I am so very sorry Anne this is just tragic to hear, poor Ella. Especially hard to deal with on her birthday
I don't think that birthday greetings are maybe appropriate yet but it is on our minds.
It's very hard - even for a "normal" dog to manage with only that amount of intestine With Ella's complications, medication etc it is going to be very difficult.
Can you talk to one of the specialists to find out their opinion?
I think everything really depends on how likely Ella is going to be able to have a good quality of life. I hate to even write that to you, I so desperately wanted her to be better as did we all, but we have to think of Ella.
I know no-one likes to give up on their dog when there is any hope at all, but you really have to think of it from the dog's perspective...this is the hardest part of having and loving your dog, knowing when it is time.
The hospital will try to keep her going - it is your decision. [Sadly they also have a financial incentive to do so, that is something you need to bear in mind too.]
I would write down the things that you think are important to Ella to give her a good quality of life. These would be on my list:
Being able to eat and wanting to eat [2 different things] I suspect she will need a very special diet which may be expensive - and are you going to be able to administer it, no treats, keeping her out of the garbage and not allowing anyone to give her anything else?
Managing a short walk - even if it's only 5 minutes for the stimulation.
Able to move about happily - I know her SM is deteriorating too
Managing a cuddle or whatever affection she wants
Not in any distress [pain being well managed - living in chronic pain is horrid]
Obviously you are going to get times where things aren't totally under control and you need to speak to your vet then to see whether it is a temporary crisis or a permanent state.
Most importantly obviously - is Ella going to be able to enjoy life?
I've always felt it is better to let them go too soon, so that they don't suffer. Too many are left too long and that is just cruel and you feel guilty forever.
I feel dreadful writing this, it sounds so negative, but sometimes someone has to say these things