Senior Dog & Cat Tips

Keeping Your Senior Pet Warm This Winter

January 3rd, 2019 by Heaven At Home Staff

Few topics inspire as much controversy as (faux?) fashion for our furry friends. Do they really need coats and booties, or is this a classic case of anthropomorphism? Inquiring minds want to know!

In actual fact, the suitability of pet outerwear depends on a number of variables, including your dog’s breed, coat, age and body condition, plus outdoor temperature and duration of exposure.

“Pets with diabetes, heart disease, kidney disease, or hormonal imbalances (such as Cushing’s disease) may have a harder time regulating their body temperature, and may be more susceptible to problems from temperature extremes,” said Dr. Laurie Brush, founder of Heaven at Home Pet Hospice.


  • As a general rule, if your dog will only be outside for 10 minutes or less, they typically do not need any clothing.
  • Once temperatures drop under 20° F, all owners need to be aware that their dogs could potentially develop cold-associated health problems like hypothermia and frostbite. Watch for signs, including shivering, anxiety, and slowing down. Beware of the wind chill factor.
  • Double-coated dogs such as Siberian Huskies and Newfoundlanders are very unlikely to need clothing.
  • Shorter-haired breeds, senior dogs, puppies and dogs with medical conditions do benefit from the additional warmth.

Paw Protection:

One of the biggest threats to healthy paw pads is the salt used to melt ice on driveways, roads and sidewalks. Prolonged contact with deicers can lead to chemical burns on dog paws. Use pet-friendly salt, and cover your dog’s paws when out on walks with paw wax or booties.

  • Booties offer the best protection: Options include rubber-sole styles with double Velcro straps, waterproof nylon socks, and disposable rubbers.
  • For elderly dogs who are more prone to slipping and falling on ice, you may wish to try booties with a grip.


Bed Warmers for Arthritic Dogs and Cats

If your feline friend or canine companion is elderly and/or suffers from arthritis you may wish to offer a heated orthopedic bed. Styles range from simple heating pads to luxurious heated lounges. Use caution with external heat sources, ensuring your pet is able to get up and move off the heat source if he/she becomes too warm. You may wish to discuss the type of heat source you should use with your veterinarian.

Tips to Avoid Stressing Your Elderly Dog or Cat During the Holidays

December 19th, 2018 by Heaven At Home Staff

You might think holiday stress is confined to last-minute-shopping humans, over-burdened hosts or folks with in-laws they secretly refer to as “outlaws.” If the holidays are stressful for you, imagine how your aging pet feels. Your own stress plus the bustle of the holiday season compounds pet stress, and it takes elderly animals longer to bounce back. Follow these tips to help your pets have a stress-free, happy holiday.

Read the rest of this entry »

The Conundrum of Feeding Your Senior Pet

September 18th, 2018 by Heaven At Home Staff

SrPetillus_580x300Many pet parents are confounded by conflicting advice on pet food in general, whether it’s commercial, grain-free, biologically appropriate and/or raw. This confusion can be compounded as your pet ages and is faced with medical conditions that require special consideration when it comes to diet. Many diseases that are common in older dogs and cats may be nutrient-sensitive, meaning that diet can play an important role in the management of the condition. As a general rule, dogs and cats 7 years of age or older are at risk of age-related diseases, though specific breed size, genetics, and physical condition influence the aging process.

Dr. Laurie Brush, founder of Heaven at Home Pet Hospice, says senior pet nutrition can be a complicated issue but that conscientious pet parents can help their senior pets enormously by dialing in their pet’s diet to prevent obesity.

“It’s important to work with your routine care veterinarian and adjust your feeding approach as your pet ages,” she said.

“Obesity aggravates many conditions, such as arthritis and diabetes, and accelerates the aging process.  At the same time, if your pet is underfed or receives inadequate protein, waning muscle mass may reduce the effectiveness of your pet’s immune system. It can be a tricky balance,” she said.

In the course of the home visits that Dr. Brush and her staff make to provide palliative care for senior and terminally ill pets, she sees the product of both ends of the spectrum: overweight pets who suffer ailments and mobility issues exacerbated by overfeeding, and pets who’ve lost interest in the foods they once loved.

“Every senior pet can benefit from extra attention to nutrition,” she says. “It can make a real difference in the quality of life a senior pet enjoys.”

Understanding Energy Needs in Senior Pets

Just like humans, companion animals have individual and specific Resting and Maintenance Energy Requirements (RERs and MERs) that vary based on genetic potential, health status, and whether the animal is intact or neutered. RERs refers to the metabolic resting state; MERs refers to maintenance and is dependent on activity level. Research suggests that MERs decrease with age in dogs just as it does in humans. In one study of English Setters, Miniature Schnauzers and German Shepherds, the MERs of 11-year-old dogs were approximately 25% less than 3-year-old dogs.

Among the veterinarian community, it’s generally accepted that senior dogs require approximately 20% fewer calories than their younger peers due to this reduction in energy requirement coupled with lessened activity. To reduce weight in an overweight dog or cat, vets use a formula to calculate 80% of the calories required for RER.

On the other hand, some senior pets can suffer malnutrition and weight loss that aggravates their conditions. Veterinarians may prescribe appetite stimulants to improve nutritional intake. In this case, it is also helpful for pet parents to familiarize themselves with energy requirements to help ensure their senior pet is receiving adequate nutrition.

(See: How to Count Calories for Your Senior Pet)

The case of cats is more complex when it comes to senior energy needs. Short-term research suggested that aging cats did not experience the same kind of reduction in energy requirement, but long-term studies indicated a reduction of approximately 3% per year through age 11. From ages 12-15, however, the energy requirement per pound of weight actually increased in cats.


The Importance of Caloric Makeup –

Research on Protein

One belief that has long circulated in the pet food world is that senior dogs and cats need a low-protein diet to protect against kidney disease. The belief originated from  rodent research performed in the 1940s that has since been disproved. Instead, numerous research studies have confirmed that protein does not adversely affect the kidneys in either healthy older dogs or cats.

In fact, research by veterinarian nutritionist Dr. Delmar Finco, among others, suggests that the need for dietary protein may actually increase in senior pets by as much as 50%.  His research also showed that higher protein diets were associated with greater life spans.

One study comparing protein requirement in 2-year-old Beagles versus 13-year-old Beagles found that the senior dogs needed at least 50% more dietary protein.

Research also suggests that L-carnitine, a vitamin-like compound made from amino acids found in red meats, fish, chicken and dairy products, may help the body use fat for energy.

“High-quality protein with good amino acids should make up a healthy portion of a senior pet’s daily caloric intake, at least 25%. A pet parent’s veterinarian is the best resource for help ensuring this is the case,” Dr. Brush said.

Watch Fat Intake, Take Care with Carbohydrates

“Fewer of the pet’s calories should be from fat because fat leads to inflammation, which can be problematic for arthritic pets.” Dr. Brush said.

Carbohydrate percentage in pet food has been in the spotlight in recent years, with many consumers trending toward grain-free options. While Dr. Brush has heard anecdotal evidence from clients who’ve elected grain-free options, she cautions pet parents to fully discuss the implications with their veterinarians. Recently, the FDA launched an investigation into unusual cases of DCM – dilated cardiomyopathy – in pets who were fed boutique, grain-free foods high in legumes like lentils and peas. The current (and early) theory is that the legumes may interfere with the production of  the vital amino acid, L-taurine. Some manufacturers have responded by supplementing taurine, which is essential to pet metabolic health, but there are still many unknowns.

“In general, it’s best to ensure that the high-quality protein is coming from meat, not protein-dense carbohydrates,” she said.

Other Nutrient Considerations:

Apart from avoiding high-fat foods and ensuring at least 25% of calories are coming from good protein sources, there are a number of supplements that are reasonably time-tested to improve health in aging companion animals, such as Fish Oil and Glucosamine. However, all supplements are not created equal, and are not tested by the FDA. Pet parents should discuss supplements and brands with their veterinarian, and consider using supplements formulated for veterinary use.

• Fish Oil – 1,000 mg twice daily for dogs < 50 lbs, 2,000 mg daily for dogs > 50 lbs.

• Glucosamine – Many veterinarians recommend approximately 500 mg of Glucosamine and 400 mg of Chondroitin per 25 pounds. For oral Glucosamine for dogs, a typical dose may be: Dogs 5-20 pounds: 250-500 mg. Dogs 20-45 pounds: 500 mg.

• Prescription Cat & Dog Food – Most veterinary clinics supply special formulations for pets with specific health conditions. For example, pets with renal (kidney) disease should avoid foods high in phosphorus and calcium, which can exacerbate their illness.If your pet does not find one particular brand of prescription pet food palatable, there are multiple others that can be tried. Work with your veterinarian to find a food that they like and that will make them feel better.


Senior Feeding Problems

Depending on the age-related disease or condition of your pet, you may find that Fido has lost interest in food, has trouble chewing, or difficulty with digestion. Here are some things pet parents can do to make feeding more palatable to their senior pets.

  • Warm food slightly – it releases the aroma and heightens interest
  • Supplement with soft foods for pets that have difficulty chewing
  • Dental disease can sometimes be ameliorated with antibiotics if your pet is not healthy enough to undergo anesthesia for a dental procedure
  • Elevate the food and water dishes to make it easier for your pet to access them
  • Hand-feeding may work with some dogs
  • Adding low-sodium broth to food can make it more palatable

Feeding your senior pet an ideal diet for his or her age and condition can be complex, but help is available. Heaven at Home Pet Hospice can work with your routine care veterinarian or a veterinary nutritionist to help you manage your senior pet’s nutrition and give your fur baby the highest quality of life possible for his or her final chapter.


Tips & Tools to Count Calories for Your Senior Pet

September 18th, 2018 by Heaven At Home Staff

TipsnTools_580x300A pet parent who wants to optimize their aging pet’s health by preventing weight-gain but maintaining a healthy weight has two avenues to success – controlling the inputs and measuring the output. In other words, “Read, Feed and Weigh.”

In this guide, we’ll help you gather some tools to figure out how much food your fur-baby needs to stay fit, from calories calculators and activity trackers to the Body Conditioning chart that helps you assess your pet’s score.

Calorie Calculators

To get a rough idea of calories required by your pet, you can use this embedded calculator from Plato Pet Foods, which is based on Ohio State University Veterinary Medical Center data. However, you can also consult with your routine care veterinarian for breed-specific and diet-specific advice. See our companion article about Feeding Your Senior Pet.

Online Pet Tracking for Weight & Calories Consumed

SampleScreenHealthTrakOne tool pet parents may find helpful is a new Pet Calorie tracker developed by PetSci in the UK. HealthTrak ( is a (beta) online system that allows you to track the caloric intake of your pet against the ideal weight sought for your pet’s breed. If your current brand of food is not in the database, it’s easy to add it by looking up the nutrient profile online or on the bag. By tracking calories and weighing your pet weekly either at your veterinarian’s office or at home, you will be able to tell how well you’re doing with a general balance between MERs (Maintenance Energy Requirements) needed and Calories consumed.

Fitness Trackers for Pets – Show Calories Expended

Fitbark_illusAnother new device can give you further insight as to your pet’s caloric expenditure based on activity level. FitBark ( is one of a few new Fit-bit style canine trackers that has a nice app interface that will show you Fido’s activity level, sleep quality, and approximate calories expended each day. The lightweight device is attached to your pet’s collar and shows results on your mobile phone. The data can be shared with your vet.

But you don’t have to go high-tech to get the job done. Reading the label for true calories per cup and then feeding according to weight management charts available from your vet or online will help you manage your pet’s weight.

Online Resources include:

Body Scoring – How to Tell If Your Pet is Obese

Dog+Body+Condition+ScoreA Body Scoring Chart (BCS) is your vet’s “go-to” chart for identifying obesity in dogs and cats. Charts are graded on either a five-point or nine-point scale, and are available for both dogs and cats.

A BCS is based on four criteria: how easily felt the ribs are, how obvious the waist and abdominal tuck is, how much excess fat is beneath the skin and how much muscle mass is present. For a dog to score in the healthy range, the ribs should be easy to feel (but not see) and a defined waist, or “abdominal tuck,” should be evident when your dog is viewed from the top and side respectively. Depending on the thickness of your dog’s coat, you might have to feel for a defined waist or tuck if it is not readily visible.

 Download a PDF of a full body condition scoring chart here from the American Animal Hospital Association that includes BOTH Dogs and Cats and shows BOTH styles of scoring points with the illustration:

The Science Behind Calculating Energy Requirements

If you’re interested in the formula vets use to calculate Resting Energy Requirements or RER, it’s this:  The animal’s body weight in kilograms raised to the ¾ power by 70.

For example, a 10kg (22lb) adult neutered dog of healthy weight needs RER = 70(10kg)3/4 ≈ 400 Calories/day. The RER is then multiplied by factors to estimate the pet’s total daily energy needs. Eg. Active, working dogs require 2.0 – 5.0 the RER; puppies 4 mos. to adult require 2.0 the RER, and inactive/obese-prone dogs require 1.2-1.4. Senior dogs typically need 1.2-1.4 RER, and cats approximately 1.5.

Senior Feline Health Issues

July 25th, 2018 by Heaven At Home Staff


As our kittys age, physical and mental changes occur just as they do with people. Their metabolism may change, they sleep more deeply and may not be able to jump as high as they once did when they were younger. This being said, cats should be seen more often than once a year (recommendation is every 6 months) as they begin to age, usually around the age of 7 years of age.
It is always easier to treat a disease if caught early on and cats often do a great job at hiding some of these changes. They may often be subtle changes that we chalk up to slowing down due to age but these changes could also be due to a medical issue.

Signs to watch for as our feline friends age:

  • Not grooming themselves or a greasy hair coat
  • Bald patches
  • Decreased or increased appetite or thirst
  • Weight loss
  • Eating and drinking more but still losing weight
  • Blood in the urine
  • Unable to urinate (especially male cats)
  • Unable to defecate
  • Any changes in litter box habits
  • Coughing or difficulty breathing
  • Has a lump
  • Not wanting to play (if they are generally playful)
  • Not wanting to be petted (if this is something they typically enjoy)

    Changes in Senses: Vision, hearing and taste may affect our senior cats. You may not even notice these slow, subtle changes as cats tend to easily compensate for them early on.
    Any time the cat’s sense of taste and smell have altered, food may not be as appetizing as it once was. If your kitty is not eating, try warming up canned food a tiny bit to see if the smell and taste are more appealing.

    Behavioral changes: Cats often mellow with age and spend more time sunbathing and lounging on our laps. They tend to be less curious. If your cat is normally cranky and that personality changes, this warrants concern. Same goes for a cat that is generally very sweet then suddenly becomes more cranky. The elderly felines do not handle stress well so if you are thinking about adding a kitten, this may not be the best idea. Senility can also affect cats though it is not as common as it is for dogs. Things you may notice, if they forget how to use the litter box, forget where the box is, or walk around disoriented you should check with your veterinarian about health concerns.

    Most common health issues we see in cats are related to kidney and thyroid issues. The most common thyroid problem in older cats is hyperthyroidism (an overproduction of thyroid hormone). If left untreated, heart and liver problems will occur causing the cat to become more sick. There are treatment options available; Radiotherapy, surgery, medication and most recently available, and iodine-restricted dietary management. Check with your veterinarian for the best option for your feline companion as each case varies.

    Urinary issues also affect our senior felines. Sometimes chronic (slow and long term) or acute (rapid onset and urgent). Treatments vary depending on specific case.

    Bad breath, tartar and gum inflammation may be a sign of tooth damage, periodontal disease, oral cancers or ulcers and even systemic health issues in our feline friends. Your veterinarian will discuss any concerns noted on physical exam.

    We know this is hard to believe, but Hypertension (high blood pressure) is fairly common in our senior cats. Many diseases can be associated with hypertension.

    Arthritis can affect our senior felines just like people. They may require assistance getting up onto surfaces or even into their litter boxes. Stairs can become problematic as our feline friends age, so take where their litter box is located into consideration. You may also need to get creative in the type of litter box you have, sometimes these arthritic kids have a hard time getting into a box that has high sides for them to step over. A paint tray or cookie sheet offer easier entry.

    Diet and keeping our cats at a normal weight is important. Overweight felines generally have a shorter lifespan than those that are at a normal weight. As with humans, extra weight can cause other health concerns as well. Today’s feline life expectancy is approximately 20 years. Enjoy this special time with your kitty and pay special attention to any subtle changes.

  • At-Home Pet Euthanasia: Ways to Say Goodbye

    June 14th, 2017 by Heaven At Home Staff

    Owner with aging dog before euthanasia depicting home euthanasia services in Grand Rapids, MIHeaven at Home Pet Hospice knows there’s no easy way to say goodbye to your loyal fur-family member. However, through helping hundreds of Grand Rapids and West Michigan pet owners provide peaceful passings, Dr. Laurie Brush feels there’s therapeutic value to celebrating the life of your pet during a euthanasia home visit.

    “Death is hard to talk about,” Dr. Brush says. “But it doesn’t need to be fraught with struggle. This might be the worst day of your life, but it doesn’t have to be the worst day of your fur-baby’s life. On the contrary, we can help your pet pass comfortably with dignity and compassion.”

    By performing home euthanasia for companion animals, Dr. Brush’s goal is to prevent animals from experiencing the stress, and sometimes fear, of trips to the vet when unwell.

    “Our service allows pets to be with their family one last time in a familiar, comfortable environment, surrounded by their favorite people, toys, bed, and blankets.”

    Dr. Brush feels it’s important that clients are prepared for the process of euthanasia, and that they’ve had a chance to ask questions, complete paperwork, decide on burial or cremation options and otherwise be prepared prior to the time so they can focus on comforting their fur-baby and celebrating his or her life.

    Planning for Pet Euthanasia at Home

    While there’s no easy way to say goodbye, there are ways you can prepare for your pet’s passing in advance. Bringing treats, sharing stories, and thinking of ways to make your pet comfortable will all work together toward a loving departure. The following are a few considerations:


    • There Are Forms to fill out: At the time of our house call we initially take care of the legal paperwork. A consent form is signed by the legal guardian as well as verification that your pet has not bitten or scratched anyone in the past ten days, to comply with the Rabies law. (If there has been a bite or scratch, we can still proceed, but Rabies testing and additional paperwork will be required so we usually try to discuss this in advance.) Other forms will ask you to confirm the type of cremation you have selected if that applies. 
    • Consider Your Other Pets: One advantage of at-home euthanasia for dogs and cats is that it helps the other animals in your home to know that their friend has passed because other pets will grieve for their friend too. They often know when another pet is sick or failing. It is thought that their noses will know that another pet family member has died. Giving them the opportunity to see and smell the deceased pet prevents them from continually searching for the pet who is no longer there.
    • Decide Who Will Attend: If you’d like your entire family present to say goodbye, we can schedule a time to accommodate that. If you have children, explain what’s happening in advance to help them prepare for the loss of their friend. The American Humane Association recommends books such as Fred Rogers’ When a Pet Dies as a way to provide comfort and understanding for children. We have other resources on our website we often recommend such as which has a good resource section for Pet Parents on kids and grief. Among other things, they suggest books such as “Dog Heaven” by Cynthia Rylant; “Cat Heaven” by Cynthia Rylant and “A Special Place for Charlie” by Debby Morehead.
    • Communicating with Children about Euthanasia: It is best to speak in honest terms, at an appropriate level of detail for the child’s age. Very small children need to know that this is final – the pet isn’t going to wake up or come back. To say that the pet “went away” or is “in heaven” without offering any other details can also confuse children. Older children need to know the reasons why this decision is being made, and why it is humane for the suffering animal.
    • Choose the Location: Many of Dr. Brush’s clients choose a pet’s “favorite” location in the home or yard to host the passing. This helps soothe the pet. Sometimes that means she’s found herself cuddling up in a closet to conduct the procedure; other times, enjoying a sunny day by a favorite tree.“What’s important is that the last resting place of the dog or cat is where they are comfortable. I think we’d all like to be in our favorite place when we die,” she said.


    What To Expect In The Process of Euthanasia

    Some veterinarians use a slightly different process for euthanasia, but at Heaven at Home, we always use a two-step procedure.

    First, a mixture of medication is administered just under the skin with a small needle to help the pet relax. This sedative is used to create a deep, pain-free sleep for the animal that is peaceful for their owners to witness. This can take up to 15 minutes to have its full effect, and this time can be spent comforting your pet, remembering special times, or just sitting quietly, as you choose.

    Once the doctor is sure that your pet is completely relaxed, and not feeling any pain, a final injection of pentobarbital is discretely administered. The Doctor will always tell you before performing this final injection.

    Pentobarbital is a liquid barbiturate that will be given at a lethal dose. Because this solution has an anesthetic effect and depresses the central nervous system, your pet will continue to be unconscious and pain-free.

    Once the solution has been administered, the Doctor will listen to your pet’s heart and will inform you when your pet has passed on.

    When the muscles relax, there may be some body fluids or stool that passes. We are always prepared for this and will have some absorbent waterproof pads to help keep your pet, and surfaces under your pet, clean. Your pet’s eyes may not stay closed, but if this is uncomfortable for family members, we can help to close them. Sometimes, there are twitches or movements and/or sounds as the air and energy leave your pet’s body.


    After Euthanasia

    There are a few options for taking care of the deceased pet’s body. Heaven at Home can help you wade through these options, and can coordinate your pet’s cremation with a local crematory. Some people prefer to bury their pets. Local regulations and guidelines can be confirmed with the county where you plan to bury the pet. If cremation is chosen, Heaven at Home will take your pet after the euthanasia and arrange for cremation. We often work with  Sleepy Hollow Pet Cemetery, which offers both burial and several levels of cremation:

    Some of the options at Sleepy Hollow include:

    • Private Cremation –Your pet is individually cremated. Cremains will be returned to the owner.
    • Semi-Private Cremation –Two or more pets are cremated at the same time, but kept separate and a barcode system is used to identify your pet. Cremains will be returned to the owner.
    • Memorial Cremation – Your pet is cremated with other pets. Cremains are interred at Sleepy Hollow

    It usually takes about a week, give or take a few days, for cremains to be returned to Heaven at Home. Then we will contact you to make arrangements to get your pet home to you. Cremains are placed in a small floral tin unless a different urn is purchased.


    Other Forms of Commemoration:

    Heaven at Home and partner vendors such as Sleepy Hollow can help keep your companion close in spirit with cast paw prints, commemorative jewelry, and other items. Keepsakes can be especially helpful during the grieving process.

    You may also find one of the following helpful: Planting a tree in your pets’ memory in a location they loved; donating to an animal protection organization or animal health research entity in their name; crafting a commemorative plaque; and creating a commemorative photo album.


    Understanding Grief and Loss

    Losing a pet is losing a family member for our clients. Grief and even feelings of guilt are expected after the loss of a pet. To move through the healing process, be certain to be kind to yourself, and talk about your feelings, emotionally and constructively, with others. Using a journal to explore your feelings will help ease the pain over time.

    If the grief and sense of loss are overwhelming or prolonged, counseling and support is available from several sources, both online and off-line. For a variety of pet grief support articles, visit our friends at Veterinary Wisdom:

    Our local pet loss support group in Grand Rapids meets about once a month and is facilitated by Ginny Mikita. Please contact Ginny by phone at (616) 460-0373 or by email at if you are interested in participating.

    There is also a pet loss support group in Muskegon by Clock Timeless Pets.

    Please Contact Us for more information about either of these groups.

    Be aware that pets may also grieve for the loss of their companion, too. They may exhibit grief by: not eating, not enjoying formerly favorite activities, or mild lethargy. Providing them with extra TLC and interaction with other pets may help to ease the transition for them. These behaviors should be mild and short-lived. If they persist or are dramatic, seek veterinary support.


    Know You Did The Right Thing

    Whatever you’re feeling, and however natural feelings of guilt may be, it’s important to understand the beautiful gift you’ve given your pet.

    “A peaceful, pain-free passing is the greatest gift you can give your fur-family member at the end of a well-lived life,” says Dr. Brush. “No one wants their pet to suffer.”





    Pain Management for Arthritis in Dogs and Cats

    May 2nd, 2017 by Heaven At Home Staff

    dog with arthritis suffering pain to illustrate pain management tips for arthritic dogs and cats in grand rapids miOne of the toughest things our West Michigan dog and cat owners encounter is dealing with that scourge of aging pets, arthritis. In making her palliative care rounds, pet hospice veterinarian Dr. Laurie Brush hears stories of how the once sunny and agile ‘Bessie the Boxer’ can no longer play ball or manage the stairs. Tommy the Tabby cat won’t allow a cuddle. And Lucy the Lab is absolutely miserable with her hip dysplasia.

    The culprit is arthritic pain, and if your dog or cat is dealing with it, they can transform from playful pals into crotchety companions.

    “Clients may see a personality change. Their pet may become aggressive, or not interact the way they used to,” Dr. Brush explains. “Our treatment goal is to reduce suffering in ways that will not compromise the animal’s overall health. This requires what is known as multi-modal pain management.”

    In other words, NSAIDs (Non-steroidal anti-inflammatory Drugs) alone will not combat suffering. In fact, for many aging pets, NSAIDs are the least promising intervention because they can exacerbate poor kidney or liver function in aging pets, and because they may not get to the root cause of the pain.

    “There are incredibly successful strategies available today for pain management in arthritic pets, such as cold laser therapy, PolysulfateD Glycosaminoglycan (PSGAG) injections, and orthopedic interventions that can be implemented in the home. Cold laser therapy can result in dramatic improvements in some cases,” Dr. Brush said.

    Pet owners can take comfort in knowing they can truly help their pets enjoy their sunset years and reduce suffering.

    “I believe in empowering pet owners with at-home interventions to help keep their fur babies comfortable,” she said.

    But first, it’s important to understand some of the contributing factors to dog and cat arthritis.

    What Causes Arthritis in Dogs and Cats?

    Degenerative Arthritis Due to Old Age:

    Osteoarthritis, also known as degenerative joint disease (DJD), is defined as the progressive and permanent long-term deterioration of the cartilage surrounding the joints. Arthritis is the medical term for inflammation of the joints, while osteoarthritis is the term referring to a form of chronic joint inflammation caused by deterioration of joint cartilage. Older dogs are at the highest risk.

    Additional conditions that can result in painful arthritic changes and decreased function: 

    • Obesity
    • Hip dysplasia
    • Cruciate ligament and meniscus damage in the stifle (knee)
    • Osteochondritis dissecans (OCD)
    • Spondylitis (a degenerative condition of the joints in the spinal column)
    • Other joint injuries due to trauma

    How Prevalent Is Arthritis in Dogs and Cats?

    Most dogs begin showing arthritic symptoms at 6 or 7 years old. While some arthritis can be prevented by maintaining an ideal body weight in one’s dog or cat, most dogs will experience some sort of arthritic pain as they grow into old age. Large breed dogs (generally over 50 lbs.) are more susceptible to arthritis and will show signs sooner than smaller breeds of dogs. Over 90% of geriatric cats and one out of every 5 dogs over the age of 7 have arthritis.

    • Labs, German Shepherds, and large breed dogs, in general, are genetically prone to suffer hip dysplasia as they age, which can make them miserable.
    • Signs of arthritis in dogs include limping, slower movements, unusual gait or hunched appearance, reluctance to jump up or use stairs.
    • In cats, arthritis symptoms may be more subtle, such as difficulty using the litter box, tiredness, and a reluctance to jump up to heights they used to have no trouble with. Their gait may become minced or tippy-toed.

    Home Intervention Tips: Gait, Weight, Omegas and Foam:

    •  Gait – Improper gait due to unclipped toe nails (dogs) or claws (cats) can exacerbate existing arthritis, and is even believed to contribute to Osteoarthritis. Be sure to keep your pets nails/claws clipped.
    • Weight – Maintaining a healthy weight can avoid undue wear and tear on joints and prolong pain-free spells. It’s extremely important that pets with arthritis be kept as lean as possible. Extra weight puts added stress on the joints, and makes it harder for your dog or cat to get proper exercise.
    • Omega 3 and 6 Fatty Acids – Either through diet or as a supplement, Omega 3 and 6 (eg Fish Oil) can help reduce inflammation naturally in pets.
    • Foam – Norsk Reversible foam floor padding will help dogs get traction on slippery surfaces, reducing the risk of painful falls and decreasing the pressure on sore joints. Dr. Brush recommends placing the mats color-side down to give your pet the best traction. You can find them here.
    • Orthopedic beds – Orthopedic pet beds range in price from $50 at big box stores to hundreds of dollars at Orvis or Dansk. Dr. Brush highly recommends orthopedic pet beds to give your pet relief.


    Home Hospice Pain Management Services:

    Dr. Brush takes a “multimodal” approach to helping manage arthritis pain in pets. During home visits she will assess your pet’s condition, assess things that can be changed in the home environment to help your pet stay a part of the family, review records from your routine care veterinarian if available, and develop a hospice care plan fopr your pet. That plan may include the injection of a disease-modifying osteoarthritis drug belonging to the PSGAG family, cold laser therapy, additional pain medication if indicated, and environmental enhancements or supplements such as foam padding and nutritional supplements. Clients who choose to can be trained to administer injections to reduce the number of visits required.

    What Are “Disease Modifying Osteoarthritis Drugs” – PSGAG Injections

    PSGAG stands for polysulfated glycosaminoglycan, which is considered a “disease-modifying osteoarthritis” drug or DMOD.  Once injected, the PSGAG is distributed into joint fluid and cartilage. Although the exact mechanism of action is not completely understood, PSGAG inhibits enzymes that contribute to cartilage degradation, thus slowing cartilage breakdown in OA joints. By blocking cartilage degradation, PSGAG helps decrease inflammation—an important source of pain. PSGAG also contributes to cartilage healing by providing the body with the building blocks of cartilage. Finally, this medication improves the consistency of joint fluid, providing better joint lubrication, improving joint mobility, and increasing comfort in dogs and cats with OA.

     PSGAG Characteristics:

    • Limits cartilage deterioration
    • Promotes new cartilage formation
    • Thickens the joint fluid – thus acting as a better lubricant
    • Increases blood flow and reduces joint inflammation
    • By virtue of these actions, it provides pain relief for a much longer period of time
    • Treats all joints of the body at the same time

    Pet owners can consult with Dr. Brush to determine if a series of PSGAG injections are suitable for their pet. Dr. Brush can also teach pet owners to administer injections themselves to decrease trips and fees since the initial course of injections is usually given once weekly for 4 weeks.


    Cold Laser Therapy for Dogs and Cats:

    Cold laser therapy is one of Dr. Brush’s favorite treatments for arthritic pets.

    “It’s not painful to the pet and we usually see quick results,” Dr. Brush says.

    Laser therapy is popular with veterinarians because it’s a pain-free, noninvasive treatment with multiple applications. It can provide pain relief and improve healing in cases of arthritis, acute and chronic pain, back injuries, strains, and sprains, inflammation, and edema, wound healing, and more. When used to treat acute or chronic pain (such as with arthritis), pain medications can often be reduced or eliminated after laser therapy treatments.

    The type of cold laser used by Heaven at Home Pet Hospice emits billions of photons of light that are absorbed and transformed into chemical energy by the body to promote faster cell regeneration and healing. The process, known as photo-biotherapy, stimulates protein synthesis and cell metabolism, which improves cell health and functionality.

    How Laser Therapy Works:

    There are three key ways in which photo-biotherapy can reduce, eliminate or prevent pain in your cat or dog:

    • Inflammation is reduced through vasodilation (opening of blood vessels), and by activating the lymphatic drainage system, thus draining swollen areas. Swelling caused by bruising or inflammation is reduced which alleviates pain.
    • Laser therapy stimulates nerve cells that block pain signals from being transmitted to the brain.
    • Laser therapy stimulates the production of high levels of endorphins, which are pain-killing compounds naturally produced by your pet.

    While cold laser therapy is not indicated in every case it is very often an additional adjunct treatment worth trying.

    Many pet owners have seen dramatic improvements in their dogs and cats who underwent the treatment. In most cases, pets feel better within 12-24 hours of treatment.

    Don’t Try This At Home:

    Heaven at Home staff and other trained professionals use pro laser gear that’s been industry tested, such as the ML830, FDA-cleared, Class 4 Therapeutic Laser.  Dr. Brush cautions well-meaning pet-owners against the “wild west” of internet laser sales, where an unregulated industry currently passes off various calibrations as being effective. 

    “The research, and hence, our usage, is based on very precisely calibrated equipment that delivers exactly the intended amount of energy. While I wish there were proven, affordable, home versions of Cold Laser for pets, the industry is not there yet, so beware of internet ads hawking low priced lasers — they’re not proven,” Dr. Brush says.

    For an at-home pain management consultation, Contact Us.


    Senior Pet Tips: Managing Incontinence in Senior Dogs & Cats

    March 1st, 2017 by Heaven At Home Staff

    As pet home hospice veterinarians, we regularly help pet owners in Grand Rapids and West Michigan care for aging and terminally ill dogs and cats to keep these loyal companions comfortable during their final stages of life. One of the more common problems we face with these pets is incontinence.

    There are a number of reasons why your canine companion or feline friend has become incontinent with advanced age or illness, ranging from changing hormones, spinal or nerve issues, infections or a particular illness, increased stress, or simply aging. Though a licensed veterinarian should be the one to make a formal diagnosis, below we’ve listed some of the common causes of incontinence in dogs and cats and potential steps to mitigate the problem.

    Top Causes of Pet Incontinence

    • Urinary Tract Infections – UTIs can cause pets to lose bladder control due to increased frequency and need to void. Bladder infections are more often seen in female dogs than in males, and affect all ages, but are especially prevalent in senior dogs.

    • Hormone Imbalance – Just as our hormones fluctuate as we age, this process also happens within our pets. A hormone imbalance or deficiency in older dogs, especially spayed females, may lessen their ability to keep their urinary bladder sealed shut, resulting in leaks or bigger accidents. During the doctor’s visit, she may prescribe a medication to help with urinary sphincter control. If your pet responds well, he or she may need to take these medications for the rest of his or her life. Fortunately, side-effects are pretty rare and usually mild.

    • Diseases – The most common diseases that cause incontinence include diabetes (usually results in excessive thirst, followed by a predictably excessive amount of urination), kidney or liver disease, polyps or cancerous growths in the urinary tract or prostate, and bladder stones.

    • Canine Cognitive Dysfunction Syndrome (basically this is the dog equivalent of human Alzheimer’s disease) can lead to old dog incontinence problems too. Dogs with CDS can ‘forget’ the house training habits they’ve known since they were puppies. Studies show that about half of all dogs who are eight years or older show some signs of this condition. By age 11, it’s over 60%.

    • Endocrine disorders – These disorders include Cushing’s Disease and Addison’s Disease.

    • Stress-related Incontinence – Psychological or emotional issues like extreme stress or anxiety can also trigger old dog incontinence, although usually on a more temporary basis.

    • Old Age – The aging process itself often means that muscles, nerves, and organs don’t work as well as they used to. Lack of muscle tone or weak nerve impulses can cause a loosening of the bladder sphincter (muscle at the ‘neck’ of the bladder, which holds it closed) and cause your pet to unintentionally dribble urine.

    Causes of Incontinence Specific to Cats

    • Feline Cognitive Dysfunction Syndrome – This age-related feline disorder has roots in neurological degeneration in cats age 10 or older and is a progressively debilitating condition whose signs resemble those associated in humans with Alzheimer’s disease and senile dementia.   In addition to signs of spatial disorientation, lack of interest in playing, excessive sleeping, and indifference to food and water, cats suffering cognitive dysfunction syndrome will frequently urinate and defecate outside the litter box.

    • Feline Arthritis – Felines suffering from arthritis may show overall stiffness, swelling of the joints, lethargy, lameness, decreased flexibility and discomfort when you pet or handle them in certain positions. You may also notice subtle behavioral changes, including decreased activity and a hesitancy to climb stairs or jump up on things. Many of these cats forego the litter box due to the pain caused by getting in and out of the box.

    Treatment for Your Incontinent Dog or Cat

    Urinary incontinence can be the whole problem, but it can also be a symptom of another underlying health issue. It is important to diagnose the underlying cause of incontinence so that your pet (and you!) don’t suffer needlessly. There are many effective treatments for incontinence issues, ranging from medications and supplements to surgery. In cases where medications aren’t indicated, there are still strategies for preventing complications from incontinence.

    • Antibiotics – Incontinent pets have a much higher incidence of bladder infections. It is believed that with the more relaxed opening to the bladder, it is easier for bacteria to migrate up the urethra and colonize the bladder. These dogs may need to be on antibiotics until the incontinence is dealt with.

    • Preventing Urine Scald – Dogs with urinary incontinence frequently suffer from urine scalding. Urine is fairly caustic, and if it remains in contact with the skin for long periods of time, it can cause severe irritations. It’s best to prevent this by keeping the skin clean and dry, using waterless shampoo and absorbent, waterproof bedding. If this is not enough, scalded areas can be treated with topical or other medications prescribed as needed.

    •Hormone therapy or a Medication to help tighten the urinary sphincter can be effective for both female and male pets.

    • Feline-Specific Strategies – For cats, treatment at home may include the prescription of anti-anxiety drugs in the case of CDS, pain medication for arthritis, and environmental interventions such as altering litter boxes for increased accessibility. Using flat pans for litter will help your cat avoid painful association with the litter box. Sometimes nutritional supplementation can help felines with cognitive dysfunction syndrome.

    • Surgery – In cases of incontinence due to bladder stones, a protruding disc or congenital abnormality, surgery has likely already been tried or discussed with your pet’s routine care veterinarian. Usually, pet owners will have explored these options prior to contacting Heaven At Home for palliative and home hospice care. Dr. Brush and the Heaven At Home team can work hand-in-hand with a pet’s routine care veterinarian to ensure continuity of care and complete records. In this case, the Heaven At Home team will perform home visits and help with environmental interventions.

    Doggie Diapers

    Pet Incontinence belly band diaper GigimodelflannelMany have found that doggie diapers help keep urine out of your dog’s bedding, your carpet, and your furniture. There are a number or dog-specific diaper options out there at pet stores.

    One of Heaven at Home’s favorites types of doggie diaper are local, homemade pet bloomers and belly bands that are easy to use and custom-fit. Our friends at the Pet Shoppe Boutique  — Visit — in Grand Rapids make “Bloomers” for girl dogs and “Belly Bands” for boy dogs that we’ve had a high success rate with. One of the reasons this type of doggie diaper is especially effective is that the strong velcro closure ensures a snug fit and stays securely in place, preventing dangerous consumption of the disposable pads placed inside. At the same time, by placing disposable pads inside, the belly bands and bloomers are convenient to use. We recommend that clients who are managing dog incontinence equip themselves with at least three pair to always have a clean one ready.

    Others have success using boy’s briefs to hold a diaper or pad in place, using the fly as a tail hole. There are also multiple varieties of doggie diapers that can be purchased at pet supply stores.

    Whatever you use you need to be sure to change it as soon as possible when soiled to prevent discomfort or infection.

    Warning – Do Not Allow Dogs To Eat Their Diapers – Dogs, in some unfortunate cases, have been known to eat their diapers when unattended. The absorbent material in disposable diapers may cause blockages and severe complications. It is recommended that you prepare a special room for your dog while you are away, rather than leave them unattended in diapers, especially if your pet has a track record of ingesting things they shouldn’t!

    Easier-to-Clean Pet Bedding

    Living with an incontinent pet means doing lots of laundry and having a fresh supply of bedding toppers. Orthopedic beds are an important source of comfort for senior dogs and cats and can be expensive, so we recommend topping them with inexpensive fleece blankets or other bedding that dries quickly and can tolerate whatever cleaning products you use to get the stains and stink out. The goal is to create clean, dry, comfort quickly and easily for your pet.

    Try the following DIY Approaches:

    • Pet bed wrapped in a trash bag, then covered with blankets (Note: Some dogs may be unwilling to use bedding with plastic under it.)
    • Old towels
    • Old bathmats (great because of rubber back lining)

    Washable Pee Pads

    Medical supply companies sell washable pee pads in a variety of sizes. They feature a top fabric that wicks moisture away from the skin to help prevent sores and a bottom material that keeps leaks from getting onto bedding or furniture. This can help keep your pet comfortable despite accidents while napping. These are Dr. Brush’s preferred solution for dry bedding.


    An Away Space for Easier Cleanups

    We also recommend having a space for your pet that’s easy to clean, keeps them comfortable, and prevents them from roaming the house while you’re away, sleeping, or they’re otherwise unsupervised.

    The best way to go about this is with a child gate partitioning their area of the house, along with some sort of waterproof barrier between the permanent bedding (cushion etc.) and the washable blankets. Be on the lookout at fabric stores and garage sales for good, cheap fleece blankets.

    There are many causes for pet incontinence, and it is important to manage the symptoms to improve the quality of life for both you and your aging fur family member. We would love to help you find ways to make your pet’s sunset years filled with fond memories instead of constant struggle.

    For an in-home consultation on pet incontinence strategies, Contact Us.





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