Thanks everyone for the support
Vet visit wasn't great..but it was as expected (regarding the results and what my vet thought of Keiko's current health). I requested a copy of the vet's notes because we went over so much information there was no way I was going to remember it all! I love my vet so much, I'm so thankful that I finally found a vet I can trust. She really cares for her patients and never tries to push things on me. She respects all my decisions and is very supportive.
Our last visit was 5.5 months ago and the vet noticed right away that he's lost a lot of muscle mass (he's lost 5 lbs). She checked his joints and noticed a big difference in stiffness from his last visit as well.
This was her diagnosis after his physical exam:
Cognitive dysfunction, intracranial neoplasia or other disease, hepatic encephalopathy, other
Skin - pyoderma/fungal, allergy/atopy, contact dermatitis, calcinosis cutis, other.
Joints -DJD, spondylosis, IVDD, neoplasia, other.
NSAID panel - mild azotemia; renal insufficiency; liver enzymes wnl - discussed that we will use NSAIDs with caution given Keiko's poor quality of life without analgesics on board. Consider Cartrophen injections, joint supplements etc.
B/d or J/d would be beneficial for joint health too.
We discussed that we would monitor his response to his medications and his quality of life. If his condition doesn't improve then we would then consider letting him go....ugh. Just typing that is bringing tears to my eyes.