Pain Management

[lannarebirth]

My 12 1/2 year old Pointer was diagnosed with cancerous tumors in his lungs a few months ago. The condition is inoperative so treatment has been centered on prolongation and quality of life. To that end he had been on a Science Diet N/D cancer formula, antibiotic for elevated white count and pain medication.

In addition to slowly losing his weight, a couple of weeks ago he developed a sever limp and I brought him back in to the vet hospital. At that time they discovered a third tumor in his front shoulder which is causing him severe pain and inability to put any weight on that front leg. They decided at that time to change the pain medication and give a blood test to see if it would be suitable to give him Tramadol, which I believe is a steroid. I'm aware of the hazards of prolonged steroid use but felt maybe that wasn't as important if "recovery" isn't really a possibility.

My dog is very stoic, he's never whimpered or cried since the day he was born. He's in great pain though. I hear him making biting noises to deal with it and sometimes he won't eat or drink for a day or more and just lays rigid due to his intense focusing on the pain.

I want him to be comfortable for however long he has, which could very well be months. Bambi, or anyone else knowledgeable, do you think this is the appropriate pharmacological treatment for his condition? Might a local, injectable steroid be of greater benefit (if you think the steroid is of benefit at all)? The doctor mentioned morphine might be appropriate, but said they don't stock it(this at Chiang Mai University Veterinary Hospital). Do other clinics stock it for animal use and is it ever an appropriate treatment?

Finally I'll say the oncologist and other senior doctors at the hospital seem knowledgable and conscientous and compassionate but perhaps due to language difficulties I'm often left bewildered as to whether or not we're doing all we could do to ameliorate his pain.

Thanks for any thoughts on the matter you can provide.

[Tammi]

My heart goes out to you both. Tramadol is not a steroid. It is a strong pain killer and fever reducer and can be bought over the counter. It is intended for acute pain and is only intended for short term use.

Your dear dog is nearing the end of his life and has now got no quality of life. Being a dog owner myself I know how hard it is to give up a much loved pet but it needs to be done for the comfort, mental and physical, of both the owner and the pet. The vet, I am sure, will do what is right to ensure he has a comfortable and quiet passing. Thank your pet for his companionship and love over the years and tell him you are now letting him go.

I would say that morphine is certainly appropriate.

Thinking of you both.

Edited July 9, 2008 by Tammi

[Tammi]

Sorry, I forgot to say that Tramadol is a narcotic-like pain reliever so would be effective too.

[mangotogo]

My 12 1/2 year old Pointer was diagnosed with cancerous tumors in his lungs a few months ago. The condition is inoperative so treatment has been centered on prolongation and quality of life. To that end he had been on a Science Diet N/D cancer formula, antibiotic for elevated white count and pain medication.

In addition to slowly losing his weight, a couple of weeks ago he developed a sever limp and I brought him back in to the vet hospital. At that time they discovered a third tumor in his front shoulder which is causing him severe pain and inability to put any weight on that front leg. They decided at that time to change the pain medication and give a blood test to see if it would be suitable to give him Tramadol, which I believe is a steroid. I'm aware of the hazards of prolonged steroid use but felt maybe that wasn't as important if "recovery" isn't really a possibility.

My dog is very stoic, he's never whimpered or cried since the day he was born. He's in great pain though. I hear him making biting noises to deal with it and sometimes he won't eat or drink for a day or more and just lays rigid due to his intense focusing on the pain.

I want him to be comfortable for however long he has, which could very well be months. Bambi, or anyone else knowledgeable, do you think this is the appropriate pharmacological treatment for his condition? Might a local, injectable steroid be of greater benefit (if you think the steroid is of benefit at all)? The doctor mentioned morphine might be appropriate, but said they don't stock it(this at Chiang Mai University Veterinary Hospital). Do other clinics stock it for animal use and is it ever an appropriate treatment?

Finally I'll say the oncologist and other senior doctors at the hospital seem knowledgable and conscientous and compassionate but perhaps due to language difficulties I'm often left bewildered as to whether or not we're doing all we could do to ameliorate his pain.

Thanks for any thoughts on the matter you can provide.

Hi, you and your dog are facing a hard time. As a western trained veterinarian I believe in euthanasia. When an animal stops eating in these circumstances that's when I indicate to the owners that the time has come to end the suffering of the animal.

Here it is a different kettle of fish but I dont wnat to start a discussion on the rights or wrong of both positions.

Sometimes with lymphosarcoma ( where tumours are becoming quite large) I prescribe Prednisone as a short term pain management: it will shrinks the tumours and alleviate some of the pressure they cause to surrounding tissue. It works for a little while but then the exponential growing pattern of the tumours win.

I would not be worried about the side effects of long term cortisone use as it won;t be the case here. Your dog has limited time left.

Pethidine tablets may be available with prescription here: short duration but analgesic effect. There are also Fentanyl patches: probably only available in a university hospital.

I would not got down the line of chemotherapy as he metastasis are probably too far gone and the side effects are opening too many complications.

I can only sympathise with you. Sorry. I feel for your dog.

[Nienke]

I'm so sorry to read this. I agree actually with Mangotogo, how tough that may sound.

I've lost two dogs due to cancer. Last year my Afghan male. He had squamous cell carcinoma. Also he started limping, made X-rays and initially nothing could be seen. Well, it didn't take long before it became visible, and soon after I needed to make the last and final decision.

Just one week ago, last Wednesday, my female GSD who also had developed cancer in lungs and bones, reached the point where the painkillers didn't work anymore (treatment wasn't possible anymore according the vet). During the day before she still initiated play and ate her meals. In the evening I saw her becoming quite depressed and she rather didn't want to move anymore. The next morning she refused her meal and was sitting the whole time in the fishpond, probably to ease the pain. I had the choice between stronger painkillers and prolonge her life a little longer or take her out of her sufferings. As the first decision would only be 'beneficial' for me (if i'm using the right words here, I'm not sure), I decided to send her over the rainbow bridge. She went very peacefully, with me right beside her, at the vet clinic next to CM Land.

Be aware that the cancer can cause bleeding, through which the dog can bleed to death. That's what the vet told me.

I wish you lots of strenght in this difficult time.

Nienke

[lannarebirth]

Thank you all for your comments and sentiments. Very quickly you cleared something up that had been nagging at me and I had put down to poor communication with the Vet.

As I mentioned the doctor wanted to give him a steroid (Prednisone) and we were awaiting a blood test. When I went back to get the results my doctor was gone for the day and another prescribed the Trammadol, which I mistakenly thought was some brand of the Prednisone we were awaiting. So, I think I need to see the vet again to see if the Prednisone is warranted.

I understand the euthanasia arguments and I have used these methods in the past. Sometimes I was left feeling I was being less selfish and more compassionate and sometimes I felt just the opposite way and wasn't doing my best for my dog. In the present circumstance it's not time yet for this decision. While in great pain at certain times, at other times he is mentally alert and engaged in activities surrounding him. It's just not time yet. I hope I'll know when that time is. Thank you all for your comments. You've been very very helpful at a difficult time.

[sbk]

Prednisone is a chemo treatment for the cancer, lannarebirth. I used prednisone on my dog donut when she had cancer. Tramadol is a strong narcotic and is an effective painkiller.

I understand how you feel, I watched my dog Donut develop a tumor under her front leg, right on the lymph gland. It did eventually kill her, but at least she went peacefully and at home. I can't give you any advice one way or the other, it is a difficult decision and one only you can make.

You have a hard time to face ahead, have my best wishes to you and your family on this

[lannarebirth]

Prednisone is a chemo treatment for the cancer, lannarebirth. I used prednisone on my dog donut when she had cancer. Tramadol is a strong narcotic and is an effective painkiller.

I understand how you feel, I watched my dog Donut develop a tumor under her front leg, right on the lymph gland. It did eventually kill her, but at least she went peacefully and at home. I can't give you any advice one way or the other, it is a difficult decision and one only you can make.

You have a hard time to face ahead, have my best wishes to you and your family on this

Thanks sbk. I wish I was as strong as my boy. It's all I can do to keep from bawling sometimes.

His mobility is way down, he can barely walk. If I drug him alot he just totally zones out and won't eat or drink. If I don't drug him enough he's immobilized by pain and won't eat. It's hard finding the right formula. What works one day doesn't work the next. When I have to manipulate his body I'm constantly worried I'm gonna break a bone or cause him injury or pain. I hope tomorrow is a little better Thanks.

[BambinA]

Rimadyl

[mangotogo]

You can't use steroid and non steroidal anti-inflmmatories at the same time.

Either prednisolone or rimadyl but not together.

If the dog's condition is deteriorating that much, time has come to do the right thing. Put yourself in the dog's place. You may be able to reason why you are in pain but the dog can't.

[seancbk]

My 12 1/2 year old Pointer was diagnosed with cancerous tumors in his lungs a few months ago. The condition is inoperative so treatment has been centered on prolongation and quality of life. To that end he had been on a Science Diet N/D cancer formula, antibiotic for elevated white count and pain medication.

In addition to slowly losing his weight, a couple of weeks ago he developed a sever limp and I brought him back in to the vet hospital. At that time they discovered a third tumor in his front shoulder which is causing him severe pain and inability to put any weight on that front leg. They decided at that time to change the pain medication and give a blood test to see if it would be suitable to give him Tramadol, which I believe is a steroid. I'm aware of the hazards of prolonged steroid use but felt maybe that wasn't as important if "recovery" isn't really a possibility.

My dog is very stoic, he's never whimpered or cried since the day he was born. He's in great pain though. I hear him making biting noises to deal with it and sometimes he won't eat or drink for a day or more and just lays rigid due to his intense focusing on the pain.

I want him to be comfortable for however long he has, which could very well be months. Bambi, or anyone else knowledgeable, do you think this is the appropriate pharmacological treatment for his condition? Might a local, injectable steroid be of greater benefit (if you think the steroid is of benefit at all)? The doctor mentioned morphine might be appropriate, but said they don't stock it(this at Chiang Mai University Veterinary Hospital). Do other clinics stock it for animal use and is it ever an appropriate treatment?

Finally I'll say the oncologist and other senior doctors at the hospital seem knowledgable and conscientous and compassionate but perhaps due to language difficulties I'm often left bewildered as to whether or not we're doing all we could do to ameliorate his pain.

Thanks for any thoughts on the matter you can provide.

I'm sorry but you want him to be comfortable for however long he has ?? after you said "He's in great pain though. I hear him making biting noises to deal with it and sometimes he won't eat or drink for a day or more and just lays rigid due to his intense focusing on the pain."

So what "you" want to do is hold onto this poor animal regardless of the fact that to do so he will need to be so stoned off his head on pain medication or heaven forbid putting up with the pain.

I do feel sorry for you, but if you love your dog let him go. There is no reason for him to have to suffer any more pain.

[lannarebirth]

My 12 1/2 year old Pointer was diagnosed with cancerous tumors in his lungs a few months ago. The condition is inoperative so treatment has been centered on prolongation and quality of life. To that end he had been on a Science Diet N/D cancer formula, antibiotic for elevated white count and pain medication.

In addition to slowly losing his weight, a couple of weeks ago he developed a sever limp and I brought him back in to the vet hospital. At that time they discovered a third tumor in his front shoulder which is causing him severe pain and inability to put any weight on that front leg. They decided at that time to change the pain medication and give a blood test to see if it would be suitable to give him Tramadol, which I believe is a steroid. I'm aware of the hazards of prolonged steroid use but felt maybe that wasn't as important if "recovery" isn't really a possibility.

My dog is very stoic, he's never whimpered or cried since the day he was born. He's in great pain though. I hear him making biting noises to deal with it and sometimes he won't eat or drink for a day or more and just lays rigid due to his intense focusing on the pain.

I want him to be comfortable for however long he has, which could very well be months. Bambi, or anyone else knowledgeable, do you think this is the appropriate pharmacological treatment for his condition? Might a local, injectable steroid be of greater benefit (if you think the steroid is of benefit at all)? The doctor mentioned morphine might be appropriate, but said they don't stock it(this at Chiang Mai University Veterinary Hospital). Do other clinics stock it for animal use and is it ever an appropriate treatment?

Finally I'll say the oncologist and other senior doctors at the hospital seem knowledgable and conscientous and compassionate but perhaps due to language difficulties I'm often left bewildered as to whether or not we're doing all we could do to ameliorate his pain.

Thanks for any thoughts on the matter you can provide.

I'm sorry but you want him to be comfortable for however long he has ?? after you said "He's in great pain though. I hear him making biting noises to deal with it and sometimes he won't eat or drink for a day or more and just lays rigid due to his intense focusing on the pain."

So what "you" want to do is hold onto this poor animal regardless of the fact that to do so he will need to be so stoned off his head on pain medication or heaven forbid putting up with the pain.

I do feel sorry for you, but if you love your dog let him go. There is no reason for him to have to suffer any more pain.

Thanks for your reply and I understand your sentiments, though I do not agree with them.

Let me give you an example. About 7 years ago , just prior to moving here, I broke my back. It's not going to get better. Sometimes it causes me extreme pain, but at other times not so much. Never once have I thought the way out of this sometimes painful situation would be to kill myself. One just endures it and enjoys that much more those days which are pain free. My dog's situation, though ultimately terminal is somewhat similar. He has some very good days and some not so good. I know the ratio of good to bad days will worsen in the near future, but for right now he has a reduced quality of life but he is not constantly suffering excruciating pain.

I find that if I give him pain meds in accordance with the doctor's prescription he is a way too zonked out and lacks appetite. I give him enough so his pain is greatly reduced, he is somewhat ambulatory so he can evacuate his bowels, can eat most of the time and he is aware and somewhat engaged with what goes on around him.

I'm not dure if I'm doing the right thing or not. I've been in the position before twice and I reacted to the situation in two different ways, both of which left me feeling I had done the wrong thing by my beloved dog. I hope I'm doing the right thing now, though I'm not sure, and I hope I will know what the right thing to do is in the future.

I do appreciate your comments though. Thank You.

[lannarebirth]

Rimadyl

Yes, he's on that. Thanks Bambina.

[lannarebirth]

You can't use steroid and non steroidal anti-inflmmatories at the same time.

Either prednisolone or rimadyl but not together.

If the dog's condition is deteriorating that much, time has come to do the right thing. Put yourself in the dog's place. You may be able to reason why you are in pain but the dog can't.

Yes, that's correct, thank you. In cosultation with the oncologist we opted to go with the Rimadyl rather than the Prednisone. He gets one tablet per day.

As far as his condition deteriorating you could say that's true. In another way though it is better than the day I first posted. That day was the first day of the new stronger pain meds and those just floored my dog and I thought he could die at any moment, but actually I think it was due to the dosage. I dialed that back and he seems to be doing a bit better in some respects. His mobility is not so good however and when that keeps him from being able to evacuate his bowels I suppose some very hard decisions will have to be made. I thank you very much for your input. I really appreciate it.

[sbk]

I know exactly where you are coming from and cannot tell you to make any decisions regarding your dog. It is not for me to stand in judgment of another person who obviously loves and cares for their dog so much.

Good luck, lanna.

[Nienke]

When reading Lanna's post I also wondered if it wouldn't be time. But then, I also realized that it is very difficult if not impossible to judge from only a view words on a forum. We aren't there, we haven't seen the dog (day in day out) and we ain't Lanna.

I remember these dogs that I have send over the rainbow bridge. I remember vividly looking at these dogs, looking for signals that they have given up.

My dear Daika, who had hip displasia. She was getting worse, but still there wasn't a clear sign. Till that day she couldn't get up to relieve herself. The desparate look on her face was enough for me to help her out of her suffering.

Tara, who developed a tumor in her abdomen at the age of 2 years. The vet's tried to remove it, but they couldn't. they told me she hadn't long to live, still she went on for 5 months. She became skin and bones, but still was eating and enjoying her swims and strolls. Till that evening where she gave me that very tired look and skipped her meal, next morning same thing, and I made the final decision for her.

Tenbaht, my Afghan, with cancer in his bones. He was not ready to go, but the cancer has caught the vein and the bleeding was so severe, that I barely could stop it. By stopping it I needed to push so hard on the wound that he was in crusiating pain. Not humane and I made the (very difficult, because he didn't show he was ready to go) final decision.

Jenny, also bone cancer. Just only two weeks ago. At the end also she indicated she couldn't go on anymore.

And my most beloved little boxer, Lucky. Despite a whole night of very high fever, recurrent epileptic attacks and vomitting blood, she was NOT ready to go. Maybe because, deep in my heart I was not ready to let her go. Nonetheless, it was not humane and I made the final decision for her. Still after all those years, it hurts like hel_l.

Little Tinker, who had kidney failure. She went bad, and I had so strongly the feeling she was holding on to life waiting for her owners to return. I sat with her and talk to her; telling her that her owners had not left her behind. That they loved her deeply. And that above all they didn't want her to suffer. They would fully agree if she wanted to go she should do so. Two hours later she was gone. Coincidence? I don't know.

Everytime when I'm confronted with a animal in its final stages, it is always a very difficult decision of when it is time to let go, whether that's my own animal or customer's pet.

I had friends coming over, who tried to push me into making a fast decision. But they didn't know these animals. They didn't see them the whole day around. I did, and although I do doubt at times, deep down I know I've made the right decisions.

I know so well where lannarebirth is coming from and I wish him and his family lots of strenght in this very difficult time.

Nienke

[lannarebirth]

Thanks for your comments sbk and Neinke.

Neinke, what you wrote rings very true for me. Each example is differet and intimate knowledge of that particular dog is very important. I'm not delusional that he'll get better and I'm not a sadist who would willingly have him suffer so I can keep him here that much longer. In the past if ever he was in distress he would be able to communicate that to me through a certain look which said "isn't there something you can do for me?". I haven't seen that look yet. If I do and I don't think there's anything palliative I can do to ease his suffering then the "final option" is always there. Thank you for sharing your stories. It helped a lot.

[Beardog]

I really feel for you Lan, Being a real dog lover I know that you are going through a very hard time with the whole experience. I wish there was some hope for you & your dog but it sounds very terminal at best. I went through this same trauma on a young dog that got distemper. Although it was not nearly as long as what years you have been buddies with your dog . It still hurts the same. I have tears welling up in my eyes thinking about your dog & how I would deal if my dog comes down with something terminal. When it gets real bad a fenryl patch might not be bad to ease the pain.

At least you have some awesome times to remember your friend that will last your lifetime. I am really sorry to hear about this as I know you love dogs as well!

SBK - I had forgotten from school 30 years ago (when I was studying to be a vet) that Prednisone is in fact what they give dogs as a chemo cure. After going through Chemo once I hate to take Prednisone for mango rash when I get it. That explanes why my skin crawls when I think of taking a steroid to cure the rash-besides the other ill side affects.