Hoping you'll see this here (I posted the same thing on Canine Club - we're both redundant here but I want to give you the best chance to see this)
No, you *don't* have to do this with every dog ... truly not. Some age and live long (Prissy lived to be almost 21 and Foxy made it to 19) and some die heartbreakingly young (Polly was only 7-8 months old - she only had three months with us!)
It took Billy weeks to truly 'respond'. Some of the drugs -- even tho they are being put in via "iv" take a while to build up to a 'level' in the body. Like cyclosporine specifically has to build to a level of like 600 - 700 'units' in the body (and that took WEEKS in Billy's case). The body only absorbs so much *even* when given IV.
I would be astonished if the liver rates got better -- all these drugs are nasty to the liver and the fact that the billirubin isn't worsening is probably a darned good sign.
Is there any way you can give her a couple more days? I'm not teasing here -- but I'd ask the vet boldly what the chances are here. Is this lack of response typical or is it truly an indication that this just isn't going to work?
The agglutination thing is the wildcard that I didn't deal with. And it's likely going to be the deciding thing here. I honestly think you have to let the vet be your guide.
And if the decision to let her go has to be made, please please remember you have to look at this from Snicker's eyes, not yours. I think aside from the fact that you love her dearly, I think this is likely challenging your personal belief system seriously ... because you feel the decision rests with you.
I never look at it that way. I can't. I look at it either that I'm allowing the dog to make the decision (and Foxy certainly did that -- he *told* me in no uncertain terms he was DONE that day). Even Ms. Socks *told* me she didn't want to live with that sort of pain. The night she came in from the back yard after having suffered one of the 'ruptures' that occurs with some cancers that produces unbelievable pain -- she looked at her bowl (as a dog who used to get so excited about a meal that her teeth would chatter) and shook her head no and turned to ME with a look. That look said "Food is life ... so no, I'm not gonna prolong this".
So this is the reason I like to be with them. Because I see it as a release ... a release from pain, and from feeling horrible.
I've seen humans crave the same release when they'd lived with some horrific disease process. I can't do anything about them and it's not my right. But when I take on an animal, I promise to see to its needs, and when this sort of 'release' is needed I'm the only one who can help with it with the vet's help.
I think part of your decision has to rest with her future as well as her present. I think she would be very very unhappy to suffer as "the sick one" given the relationship with Koahle. I truly think you'll find part of your answer in thinking what Snickers would say to you if she was sitting next to you and could just open her mouth and have real words spill out.
None of this is easy ... it's the hardest part of loving an animal. But it's also the most valuable part of their love ... because thru this we can grow as humans for having loved them. I am better for every single animal I've loved -- I've let them change me.
If you think you will unavoidably break down then it's easier for Snickers for you to not be there.
I think it's important for me to be there. I wouldn't have missed those last couple of minutes with Socks -- I brought her a new ball. She didn't want to play with it cos she felt too horrible. But she appreciated the thot and the 'feel of a new ball in your mouth' was apparently the best gift I could have given her. And with Foxy? It's honestly probably a good thing it was JUST me and the Fox. He never was close to David ... and saying goodbye as just Foxy and I was somehow ... right.
I'm sitting her bawling ... it's hard to lose them ... but oh, the richness and depth of their love has made me SO Much a better person.
I've told you all about Foxy's situation -- and he was ready. I guess it's just part of me being 'me' to want to say goodbye.
It's not easy to maintain control -- shoot I thot I was doing so good with Foxy and later that evening I puked uncontrollably for hours. Would I have changed it? NO WAY.
But I think if you think of your girl and the relationship she's had with you ... how is she going to feel about this? I think you'll find the answer surprisingly clear ... what WOULD she say to you? She tried FOR YOU, Karen. She knew how upset you were and she tried .. so now you have to ask yourself how much 'LONGER' is it right to ask of her?
Life really isn't something that must be extended at all costs ... *quality* of life is too important ... especially to a dog. If you have to release her from pain do it without guilt ... simply because you know she'll be unhappy just lingering, particularly if she can't be with you and fill the role with you she has loved you with for so long.
I'm here if you need to talk.