15.5 year old Lhasa with lymphoma

Question
My neutered male Lhasa is 15.5 years old.  One month ago he was diagnosed with lymphoma and told he has anywhere form one to three months to live. We decided against chemo due to his advanced age. He receives prednisone eye drops and an antibiotic eye ointment for an eye infection that led us to the vet in the first place.  Needle aspiration confirmed the lymphoma. He also get prednisone and antibiotic orally.  My questions are in regard to the increased panting and restlessness--he paces the house at night and no longer Nat to sleep on my bed.  He drinks like crazy and his appetite is greatly increased.  I don't know what to do to make him more comfortable.  The second question is in regards to the progression of the lymphoma--what to expect and when it is time to consider putting him down.  I don't want him to suffer. Right now he is still spunky and happy to see us, just slowing down some in his activities.  I worry that I will not be able to make a decision at the right moment to save him form pain.  I know many say better a week too early than a week too late, but this grumpy old man dog has been my little puppy boy for his whole life.  Loosing him will be such a tragedy, but I know he doesn't have much time left.  What to do?

Answer
Hi Eileen,
I am truly sorry to hear this about your dog. It is never easy to hear a diagnosis like this of our beloved pets.
Thank you for being such a good pet owner and for asking these questions before the emotions get too high.

First of all, the increased drinking and eating are due to the daily prednisone he is getting. I don't know what dose he is on but even 5 mg twice a day can increase both of those things. The increased panting is usually a side effect of the steroid also. He is not uncomfortable at this point, indeed he is actually feeling pretty good with that pred in him. It makes you feel a bit euphoric, at least in humans it does, so we are guessing it does the same to some extent to dogs. They actually tolerate prednisone much better than we do.

Now for the hard part. When do you say enough is enough? Dogs with Lymphoma usually start getting thinner and thinner, no matter how much prednisone they are on or how much they eat. That is a side effect of the cancer. Cancers in dogs many times create a situation where the body starts to catabolize the muscles in a desperate attempt to sustain life. Catabolism is when the body breaks down muscle proteins. The result is a wasting away of all muscles in the body-hence the extreme thinness you see in cancer patients.

Long before he would get to that point however, he will stop eating. The prednisone will artificially elevate his appetite for a while, but when he starts to feel the effects of the cancer more his appetite will wane. At that point is when they will tell you by a look, or the fact that he turns his head away from food, that he is ready to go. They do tell you, believe me. I just lost my 15 yr old cat and she let me know in no uncertain terms by giving me a look one morning from under the bed.

We love our animals so much that we become selfish. It is just our nature to hold on Eileen. I wanted to do the same with my Crouton but she was done, she was ready. So I took her into work and it was over so quietly and quickly. When your little guy says no more, you will know. If he doesn't say it, then you must ask yourself at what point is he no longer leading a life of quality. Then it's time.

I am sorry you must make this choice soon. It is very painful but this is what I told myself and everyone facing this same situation:
We are giving them a gift we cannot even give to ourselves. They have given us years of unconditional love- now we get to give them the gift of ending their pain softly.

That helped me through this and I hope it will help you as well. My prayers are with you both.