
Back to the vet I'm afraid - at least that's what I'd be doing. I do think, hard as it is always when a dog reaches a good old age, you have to consider whether continuing to keep him going, given all the medication he's currently on , is fair on any of you. Quality of life is paramount for me, and once there is little, the down days outnumber the up days, I believe it's usually time to call it. Unless the vet has alternatives to offer - they had to have no further options as much as we do so if there is anything more he can do he will. If not, then it's time. Sadly. I hope you have a little more time with him of course.
ps I had one on Tramadol when she was end game with terminal cancer. It totally spaced her out so she was taken off it. Never again.