Her leg was amputated in Aug 2005.  I have created a blog with a picture as a pup with leg, right after surgery, 2008 and 2012.  

Thought I would give an update on Nyaya.  I was going to do it in her blog I created, but apparently I failed to actually create a blog.  So I dug up this post.  It is much more relevant to put her update here.  At the end of my first post in this thread I mention I was going to take Nyaya to a new vet that could do acupuncture because she had gotten to where she was hardly moving and had no puppy left in her at all.  I didn't take her into see her usual vet about her decreased mobility because I assumed it was due to increased pain.  The acupuncture vet said he had to do blood work before treating her, I mentioned she had been getting monthly liver tests and a complete panel was done about 4 months ago and he insisted on retesting because 4 months was along time.  Turns out that was a good thing as she was not immobile from pain but from anemia.  After several months of ruling out other causes she was finally diagnosed with IMHA.  A horrible disease that kills about 50% of the dogs that get it.  The research vet school vet (where she had to go for all sorts of tests to rule out other possible causes) put her on prednisone which gobbled up all the muscle we had spent years building in just a few weeks.  She eventually coughed up blood clots on the prednisone (not good when your anemic!).  Thank goodness my regular local vet overrode the recommendation from the university vet to continue her on prednisone anyway and moved her to mycophenolate and cyclosporine.  That probably saved her life.  She took those for about a year and half (until late 2017) and we eventually got through the IMHA scare and off those meds.  Her puppy attitude that ever morning was the beginning of the 'best day ever' came back after about a few months on the mycophenolate and cyclosporine in late 2016.  But her muscle never came back and she strength wise she never returned close to what she was before the disease.  

As part of following up on IMHA we got periodic blood work and her liver numbers started up again when she was 13.  Last August at 13 with her ALP over a thousand and ALT near a thousand the vet suggested I just make her comfortable as with her age exploratory surgery would be difficult and none of testing or blood work showed a definitive cause for the liver numbers.  The vet said her liver numbers were so high she could go at anytime.  So I took her home and made her comfortable, apparently plenty comfortable because she has been in good health other than the continued long, slow, torturous loss of mobility.  Over the last 9 months the distance she can walk without a face plant has decreased from about 15 feet to 3 if she is luck.  I started always carrying her outside about a year ago (of course I also had to do that when she was anemic).  I lost the vigorous tail wag upon getting up each morning due to pain/old age about 6 months ago (not bad considering I thought I had lost it in July 2016!).  In the last month I have had to start supporting her missing front stub while she goes to the bathroom to keep her from falling on her nose mid-stream (when she did this she would just stay there using her nose as a 4th limb 🙁 ).

She has been accommodating these losses with stride, or at least not dwelling on it, but it has been hard to watch.   As of now her life revolves around sleeping, eating, drinking, pooping, peeing, playing tug-of-war or chewing on a Nyla bone (that I hold for her since she can’t flex or move her front wrist/leg much).  Barring getting super sick, when she gets to the point that she can’t get up at all and gets bed sores or if she loses interest in eating/playing then we will have to say good bye.  She isn't ready to quit yet and we don’t have the heart to put her down when she is alert and content most of the time.  She falls on her face all the time but she gets herself up and lurch herself forward in a torturous limp, fall, motion just to get to her basket of toys.  That doesn’t seem like a dog wanting to die to us.  It is awful and awesome all at the same time.  How she lays down is by leaning down like in the doggy play pose, but with no bending in front leg and resting her face on the floor with her butt high in the air and then collapsing on her side all at once with a whomp, because her hips don’t like to bend.  I am able to come home at lunch each day so worse case if she falls and can’t get up because how she has positioned herself amongst the furniture or wall so only has to lay there for a few hours before I get her up.  She doesn’t get freaked out about it.  I have padding spread out over the floor so it is nice and cushy when she falls to soften the blow and make it more comfortable if she has to lie there for awhile.

For pain as noted in my original post I looked into acupuncture and PT before the IMHA, but after that diagnosis it became about just surviving for about a year and she hates (I repeat hates!!!) being touched by others.  So I am not sure either of those will help more than the will stress her out and make her miserable.  Currently I manage her pain with tramadol (her liver issues prevent her from NSAIDs).  I checked in with my vet about gabapentin based on posts I have seen here but see mixed information about liver risk.  Given the tramadol is working (my vet says it either helps or doesn’t help depending on the dog and it definitely helps Nyaya) and is very safe she suggested I stick with it until we max out the dose and it looks like it isn’t having an effect.  I also give her regular doses of CBD oil. I think it suppresses her symptoms of Cushings disease (yes she has that too, plus a gallstone that she gets a pill for ever day).   I am not sure the CBD does much for suppressing pain it seems mostly effective at cutting her panting and thirst associated with the cushings.

She has been a great dog and lived an active life.  Before IMHA she went on lots of overnight camping and rafting trips.  Since the IMHA she prefers the creature comforts of soft beds and conditioned air.   She still goes to the ski hill most weekends in the winter (loves making doggy snow angels), RVing with us in the summer, and we go on daily walks to the park in her doggy ride dog cart .  Life with three legs is harder, but it can still be rich and enjoyable.  She has had an amazing run and my goal from here is to make sure it stays good as long as possible.

I appreciate your ideas.  It is always good to have more input.  I was not familar with Grapiprant, but have it on my list if the tramadol is maxed out and has no effect.  I agreed with my doctor when we met last week that we should stick with it because it has no side affects and it is giving her some relief. 

I have a front wheel cart I got for her when she was young hoping I could train her while she had energy.  I spent months trying to get her to not be miserable in it.  For a front wheel cart you have to strap them down over the shoulders and cart is right under her nose.  For the longest time she would just stand there with her eyes side open staring into space and panting.  I eventually got her to take a few steps forward by putting steak in front of her nose.  She could sometimes turn, but usually the lean of the road would cause her to head into the curb and there she was stuck because she had zero clue of reverse in the cart.  The best we ever did was about 100 yards and back (with steak motivation every 10 or so feet, BTW it had to be steak, chicken wasn't good enough).  In a house there is very little room to travel that doesn't require turning and lots of things to walk toward and be stuck so I don't think it would 'free her up' indoors even if she had figured it out.  I thought about giving the cart back to Eddie's Wheels to donate and they don't take back front wheeled carts because they are so hard to fit.  I was surprised they didn't even want it for its parts, its very well machined.  The one I have fits great, but she never could figure it out and more importantly she couldn't get past being very stressed by it.  I would encourage others to try the front wheeled carts because if I could of gotten her to use it I believe she would be better off today in terms of less arthritis and maybe even to help her get around on her own.

We let Nyaya go Thursday.  She started having progressively more pain and loss of energy and movement last weekend that escalated a bit every day.  Saturday and Sunday I just thought she was having slow days.  Sunday night was the first time she couldn't sleep comfortable through the night.   She tossed and turned (like a clock hand by spinning herself with her front leg) trying to find a comfortable position.  She could occasionally get her self to a standing position, but when she did she was in a lot of pain (indicated by massive panting) and the range of motion of her front leg and weakness and arthritis in all her joints prevented her from being able to do much more than topple over a foot forward.  I started giving her gabapentin each night around 2 am (I was up frequently with her) and upped her tramadol to two a day.  That gave her few hours rest.  I had to pull her out from under the dresser a couple of times that night (I blocked that the next day).   Monday I started thinking I may have to do something but I didn't want to pull the trigger.  After a repeat Monday night of Sunday night but a little worse I called the vet Tuesday and got an appointment for a house call Thur afternoon.  The tramadol went to the max limit of 3 a day.  I took off work to be with her the rest of the week and started mixing steak into her meals/treats (I had cut that out a couple of years ago due to liver disease).  Each night was a bit harder than the night before, but the days had a few bright spots. 

We had 5 walks together in the dog cart to the park in those three days (usually it was one each morning, but we started doing morning and evenings).  I timed them an hour after a tramadol and she was able to lay in the cart with her head up most of the time enjoying the view and fresh air.  She continued to grab the play toy and just hold it with me; she didn't have the energy for any tug or pull.  She was also able to chew her bone a bit but even that made her tired.   She had never been a dog that liked being petted or loved. 

She would let me pet her and love on her for a little while but then she would get antsy and grab any toy/ball and convert the time together to play time.  I was good with that as it was about giving her the best dog life possible.  But several times this past week she stunned me with overt long, comfortable happy dog displays of love and affection that she would initiate.  She has only ever licked my face a few times in her life and always nervously and then jump up and play.  I imagined she was telling me 'yes, I'm doing this for you but I'm uncomfortable with it so lets move on to something else'.  This week there were several times she looked me long and hard in the eyes licked my nose and cheeks and then looked me long and hard in the eyes again afterward.  It was very out of character as she was very submissive and nervous (she was over a year and half old before she could bring her self to look me in the eyes at all).  It felt she was making sure I knew how much I meant to her.  There were other times she would look at me where it seemed she was wanting me to do something to help her.  Weds night I worried that the vet wouldn't come soon enough for her to avoid suffering.  Thursday morning we still got a cart ride to the park and hung out for an hour watching the world go by.  Usually she could sleep peacefully after a cart ride but Thursday morning she needed an extra above max dose tramadol to get there.  She also had a bit of loose with blood that morning, but that could of been because of the steak.

The vet came out to the house Thursday afternoon.  Nyaya had enjoyed her lunch and was managing to sleep a bit.  She doesn't like other people touching her so we tried to distract her when they came into the room and got things going (I didn't watch what they did).  I held her head was on my lap and looked at her face.  She was a fighter to the end and would of gotten away from them if she could.  I guess the process of her passing was as good as it can be.  She was still there in terms of her spirit and hadn't suffered in the sense of being really sick, but her body was completely used up and she was unable to be comfortable for more than an hour at a time.  With each day/night being worse than the one before I was afraid of what Friday might bring.  So it was absolutely time.  Yesterday I went alone to the park a few blocks away that we must of visited thousands of times where we would go over the years and recalled great memories of chasing tennis balls, fetching freebies and sticks in the river, chasing squirrels and geese, and in the end sitting together under shade trees.  I would of thought that her not suffering needless and having lived a great doggie life would give me solace, and maybe it does, but I still have a profound sense of loss.  I miss my little Nyaya girl.