Caring for a Three Legged Dog or Cat

Thank you all so much for this site and these forums! I have read through several of your experiences in Coping With Loss and your compassion and support is beyond amazing. A quick summary of Bailey's journey since I am not a frequent poster:

Bailey was diagnosed with histiocytic sarcoma in her left stifle joint in September of 2017. We met with a radiation oncologist and medical oncologist at Purdue University and decided to first try radiation to shrink the tumor in the stifle joint as well as a lymph node near the site that seemed likely to have cancer but was too vascular to safely biopsy. Bailey handled radiation like a champ but after the series of treatments, she was still not using her left leg. We started her on a monthly chemo (Loumistine/CCNU), that in the words of her oncologist, would need to be given "until it no longer makes sense" (basically the rest of her life). Prognosis at the time was 6-12 months. Bailey's left hind leg was amputated in December of 2017 and we continued the monthly chemo until March 2019. Bailey is in the unlucky 20% of dogs that has adverse side effects from chemo. She had to be hospitalized after her first dose and had several courses of antibiotics due to low white cell count after subsequent doses of chemo. We finally landed on a reduced dose of chemo that she could tolerate but we still had to put her on Cerenia for 7 days following each treatment and, even with the medication, she still was uncomfortable. We made the difficult decision in March 2019, to stop the chemo. In June 2019, Bailey had a full body, contrast CT scan done because she was showing weakness in her remaining back leg and we feared the worst. The CT scan showed no signs of mets! Yay! Except there were some small lesions on her spleen but the radiologist felt that those were within normal range for a dog her age (well...histoiocytic sarcoma likes to go to the spleen so we were cautiously optimistic at best). Turns out, Bailey had a nasty uti that presented as weakness in her back leg. Who knew?? A course of antibiotics and she was back to her hoppy self!

So, here we are nearly 2 years to the day after diagnosis of cancer and Bailey has started to decline. The first week of August she enjoyed a bucket list-worthy vacation at the lake with us. She swam, chased her ball, went for boat rides, and had near constant love and attention. When we got home, we thought that she was just worn out from her vacation (we were!). When her exhaustion persisted, we thought maybe she had another uti. Bailey also experienced two very mild seizures (my husband does not even agree with me that they were seizures) about a month apart during this time. So, we called her internist and she suspected hypothyroidism. Thyroid tests confirmed that her levels were super low and her cholesterol and triglycerides were super high. Those results, along with the seizures, made a strong case for hypothyroidism. So, we put her on medicine right away. However, the CBC taken at the same time revealed dangerously low platelets. Our primary vet thought it might be a mistake so he re-ran the test in-house the next day. Nope, very low platelets. Bailey's internist and her primary both agreed that the platelet issue was separate from the hypothyroidism and suspected that Bailey's cancer has returned, likely in the spleen. We started her on prednisone and just had her 7 day post prednisone blood check yesterday. Not good news. Her platelets did not come up at all. She is at high risk for spontaneous bleeding. In fact, we suspect that she may have some upper gi bleeding as her stool has turned black.

This news is devastating. Bailey is still wiggling, meeting us at the door, and eating. However, she has stopped going for walks and seems to have very low energy. If she truly is bleeding inside, we know that it will just be a matter of time. She is 11 and has long outlived her prognosis with histiocytic sarcoma. We have drawn our line. We are not going to put her through anymore painful procedures or tests. We are scheduled to have an ultrasound of the spleen done on Monday just to confirm what we already know. I feel some guilt for discontinuing the chemo back in March but our internist told me yesterday that, even if we had persisted with the chemo, the cancer would likely have come back anyway. She said this is one of the most aggressive cancers they see in dogs. 

So, now comes the difficult time of watching and waiting and trying to determine when it is time. Our top priority is that Bailey does not suffer. We do not think she is suffering currently but maybe in the coming days? She is terminal. There is just no other way to say it. As hard as it is, I would rather end her life after a good day then after a struggle. But, I don't know...this is so hard. Thank you if you have read this far! I appreciate any thoughts or experiences you would like to share. I know opinions vary greatly on the end of life stuff. I just feel like Bailey has been through so, so much. She is my eternal puppy and is always happy and energetic and crazy. Her personality has remained through the whole journey over the last two years. When that light goes out, we will know it is time.