Decisions

Reyna has been deteriorating physically over the last few months. She’s been seizure-free for over a year now, and her allergies are under control. Unfortunately, her joints are causing a lot of trouble.

Two years ago she was diagnosed with severe dysplasia in her right hip and moderate dysplasia in her left hip. We’ve been treating that with glucosamine, chondroitin, omega 3 and Rimadyl, an anti-inflammatory. She would have occasional bad days, but most were good. The exception was last summer with the Phenobarbital, but once I got her off of that, she went back to normal. That’s changed.

Over the last 6 months, I’ve had to increase her maintenance meds twice and finally upped them a 3rd time this weekend. She’s had to have a higher dose on weekends (when I’m home and she’s more active) just so she can function. Every week or so, I see a new indication that she’s in constant pain, although I do think the severity of that pain changes throughout the day. In May, the vet found arthritis in her right front shoulder. Friday, the vet found early signs of arthritis in both knees. And when he made her bear her weight on her right rear leg, she bit him. Politely, of course. But, still. We’re rapidly reaching the point where I have to decide what’s the right thing to do for my girl. I have options. I just don’t know which one I’m going to select.

The first option is to do nothing. Keep her at the current (max) dose of anti-inflammatories and just wait it out. I don’t see this happening, because I will not be the person who says, “But she’s only been crying every time she gets up or lays down for the last few months...”

The second option is to start creating a cocktail of anti-inflammatories and pain killers, trying to find the right combo that eases her pain but doesn’t make her stupid or sick. This would be a slow process, figuring out which meds are the most effective and at what dose. Basically a trial-and-error process that is based solely on my observations of her behavior. And she would be on these meds for the rest of her life, making alterations when some new indication popped up that they weren’t working as well as they should.

The third option is surgery. The vet checked her x-rays from 2 years ago and said she is not a likely candidate for a hip replacement, because the neck of the femur bone of her right hip was already deformed. He is recommending a Femoral Head Ostectomy (FHO). In an FHO, the femur’s head and part of the neck are removed. Muscle is pulled up and over the remaining bone. This creates a “false joint” and prevents any more bone-on-bone contact. Its generally considered a salvage surgery, because once the bone is removed, nothing else can be done. The dog never gets back full range of motion, but the amount of pain should decrease significantly. Rehab takes 2-3 months for an active dog and involves a lot of work from the owner. The good thing is that the dog cannot damage the bone by too much activity (which is important, because I don’t think there are enough drugs in the world to keep Reyna quiet for several weeks), but they can set their recovery back a bit by making themselves sore. The surgery is generally done on one hip first, and the dog is given time to heal. If there appears to be a need for it, sometimes the second hip is also done. It just depends on how the dog reacts.

The fourth option is putting Reyna to sleep. This is the option I REALLY don’t want to do. The vet is against this because she’s young, active, and her pain is still manageable. Of course, the vet isn’t the person who has to pay for surgery or a lifetime of drugs.

The vet is suggesting either the drug cocktail or the surgery. I don’t want Reyna on a lot of drugs for the next several years. Never mind the wear on my bank account, I just don’t see how loading her with drugs can be a good thing. Especially since the pain is likely to continue getting worse over time. And its not like she can tell me if she doesn’t feel right...she just has to hope I see every behavioral change.

At this point, though, the surgery is pretty much a non-option, just because of the cost. An FHO is a lot cheaper than a total hip replacement, but I’d still be looking at a significant lay-out of funds. And even with the surgery, Reyna would still likely be on a low dose of anti-inflammatories for the rest of her life because of the arthritis in her shoulder and knees. Granted, there’s a good chance the arthritis wouldn’t get much worse, because she would be able to actually use her back legs more than she can now.

The vet and I talked about the financial aspect on Friday, and he told me this morning that he’s contacted Ashley’s Angel Fund to see if they would help us. The Fund is set up to assist with the cost of procedures that will either save a dog’s life or significantly increase the dog’s quality of life. If they agree to help us, the Fund would pay for 50% of the costs, which would already be dropped by 20% because of the arrangements between the vet’s office and the Fund. We should know in the next week or so if they’re going to agree to help Reyna. If they do, that puts the surgery option back on the table. I have to admit, I am extremely touched that he thought about this over the weekend and went through the process of applying for us. And my dear, sweet boss has already said he’ll arrange for me to work from home for a couple of weeks so I can take care of her, if this is the route we take.

For now, though, I’ve decided to add one new pain med to see if that helps her get through the day. She had trouble this Sunday during her SAR session – her first short search went fine, but she was hurting enough that she didn’t even pretend like she was searching the second time. Beyond this, I just don’t know what I’m going to do. I don’t really like any of the options, but I know I can’t let her go on like this, getting worse on a steady basis, and not do something to help her. I know some people will say, “Its just a dog.” And to those people, I say, “How sad for you, that you’ve never experienced the joy of having a Reyna in your life.”