I would have a "heart to heart" with my vet-it would be something along this line of thinking:

"My sweet dog, whom I love, is very old and sick. Do you, my small animal vet, believe from your experience, that money I spend in the diagnosis of his condition, will bring him a meaningful amount of time and happiness? How will the results of these tests change what we can do for my dog? Or, does he look to you, a person with experience, like he has entered a period of non-reversible decline?"

Now, I am an old person. And I have tried, with all technology available, with tremendous hope, and effort, up all night over and over and over again, burned up thousands of dollars of clients money and my own trying to essentially turn back the clock. I have seen it done with my grandparents, my parents --- and dogs, and cows that were a piece of my heart, that I would not let go. I have come to accept that some losses are coming despite everything that I do.

IF you trust your vet, and he is a good person, which most vets are, he will answer this question as honestly as he can. With that information I would make my decision.
If he tells you, "no one has a crystal ball, I can't help him if I have no diagnosis"
I would take my lab work and go elsewhere, I would seek the opinion of an older
veterinarian. 15 years ago, there were no ultrasounds and liver biopsies. A diagnosis was made by physical exam and lab work. The smart guys weren't wrong all that often. If your dog will still eat, and do his business, and wag his tail, if he still has good days, medications can be given that will improve his quality of life. A compassionate veterinarian will have you spend money on this, rather than on tests which will not change what can actually be done to HELP the dog, which is the real point of all of it.

I apologize for going on and on, but this subject really hits me.

There is not much I can add to that except "amen."

I have also asked this of my vet: "If this was your dog, what would YOU do?"


I'm old now too, and one of the things I have learned through the decades is that sometimes we are offered and advised to do tests and procedures and so on for this reason: because they exist. Because they CAN do these tests and procedures, and there was a day when they could not.

But the litmus test is what Betty talks about - is this procedure going to change how much we can help the dog? Does it offer significant increase in life-quality?

And here you are, Cat, in the middle of the hardest thing we dog-lovers ever go through, trying to think in between a vet who may with the best intentions in the world be offering everything he can offer just because it's there and the ideas about "How much does this dog need to go through besides to be made comfortable? How much of this is actually going to give this best friend relief?"

I hope I don't sound negative. Please believe me that I mean only to offer a perspective from someone who has been there many more times than I want to think about.

Hi Cat,

I am so glad Betty is here to share her professional experience. I second everything she just posted, especially her point about what would the results of any test make you do differently? IMO the ultrasound (if it is done by someone who really knows how to interpret what they are seeing) might provide information about what is going on with Buddy's liver, and it's painless and non-invasive. The high ALT numbers indicate that liver cell damage is occurring but there are several possible causes. Personally, I would be very hesitant to put a sick old dog like this through a liver biopsy - even a needle biopsy. Apart from the expense, he will need to be sedated or anesthetized. Plus, if you get a definitive diagnosis how will that change what you are currently doing for Buddy's care and treatment?

It also bothers me that your vet is pushing for a liver biopsy without even seeing the results of the ultrasound. Betty's idea for a second opinion from an experienced veterinarian IMO is a good one and might be a better way to spend your money than a biopsy.

I'm really sorry you and Buddy are going through this. We want our dogs to live forever and we are willing to do anything that might keep them with us for longer. But you do get to the point when you have to ask yourself whether more invasive medical procedures are really going to help the dog.

Thank you for all your opinions and kind advice Buddys bin to 2 vets recently both of whom recommended a biopsy, both of whom were older(one 40ish, one 60ish) The first vet said he would have to be sedated so we declined but his current vet said he would not have to be sedated. Does this sound right to you? My moms an RN and said it sounded odd to her. I just never want money to be the reason my dog doesn't get a procedure or test done that could answer questions and help him(despite being very very poor) I certainly dont want to cause him any discomfort but on the other hand a little pain might be worth some answers....I feel like why not take advantage of the latest technology, thats why it was invented, to help. Other than not being able to walk well he outwardly appears to be healthy and happy! I guess I just dont want him to be gone one day and to think that theres more I could have done....

I will definitely ask him what he hopes to find with these tests and what it would mean. I feel comfortable with the ultrasound so will be getting that done, but am still hesitant about the biopsy....will talk to him more about it. I guess when I talk to vets I feel like they feel Im questioning them when I ask lots of questions but Im really just trying to know exactly what will be going on to my dog and why.

I appreciate all your experiences and advice, Buddy is my first dog that is soley mine to get old(had family dogs my whole life)he is soley my responsibility so its just bin really stressful and confusing.....

Cat,

You said in your first post that Buddy wasn't eating much and he had a fever. Has that improved?

He is definitely eating better, I have bin feeding him smaller portions more times a day. I dont know if his fever has improved, we are taking him back to vet this week, the vet said fever was caused by infection and thats what all this is about is trying to find out whats causing his infection.

i also started just walking him on leash around the yard and although slow once he gets going he can walk decently so Im hoping that will help give him some strength back...

I add hot water to his food and canned food too to make it more appealing, he will usually eat it w/o the canned though.

Cat-
It sounds like you have taken great care of Buddy, that you are doing a great job.
I am glad for you both that he is feeling a little better.
I wish you the best.

Thanks Betty, Buddy is the best dog in the whole world so its the least I can do

Hello all again! Buddy went to his first accupuncture appointment today. She had some neat ideas and things to try, anyway she reccomended gabopentin for his pain but after researching it found it says not to use with dogs with liver problems.....My question is: Is any drug that will help his pain going to be really safe with his liver problems? Im thinking no, so what drug would you all think is my safest bet??

Thanks again!

Tramadol, I have read, is used with animals who have kidney or liver disease, partly because less is needed with either kidney or liver disease (I do not know that mechanism).

Buprenorphine has very few side effects, I have read, when used as directed, and is about as effective as tramadol.

The vet is the best source of this information. I personally wouldn't much care about whether I sounded like I was questioning the vet's expertise. Not asking means you won't get the answers. It might help if you practice what you want to say and if you take along a list of questions.

I hate to think of this guy in possible unrelieved pain. You might also want to pick up a thermometer reserved for him, too.

I'll be thinking about you both.