Visiting Vet: Aging gracefully

When pets are hit with multiple ailments, keeping their suffering at bay is key.

Owners might need to talk about their pet's death and make arrangements. —David Fintz

I only met my little friend Beulah two years ago. She was already a senior citizen, with bilateral cataracts (meaning both eyes were affected), causing vision loss. As many visually impaired dogs do, she had adjusted well, but as she aged, Beulah became increasingly anxious.

There were many possible reasons for this. She certainly had arthritis, a common problem for elders. Perhaps her pain was increasing, making her restless and anxious. Sensory deprivation was another thing to consider. Just like people, as dogs age, the acuity of all their senses can diminish. In addition to the cataracts affecting her sight, Beulah may have been experiencing some degree of deafness and/or loss of sense of smell — all the things dogs use to experience the world and feel safe. What about “senility?” Veterinarians call this cognitive dysfunction syndrome. It’s harder to diagnose pets than in people, as I can’t ask Beulah who is president and what year it is, but there are telltale signs that lead us to consider CDS.

But this column isn’t about senility or sensory deprivation. When Beulah came for her annual physical exam this summer, we talked about all these things. We started her on a nonsteroidal anti-inflammatory drug (NSAID) for arthritis. We started her on fluoxetine (a.k.a. Prozac) for her anxiety. We discussed environmental management and behavioral modification to minimize her anxiety and age-related challenges. And we found one other issue. In addition to cataracts, Beulah had glaucoma.

Glaucoma is defined as an increase in intraocular pressure. The eyeball is basically a fluid-filled sphere in which fluid is constantly being produced and drained. Anything that affects the normal drainage of fluid can result in a buildup inside the eye — like overinflating a tire or a water balloon. The increased pressure inside is painful, and damages the internal structures of the eye, especially the delicate cells of the retina. Untreated, this ultimately can result in blindness. The term glaucoma encompasses a number of different diseases, depending on the underlying cause. Glaucoma is classified as primary or secondary. Primary is generally an inherited condition in which there is abnormal anatomical conformation of the drainage angle inside the eye. Secondary glaucoma occurs when other diseases, such as inflammation or tumors inside the eye, block the drainage angle.

I started Beulah on eye drops to reduce the pressure and inflammation in her eyes. I adjusted her pain medications, now using them for both her arthritis and her eye pain. I advised her owners to consult a veterinary ophthalmologist who could assess whether this was primary or secondary glaucoma, and modify her treatment accordingly. I also strongly advised that if Beulah’s glaucoma could not be controlled, the family consider bilateral enucleation. Yup. That means removing her eyes. I spoke from experience. Many years ago, I had adopted a young Samoyed with primary glaucoma when she began losing her vision at six months of age. She lived a long, happy life with me, but in her later years, when she was totally blind and in pain, I eventually surgically removed both eyes. The difference in her demeanor was remarkable. I had not realized how uncomfortable she had been prior to the surgery, and only wished I had done it sooner. I knew Beulah’s family didn’t want their pup to be in pain, but also understood their preference to avoid surgery if we could control her glaucoma medically.

But this column isn’t about glaucoma. Beulah’s humans took her to the ophthalmologist, who tweaked her medications to improve the response. This helped for a few months. Then Beulah developed a corneal ulcer — an abrasion of the surface of the eye, which can be quite painful. We treated the ulcer and conferred with the ophthalmologist again. Her owners also found a mass on Beulah’s side that was growing fairly quickly. If this was a malignant tumor, we needed to take that into consideration before thinking further about enucleation surgery. Arthritis, anxiety, glaucoma, maybe cancer. What else could go wrong?

Seizures. One weekend in November, Beulah had a seizure. Then she had another. Seizures occur when abnormal electrical activity in the brain leads to loss of consciousness, collapse, stiffness, and classic “paddling” behavior (technically called tonic-clonic action). There are other kinds of seizures, but these generalized “grand mal” convulsions are the most common. The causes for seizures include everything from genetically based epilepsy to infectious diseases to toxins, but in a dog Beulah’s age, the most likely etiology is a brain tumor. I talked to the family by phone. They already had an appointment for Beulah on Monday at the referral veterinary hospital off-Island to see the ophthalmologist. She seemed fairly stable, so we agreed they would call ahead and see if a neurologist there might examine her at the same time. Then, on the way to that appointment, Beulah started seizing repeatedly.

But this column is not about seizures. After consulting with the specialists, Beulah was humanely euthanized. I called her family as soon as I got the news. They were so sad. They were en route to be with relatives for Thanksgiving. They knew that the prognosis for Beulah had been very poor, but were still struggling with having made a decision “to end her life.” Here’s what I told them.

Please never doubt your decision. In the wild, Mother Nature would have ended Beulah’s life years ago, probably soon after she began to lose her vision. We had been able to extend her days, giving her a good quality of life for many extra years. That was wonderful — as long as she wasn’t suffering. But now we had to take responsibility to also give her a good death. That’s what you did, I told them. I have had this conversation many times with many people over the past 40 years, but Beulah’s owners were particularly comforted by my words. “You should write a column about that,” they said. So I did. A good dog. A good life. A good death.