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Dr. Z Max P is currently on the following medication. In the

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Dr. ZMax P is currently...
Dr. ZMax P is currently on the following medication. In the morning 10Mg of Prednisone, 20Mg of Famotidine and 2 x 25Mg of Diphenhydramine. In the evening he has 2 x 25Mg of Diphenhydramine also.The cycle of living with Max p's Mast Cell Tumor has been roughly every six weeks it has an event. Max is off for 1 day, severely stressed for two days with constant panting and difficulty breathing and is very lethargic. The 4th and 5th day he improves and by the 6th day he is back to normal. So he has 3 bad days and 2 very bad days every 40 or so days.The rest of the time he is fine. Poop is good, good appetite with a distinct preference for human food, and obviously with the steroids drinks and pees a lot. He has full control of all his faculties and loves his walk and is very energetic most evening on it. So he has a reasonably good life.Today was the first normal day after his last Mast Cell Tumor granulation or event. Last night on our walk he was back to normal. However today his tumor started bleeding due to his constant itching / licking. This is new.From what I have read this is the final stage. My plan is that Max should live as long as he has a good life but when the ratio of good to bad exceeds 20% bad then he should be allowed to pass without much pain or distress. Is this close to the end? To recap he got operated on last January so its a year. The first event was in August.I appreciate your expertise and would like your advise and guidance to make Max's final days as positive as possible.Firstly am I right, based on my description and the pictures that this is the final stage? If so how many weeks of relative comfort does he have 1? 2? More?Is there a way of increasing the amount of antihistamine so hat he stops itching as much? If so what are the downsides to this approach?Max has had a good life and I think it is close to its end. I want this to be positive for him and my family and your help would be a great asset and greatly appreciated.Our plan is for Max to go on a final road trip to my ex's parents house and have a picnic near their pet graveyard. Then he would be given a real big feed of his favorite human food. I dont know if its possible to put the narcotic in the food but if it is then he can pass gently surrounded by people he loves, with a full belly, on a road trip. A pretty good end.Thank you.Dave(###) ###-####
Submitted: 2 years ago.Category: Dog
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Answered in 11 minutes by:
12/31/2015
Dog Specialist: petdrz., Dog Veterinarian replied 2 years ago
petdrz.
petdrz., Dog Veterinarian
Category: Dog
Satisfied Customers: 7,492
Experience: Over 30 years of experience in caring for dogs and cats.
Verified

Hello again,

I do recall that we talked via phone consult back in August, but if you could refresh my memory in regards ***** ***** P and his mast cell tumor. Has a biopsy been done to better grade the aggressiveness of the tumor? Has surgery been discussed if this is a solitary lesion? Have other treatment options been discussed (vinblastine? lomustine?)

Thanks and I will respond further after you reply. There may be a slight delay while I formulate and type a thorough response or I may be offline, but if so, I will respond as soon as I am able.

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Customer reply replied 2 years ago
Hi Dr. Z.I hope Xmas was great and that 2016 is your best year yet. We tried surgery this time last year. So we will not go down that road again. The tumor, or cluster of tumors are huge. Its more like 4 tumors very close together at the original spot of teh surgery which is just behind teh right front paw. It now reached back towards Max's hind leg. Maybe 10 or 11 inches long by 3 or 4 wide and 3 or 4 deep. So surgery is not possible. It really is an end of life situation. As for the aggressiveness. He had an operation to remove the original tumor last January. So 1 year ago. The tumor came back slowly and a 2nd one beside it. Last August he got very sick. The first time that he had got sick from the tumor. That is when I contacted you originally. Since then teh tumors have grown aggressively and every 6 weeks or so he has a setback and has a bad few days.But even though the tumors have been growing Max's quality of life have not been affected.We have been unaware and have not discussed any other options. We don't believe it is right to subject Max to unnecessary pain or discomfort. So from a quick web search the two drugs you mentioned look like they are part of a Chemotherapy regime. Would that not be very painful / distressing?My main concern are my two daughters who are 10 and 14. This will be their first death. So its very important I manage this correctly so they understand that Max had a great life, was happy till the end, that we postponed the end as long as reasonably possible without bankrupting us or making Max suffer. And that we made his passing as positive as possible.Thank you once gain. I feel great confidence that you will guide me and Max wisely.Dave
Dog Specialist: petdrz., Dog Veterinarian replied 2 years ago

Dave,

Thank you for the review. I do recall the details now, but since we had a phone conversation previously, there was nothing to remind me.

I understand you concerns for quality of life for Max and even though the drugs mentioned are often tolerated well by many dogs, with the rate of recurrence that you have already seen, I think the risk versus benefit is too high. It sounds as if you making the right decision.

As far as how long does he have, it is really impossible for me to say, and that would be my response even if I had him there in front of me. You really have to take each day at at time. I would guess that as the end approaches, you will note the same cycle that you have been seeing, but that he won't start to improve or his recovery will be much more prolonged. Diphenhydramine can be dosed at 1-2 mg / lb and can be given every 6-8 hours. At the higher end of the dosage is where we usually see drowsiness, so that may be a good way to help calm or sedate him as things progress.

Unfortunately, it is not possible to give the euthanasia drugs orally and expect predictable results. I guess that would be the challenge. It is still possible that you would be able to arrange the send off that you have in mind (which sounds lovely, by the way), but you would need to arrange to have a house call vet met you at the house. This may take some calling around if your vet does not provide this service, but it is getting easier to find in many communities. The other challenge is the timing. You will know when it is time, but it is not always a convenient time, especially when you have a plan in mind as you do. He could go on as he has for months yet so it is just impossible to say, but I would start to make some calls so you hopefully are ready when the time comes and then things will run smoother.

As far as deciding when it is time, what I always tell my clients is to look at their pet and decide if they are still getting any enjoyment out of their day. Most owners know their pets pretty well and know the things that, through their life, made them happy. Maybe it was a special toy, going outside, greeting their owner, etc. If they are still experiencing those things, then let them continue until that goes away. Most pets, in terminal stages of discomfort or mental decline, get no joy from the things which previously had an effect and begin to with and begin to withdraw into themselves. If that is the case, then it is probably the right decision to intervene. As long as they are alive, in your heart, it will never seem like the right thing, but there comes a time when you realize they are really no longer here anyway.

Good luck with your upcoming time. Max is lucky to be in such a loving family.

I hope this is helpful. Please let me know if you have ANY other questions. My goal is to give you 100% satisfaction and if you are not yet satisfied, please reply so I can clarify for you.

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Dog Specialist: petdrz., Dog Veterinarian replied 2 years ago
Hi,
I'm just following up on our conversation about Max P. How is everything going?
Dr. Z.
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petdrz.
petdrz.
petdrz., Dog Veterinarian
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Satisfied Customers: 7,492
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