they feel that would decrease the quality of their life. It's hard though when they can't tell you what they want but you do well in interpreting them.

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Carol

the trust issue with raymond is interesting...he is incapable of trust...he still shudders and moves away whenever i reach out to him..but... as he wanders away in avoidance, he sometimes circles back in again to lay his head against my hand or to see what i have.

the m&m "happy pills" speak to raymond the most, no one has ever fed him candy and then hurt him so the m&m's become the brief bridge of safety and trust between us...my pledge to him that i won't hurt him right now.

it is like a peace offerring, simple and easy for him to understand.
and even more interesting is that raymond occasionally actually looks to me and connects...when i come home or enter the yard or meet him on his wanderings in the field...on some level he remembers i am the good guy and comes over to be briefly near to me.
mo said last weekend that he was wandering around the barn, looking for something or someone..probably something familiar...anyway i went to find him and as soon as he saw me, his eyes lit up just a notch and he came in behind me to follow back to the house.
raymond won't ever love me, he won't ever trust me...honestly he just can't, that part of him is buried too deep or maybe it has just ceased to exist..but there is enough of raymond in there to know that i might be his friend.
this is enough for raymond, therefore it is enough for me.

i cannot speak to how raymond would be in a quiet, stable, predictable home...we don't have that here and truly it is now too late for that, i would not risk moving him now.
he is a good dog. i can even imagine how great he could have been if he had lived his life differently.

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Deb

Raymond has, probably for the first time in his life, someone who only wants what is best for him. I don't know whether Raymond has come to trust you yet, Carol, but I do, and I know how much love and compassion goes into your decisions about end-of-life care.
Raymond has had a horrible life, a tragic life, but now he's with you, and regardless of all his impairments, I truly believe he knows, on some very basic level, that he is safe and loved. Sometimes you can't give a dog any more than that.
Sleep well, Raymond.

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Rae

Raymond sounds so much like my friend Fred. He probably could've/would've lasted months longer but it was ultimatly my decsion to let him go because the quality of his life had disapeared. Fred didn't deserve that and Raymond definatly doesn't either. I remember talking to you Carol when the time was approaching and it was time for me to say good-bye to Barney the Basset. You told me I would know when it was his time. I would be able to see it in his face and he would start to shrink before my eyes, not so much physically but spiritually. I didn't understand until I saw it happen with both Barney and Fred. I knew exactly when it was time for both of them because they told me.
My thoughts are with you Carol as it's a difficult position to be in as the gift you'll give to Raymond knowing when it's time and he trust that you'll make that choice evn though it will be difficult.
It's one of those adult decsions that totally suck!!!!

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bridget

it is all sound, and reasonable, carol. you, and your partners at saints, all understand these animals and how to control their pain, and you all know when the pain comes to be too much for them. the point is, always, to keep them comfortable, happy as possible, and let them have anything they want and need.

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