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Hi there. Thanks for the question. Im sorry to hear your sweet old dog is struggling. We address this concern all the time....when is it time to let them go. It is never an easy decision and of course is a very personal one as well. One thing we often tell owners to consider, is to think of 5 things that make your dog happy or make up their personality (for instance...loves to play fetch, or loves to go for walks etc). If they have lost the ability to enjoy 3 or more of those things, then maybe this is a sign that their quality of life is suffering. In addition, if the dog is unable to eat on their own or urinate and defecate on their own, this is another big sign that their quality of life is deteriorating. As they lose their appetite and ability to move around on their own, the body is shwing signs of shutting down whether from disease or chronic pain or some combination of these. I hope this helps you make this ultimate and terribly difficult decision about your dog. Best wishes. Take care.