Thanks so much for the additional information.
It's possible that she would benefit from medication for her arthritis such as anti-inflammatory drugs such as Rimadyl
. Pain medication such as Tramadol can also be prescribed.
Most dogs with arthritis rarely vocalize or cry in pain but we know they experience it because their symptoms resolve or are reduced once drugs are begun. Her respiratory issues may be related to her Cushing's disease but it can also be secondary to pain/discomfort.
So, I might have a discussion with your vet about this although he may feel her liver is too compromised to use anti-inflammatory drugs. At least pain medication could be tried, if that's the case.
I also usually recommend supplements for these dogs but they can take longer to work..usually several weeks in most dogs.
Joint supplements such as Dasaquin or Cosequin which are veterinary products specifically formulated for dogs are one suggestion. Quality control is a big problem with these products since what’s on the label is not necessarily what’s in the bottle which is why I mentioned specific brands. These are available on the internet.
Also, fish oil supplements can be helpful since they have anti-inflammatory properties. Welactin and 3V Derm Caps are good veterinary products and are also available on the internet. It takes several weeks for these products to build up in the system, so you might not see immediate results. But once started, these supplements should be continued for them to be effective; you wouldn't stop and start them, in other words, like you would drugs...but you may already know this.
Another option would be Zeel which is a combination homeopathic that can be used in conjunction with other NSAID medications and has a very low incidence of adverse effects (LINK). Dose would be 1/2 tablet two to three times a day for a small dog....I'd go with three times a day for the first 2 weeks, then drop back to twice a day for maintenance.
Alternative therapies such as hydrotherapy, laser therapy, massage therapy and even acupuncture have been shown to be very useful for joint problems.
As to the question about when it's time to let her go, this is always a difficult topic and there isn't always a clear cut answer to this question in every case, unfortunately.
For me, it comes down to quality of life issues; this is the priority although often this is very subjective between individuals.
Questions to consider include:
1. Does she have more good days then bad? Sometimes it helps to keep track of good days and bad days on the calendar.
2. Does she still enjoy doing the things she used to enjoy doing, (even if for shorter periods of time) or is she too painful, tired or weak to do so?
3. What is her attitude like? Lethargic or upbeat and enjoying the interaction with her family?
I find that if you can answer these questions honestly and objectively, then it often helps make this difficult decision.
My personal opinion is that it's best to let our pets go before they deteriorate too far, while there is still some dignity to their lives. But, I emphasize that this is just my personal opinion. For me, quality of life is more important than quantity of life.
I hope this helps as you face this difficult situation with Tiny; I know you love her and want to do what's right for her although it's hard to think of saying good-bye. But I might consider trying to make her more comfortable with other drugs before making this very hard decision. Deb