1. Your 13-year-old dog has laryngeal paralysis, a progressive condition that is making it harder and harder for her to breathe. She’s getting to the point where she’s literally struggling to take breaths. You
a) Schedule a surgery to treat the condition.
b) Know that the breathing problem is going to continue to worsen and will just put her down when you have to because the risks of anesthesia that go along with the surgery are too great for her.
c) Wait and see.
2. Your 13-year-old dog has a largish lipoma on her side that has been steadily growing. The lump is benign and so far has not been limiting her mobility or comfort, but you’re concerned that it will begin to hinder ability to move about without pain. You
a) Schedule a surgery to have the lipoma removed.
b) Know that the bump is going to get bigger and bigger and will just put her down when you have to because the risks of anesthesia that go along with the surgery are too great.
c) Wait and see.
3. Your 13-year-old dog is diagnosed with osteosarcoma—bone cancer —which is a very painful disease. If you amputate the limb where the cancer has manifested itself and authorize chemotherapy, there’s a chance that your pet will live another year of good-quality life. That’s a reasonably long time for a dog, but the treatment will be costly, and there are no guarantees about the effectiveness of the operation followed by chemo. A year is an average estimate based on research of other dogs, not by any means a prognosis engraved in stone. Some dogs live longer; some succumb much sooner. You
a) Schedule the surgery to amputate the affected limb.
b) Know that her pain is going to continue to worsen and will just put her down when you have to because the risks of anesthesia that go along with the surgery are too great.
c) Wait and see.
As the three scenarios make clear, there is no one-size-fits-all answer. But for the first two, at least, there are truly informed ways to narrow the options. One of them has to do with an understanding of anesthesia in old dogs.
Worries about anesthesia usually a boondoggle
“A common fear people have is that it’s unsafe to anesthetize a dog over a certain age,” says Tufts veterinary surgeon John, Berg, DVM, DACVS. “It’s a question we get all the time: ‘Can my old dog withstand anesthesia’?”
The answer: “as a general rule, it’s very safe to anesthetize old dogs,” Dr. Berg counsels. “It’s probably true that it’s slightly less safe to anesthetize an old dog than a healthy young dog,” he says. “But many of the dogs who are sick and need surgery are old dogs. We anesthetize them all the time, and most do have something wrong with them. That’s why they’re having surgery.”
Of course, he points out, it’s not going to be as safe to anesthetize a very old, very sick dog. But it’s very safe to anesthetize an old dog who has one or two health problems. “In fact,” Dr. Berg says, “it’s extremely rare that we say to an owner, ‘we can’t anesthetize your dog because it’s just too unsafe.’ Maybe for an old dog who has, say, severe congestive heart failure, the risk of anesthesia becomes a real factor in the decision making. But for the most part it’s not. That’s why, in the vast majority of cases, the need for a dog to have a problem corrected surgically is going to outweigh the anesthesia risk.”
Another way of putting it, both for veterinary medicine and human medicine: age is not a disease. “What I’ve always interpreted that to mean,” Dr. Berg says, “is that just because a patient is old doesn’t mean you shouldn’t treat her. Age is a consideration, yes, but there is no such thing as an age that precludes appropriate interventions should a disease arise.”
Which brings us back to Question 1. You can take answer “b” out of the running because you now know that concerns about putting an old dog “under” are unfounded. But what’s it going to be: a) Schedule the surgery or c) wait and see?
The answer is A—go for the surgery, as long as financial considerations don’t preclude it. Why? The positive effects of the operation are immediate. As soon as she comes to, your old friend will be breathing normally rather than struggling to get breath on a minute-to-minute basis. Whether she has six months left or three years, she’ll have a much better, much more comfortable quality of life.
“It’s akin to helping your 85-year-old grandmother breathe easier,” Dr. Berg says. You don’t know how much time she has left, but she shouldn’t have to die of shortness of breath if she doesn’t have to, and can go back to leading a reasonably comfortable, happy life as soon as the operation is over.
Of course, if an owner can’t afford the couple thousand dollars or more for the operation, that’s a different story. And no one is “bad” for deciding not to put themselves into a financial crisis to save their pet. We firmly believe that as long as you love your dog from the moment she’s under your care until the moment she leaves this world, you have made the right ethical and emotional commitment. But if money is not an issue, or if you have pet health insurance, in this case, the operation is the way to go.
That’s true for any condition an old dog might have where an operation brings quick relief and takes a dog essentially back to the quality of life she had before, or at least a quality of life that she can enjoy. If you can afford it, go for it, pretty much no matter how old your dog is, if the problem far outweighs any anesthesia risk.
Okay, but what about scenario number 2, in which the problem, which can be fixed surgically, is not causing immediate harm or danger?
Scenario number 2
Okay, so your old dog has a large, benign lump that at this point is not causing her any difficulty. Do you have it removed in an operation to make sure it doesn’t reach a tipping point that will interfere with her quality of life? It doesn’t sound unreasonable now that you know the anesthesia risks are very, very small.
“I would never recommend removal” in such a case, Dr. Berg says. “The dog, already in her later years, is highly likely to die of something else before the lipoma would ever cause a problem. It won’t interfere with comfort or mobility until it gets huge, and that is unlikely to happen during the remaining course of her lifespan.”
This one is definitely a “wait and see,” as are other problems that need to be watched but are not interfering with your dog’s enjoyment of her days, and not shortening her lifespan, either. No matter what the issue, your veterinarian should be able to go over with you whether treatment can wait based on your dog’s current quality of life measured against her age.
Scenario number 3
Bone cancer, along with other ultimately fatal illnesses like severe heart or kidney disease, is the most difficult kind of disease to make a decision about. That’s because it can’t be predicted with certainty what the result will be in terms of how long the dog will continue to live, and whether she’ll continue to live well. Your dog could live another year, a year plus many more months, or much less than a year. “You’ve got a potentially difficult, costly treatment where the outcome is uncertain,” says Dr. Berg. Complicating cases like this is that “the old age of the dog will make a major surgery like an amputation harder to go through and harder to recover from. It is easier for a young dog to recover quickly from an amputation than a really old dog. It’s more of an adjustment for an old pet,” Dr. Berg says.
Then, too, he says, “if a dog is 11, she would have a much better chance of getting that extra year if her osteosarcoma were treated. A dog who is 13, even without osteosarcoma, might not have a year left. In other words, you have to balance the age and the likely amount of time the dog has left naturally against the odds of extending her life with treatment.
It’s hard, Dr. Berg says. “The very things an owner needs to know—how long will my dog live if we treat her and how long will she live if I don’t—we can’t give an answer to.”
Interestingly, this is a grey area in which an owner can bring something to the table that the veterinarian can’t —a sense of where the dog is in life, regardless of her age. Consider that not all old dogs are alike. “There are 12-year-old dogs who are very old and very tired and not able to deal with as much as when they were three, and there are 12-year-old dogs who are more like three-year-olds,” Dr. Berg remarks. That is, medical care decisions often depend more on the attitude and vigor of the dog than on the age. “The owner probably has more of a handle on that,” Dr. Berg comments. “The owner sees the dog every day, not the vet who is making an assessment during a relatively short visit. That knowledge helps an owner to play the odds.”
And playing the odds is exactly what an owner is doing in that situation. “It’s impossible in such cases to tell owners what to do,” Dr. Berg says. “We can give an approximation, some level of probability, but we can’t say what will happen in each scenario. We are blinded to the outcome.”
So how, really, can an owner finalize a decision? “They have to do it based on a gut feeling,” Dr. Berg says. You can factor in probability on how well and how quickly the dog will recuperate from the surgery, you can factor in her age, how vigorous and happy the dog is regardless of age, cost, all those things, but in the end “it’s impossible to make a purely intellectual decision. There are key pieces of the puzzle the owner just doesn’t have,” he says.
Going with your feelings might not seem helpful, Dr. Berg says, but it is a way of taking all the uncertainty combined with the certainties and synthesizing the whole into a choice. “Generally, we find it’s really helpful to people when there’s no cut-and-dry answer and we advise them to do what their gut and their heart tell them to do. It’s a way of letting them know it’s okay not to be able to make the decision entirely with your brain because there’s just too much missing information.”