We're home from the vet. The important word is "WE." Cosmos is still with me. He is a miracle dog.
The vet agrees that he does not have much time yet. He's lost four pounds in the last two weeks, now weighting in at slightly over 38 pounds. I remember the good ol' days when Dr. Florio begged me to try to just get his weight under 60. He was even a success story in Richard's short lived Slimmons Newsletter when he got to 58. Now he is skeletal. Getting him to eat is critical. The unfortunate part of renal failure is that it doesn't just affect the kidneys. The animals who get it generally stop eating at some point and starve. That's what we're afraid of here.
She also feels very strongly that it is not yet his time. He's alert, he's interested, he still tries to pursue most of his normal activities. She says that the Ethical Euthanasia list is a tool, I should use it as a guideline, but also use my instincts too. She says that Cozie still seems way to vital to be putting down, despite the number.
We've agreed on the following:
1.) I"m going to increase his IV intake to 750 ml per day, and do it split up over 2 infusions. That should help take the toxin levels down.
2.) He got an appetite shot today, and she sent me with appetite pills which I will use very carefully. The pharmacy does not advise using them for more than five days, so we will start by me giving them to him every other day, then every third day, augmented by the appetite shot if it seems to work. We also agreed that if the situation calls for it, the warnings by the pharmacy about the possible side effects if we give Cozie too much medication are meaningless at this point in his life. They will continue to prescribe the pills to me as he needs them.
3.) I'm to increase his anti-nausea medication to 1 1/2 pills per day.
3.) Cosmos's sluggishness is probably caused by anemia secondary to his heart failure - which is also caused by the renal failure. We agreed that it was not an option to hospitalize him for blood transfusions at this time. The trauma of hospitalization (and the cost) was probably not worth the lifespan that he has left, and that it would likely not influence the quality of his life much at all.
4.) We are not going to resort to force feeding him via syringe. At that point, I feel that is torture beyond justification. He already takes issue at getting force fed his meds via syringe.
5). We are not going to perform any more blood tests on him. Although small, it's still an invasive procedure and the results at this point are meaningless. Cosmos is strictly Hospice. I will inject him with IV fluids, force medicines, and give him appetite shots because they can influence how long he is going to be here and the quality of his life. Beyond that, no more invasive procedures. It's unfair to him.
6.) I do not need to fear leaving him at home for periods of time, even up to a couple of days right now. Although his heart is bad, he is not showing signs of acute distress in that department and it's unlikely at this late date that his heart will take him before his kidney disease does. And the kidney process is a slow one where there is no one right time to release him.
You should know that Cosmos has not smiled in a week. But today, when we got home from the vet and were only a couple of units from his condo, he got the biggest, happiest smile on his face that I've seen for a long time. I swear he knows everything I say (and that he also follows TV intellectually), and that he knew that his life was in the balance today. He's home. Maybe only for a week or two or if we're lucky, a month, but he's home.
Thank you all for your thoughts and prayers. We really appreciate it.