Dear Dr. Dog: My 12-year-old Beagle is gradually slowing down and getting lethargic. He’s been pretty healthy over the years. Should I worry that he is sick or just assume that he’s getting old?
When I discuss the disease processes that occur in older dogs with my human clients, they often ask: “But isn’t that just old age?”
I usually reply that old age is not a disease, in and of itself. Of course, many disease processes are much more prevalent in older dogs. We have all seen people and animals whose diseases seem to accelerate with the aging process, but this can be traced to the effects of the diseases on metabolism, nutritional balance, or other complicating factors.
Watching my canine patients age reminds me of my own aging process, albeit a much slower one than they exhibit. I hope that when I am suffering from an age-correlated disease, my doctor will not dismiss it as “just old age,” taking the easy way out and ignoring treatments that could slow the progress of the disease, avoid complications, or help me to maintain function and keep my quality of life.
Many of the canine diseases of old age are not fully curable: chronic kidney disease, arthritis, heart disease, diabetes, and many forms of cancer are good examples (interestingly, cancer may be the most curable of that group if detected and treated early and aggressively). Should we ignore treatment of these incurable maladies? Of course not! We do our best to manage the situation. With medication, good nutrition, surgery, and behavioral modifications, we can often minimize the effects of the disease, slow its progression, and maintain or improve quality of life.
Chronic kidney disease (CKD) in dogs is an excellent example of the importance of intervention in a chronic incurable disease process. Unless recognized and treated early, chronic kidney disease can become a rapidly progressive condition, resulting in extreme malaise and, fairly rapidly, death. However, if we diagnose early and manage the disease effectively, we can often delay the progression for years while maintaining excellent quality of life.
As CKD progresses, the kidneys lose their ability to excrete waste products, conserve water, stimulate the bone marrow, maintain acid/alkaline balance, and maintain appropriate blood pressure. Through dietary changes with foods specifically formulated for kidney disease, we can decrease the amount of work required of the kidneys and compensate for the diminished excretory function. Medication can be given to stimulate the bone marrow. Blood pressure control minimizes the continual damage to the filtering mechanism of the kidneys, thereby slowing progression.
Drugs to maintain proper calcium and phosphorus balance can help prevent mineralization of the kidney tissue (which would damage the kidneys). Assuring adequate hydration helps keep our pets feeling good and prevents further loss of healthy kidney tissue. Management of CKD requires monitoring of kidney function and adjustment of treatments as required, for life.
Another common problem with older canines is arthritis. We have all known old, creaky, stiff dogs who walk with difficulty. This can be caused by acute or chronic trauma, immune system malfunction, or infection. Unfortunately, the most common cause appears to be chronic trauma (long term wear and tear) due to obesity. Needless to say, prevention is preferable to treatment.
When arthritis is present, medication can be given to increase comfort and minimize further cartilage damage caused by inflammation. Of course, when infection is present, it should be eliminated with appropriate medication. Moderation of exercise is imperative to prevent overuse and maintain good comfort. Surgical joint stabilization for knees and joint replacement for hips contributes mightily to the quality of life of our beloved older pets.
If your dog is obese, weight loss can go a long way toward preventing joint problems.
Heart Disease and Diabetes
In patients with heart disease, medications to improve the strength of the heart muscle are available, as are drugs that decrease the heart’s workload by lowering blood pressure. Diuretics and low-sodium diets can reverse fluid retention and prevent fluid accumulation in the lungs. Modification of exercise is important to avoid overtaxing the heart.
Dogs with diabetes usually require insulin to help their cells utilize glucose; dietary modifications to avoid sudden changes in blood glucose are often helpful in regulating the dose of insulin, and regular exercise helps to maintain a more normal glucose metabolism. Proper treatment of diabetes can help prevent common complications such as cataracts.
As mentioned earlier, cancer is really the mostly likely of all these diseases to be cured, most often with surgery. Not all tumors can be completely removed surgically, however. In these cases, medications to decrease the number of tumor cells remaining and minimize their effects (such as pain) can extend and improve the lives of our patients.
The dreaded word “chemotherapy” frightens many people away from treating their pets who have cancer. Cancer therapy in pets is not the same as cancer therapy in people, in spite of using many of the same drugs. For our pets, we are trying to achieve remission, not cure; doses required for cure are associated with much higher toxicity and side effects. In a person who might have decades of life ahead if a cure is achieved, the side effects are considered acceptable. For a pet whose natural lifespan is much shorter, we strive to achieve remission, because the side effects of higher doses are not acceptable.
In all of the above scenarios, the emphasis is not just on extending life, but on maintaining or improving the quality of life for as long as possible.
We all want to delay the day we must say goodbye to our special friends, yet recognize that it is inevitable. How to decide whether that day has come? Where do we draw the line? When we have been working hard to manage an incurable disease, given the practical and financial limitations we face, the decision to let go is often easier. We have time to prepare ourselves emotionally, and we watch closely for the time that our pet’s bad days well outnumber the good ones. As long as our focus is on the quality of life of our pets, we recognize when the time has come and are comfortable that we have done all we reasonably could do for our friends.
After all, they earned it by brightening our lives every day they lived.
Daniel Hershberger DVM is managing veterinarian at All Pets Hospital, 269 South Van Ness Avenue at 14th Street, San Francisco. Call 415-861-5725 or visit APH on the web at www.aphsf.com.