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The human/animal bond is never stronger or more tender than when your dog's muzzle turns gray and the spring in her step begins to diminish. After spending the better part of a decade with this beloved member of your family, making sure your canine friend ages comfortably, contendedly and well is a natural priority. And no one knows how to ensure healthy aging better than the renowned faculty of the Tufts Cummings Veterinary School, who treat more than eight thousand older dogs annually. Good Old Dogbrings their renowned clinic into your living room, providing you with essential advice on nutrition, health, and caretaking to see your dog through the golden years.

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“Old” Is Not a Disease
I HAD MET Bucky four times over the previous eight months. He wasn’t the kind of dog who bounded around the waiting room, but this gigantic, obese ten-year-old was a happy goober, always glad for a belly rub or an affectionate stroke on the side of his face whenever he came to the clinic. He still had plenty of good-natured slobber in him; it was always a treat to see him.
His owners were referred to us from his primary care veterinarian. I could see from their address that each visit meant a forty-mile drive down the turnpike, then ten more miles past the office parks, until the road gave way to cows grazing on the hills where we let out the larger animals that we take care of.
They brought in Bucky, a velvety chocolate Lab, because he had a condition that makes it difficult to breathe — laryngeal paralysis, which occurs in older dogs. He needed an operation to correct the problem, but his owners kept resisting because they were afraid for their old dog to undergo surgery. They felt it was too much to put him through.
A lot of owners fear surgery for their dogs, particularly their older ones, in part because they project their experience, or that of a relative, onto their animal. But while dogs do contend with postsurgical pain, they tend to deal with operations very differently than people do and heal faster, putting them back on their feet and into their normal routine much sooner. That’s true even for dogs of ten or older.
I explained this to Bucky’s family at our first meeting, but still, they were skittish about the surgery and asked whether there was any alternative. Because Bucky was so overweight, I explained that slimming him down would at least buy some time by helping to keep the problem from progressing rapidly. Relieved, they went home determined to curb Bucky’s calories and also have him burn off some pounds with increased activity.
But a couple of months went by, and when Bucky showed up at our clinic again, his breathing was more labored. He had not lost an ounce.
This happened two more times. Finally, Bucky came in barely able to breathe. He was so unable to take in air that he had to be anesthetized so a tube could be put down his throat to help with respiration. We thought that might give him the boost he needed, but every time we woke him up to see if he could breathe on his own, his tongue turned blue from lack of oxygen.
Sending him home and waiting for the next crisis was no longer an option. This was the ultimate crisis: he couldn’t breathe on his own.
With misgivings, the owners gave permission for the procedure. Bucky came through with flying colors, as most dogs do, and went home within two days, breathing normally and comfortably.
About six months later, a chocolate Lab came in with a laceration in his paw that needed to be tended to professionally. The dog had been running along the beach and cut himself on some rocks. He was happy and calm, albeit dripping some blood from his foot pad.
It took only a moment to realize the dog was Bucky — not Bucky as I had first met him more than a year earlier, but Bucky the way his owners remembered him from before his laryngeal paralysis ever developed: exuberant, charged up, and happy to run around — as well as a little thinner because he became more active with the improvement in his breathing. The old boy lived a couple more years after that, with a wonderful quality of life unhindered by significant health problems.
— Scott Shaw, DVM, Assistant Professor, Department of Clinical Sciences/Emergency Critical Care

BRANDY SUDDENLY collapsed at home one morning while chewing on some rawhide. The family rushed her to the emergency room. They had no idea what was going on. She was eleven, but she had seemed perfectly fine until then. She was so sweet — a little curly-haired dachshund.
It turned out she had advanced heart disease that hadn’t been picked up. But that morning, a valve malfunction in her heart apparently caused the pressure there to go high enough that she actually tore the wall of her left atrium. So much blood spilled into the sac around her heart that it just looked like a huge round basketball on an X-ray.
It was a bad sign — advanced heart failure. Her prognosis was only six to eight more months of life.
The family was panicked. They didn’t see this coming. They had first brought Brandy home as a young puppy when the wife was pregnant with their first child, and the tiny thing would cuddle on the woman’s stomach, even though a kick from the baby was enough to send her tumbling. Now the family numbered four — the children were ten and nine.
Scared as they all were, they sprang into action. They kept Brandy on the necessary exercise restriction. They enrolled her in a clinical trial at Tufts to test a new drug meant to treat heart failure — never knowing whether Brandy would get the drug or the placebo. They kept her from being startled, even telling people not to ring the doorbell, because the excitement would cause Brandy to faint. They taught the kids to administer extra Lasix to Brandy if they found her short of breath. They even allowed us to put her on Viagra, a potent pulmonary vasodilator that would open the vessels in her lungs, although it was prohibitively expensive.
The parents would come in with spreadsheets listing all the medicines Brandy was on, her dosages, and how often she was supposed to take them. And, beyond all probability, they rigged an oxygen cage for her at home from the wife’s late father’s oxygen concentrator — he had had emphysema — which we tested at the hospital to make sure it worked. That cut down on hospital stays, which cut down on costs. They were the most amazing people, and Brandy would always continue to run around like a loopy bandit, even though her heart by that point literally took up her entire chest.
My office isn’t in the small-animal hospital itself. It’s in the red barn on the other side of the road. I don’t know how many times I ran across the way to see Brandy for various emergencies. When she finally died in the emergency room one night at age thirteen, twenty-two months after her first visit, we all had a good cry, including the husband, a six-foot-four lug of a man who was not prone to displays of raw emotion. It was cathartic. Though shaking with tears, the family had done everything they could to give Brandy almost two good years she wouldn’t have had without them.
— Suzanne Cunningham, DVM, Cardiology Assistant Professor, Diplomate of the American College of Veterinary Internal Medicine (Cardiology)

Owners of old dogs often come in understandably frightened. They hear terms like “heart failure” or “laryngeal paralysis” and assume all is lost. Or maybe it’s simpler. Their dog has lost bladder control to the point that expensive rugs in the house have been ruined and the owners are at their wits’ end. Or a dog’s joints are so stiff she can’t make her way into the car, and they assume they will soon need to make an awful decision. Maybe nothing in particular is wrong, but the very idea of a dog’s drawing near to the full span of life expectancy often fills owners with dread. Indeed, of the four million dogs relinquished to shelters every year in the United States, almost a million are given up because they’re “too old.”
But old age is not a disease. It’s a stage of life.
Yes, the older a dog, the more vigilance is needed to combat various illnesses, and the more challenging the medical treatments. But, as they say, with age, what is lost on the swings is gained on the merry-go-round. An older dog may be more physically vulnerable, to be sure, but at the same time she may be more serene and easier to get along with — qualities that come with ripening, if you will.
Bucky and Brandy, for instance, still had a lot of life in them, but without the challenges of a puppy’s incautious exuberance and curiosity — licking up antifreeze and other toxins, running into the road after a squirrel, jumping on everyone who walks into the house.
In other words, a dog’s later years simply comprise one of a number of life phases with its own pluses and minuses, and are not to be dreaded but embraced.
Therein lies much of the pleasure we derive from our work — helping people enjoy their dog’s old age rather than spend it in worry and despair.

JUST WHAT IS “OLD,” ANYWAY?
The baseball legend Leroy “Satchel” Paige once asked, “How old would you be if you didn’t know how old you was?”
It was a rhetorical question, posed to make the point that age isn’t just a number. It’s also very much a state of mind, as well as a state of physical health. There are eighty-year-olds who seem more like sixty-year-olds, and people in their sixties who come across like octogenarians.
So it goes with dogs. We’ve cared for a thirteen-year-old poodle who had so much energy and joie de vivre you’d swear she was five. By the same token, we’ve taken care of five-year-old dogs hobbled by arthritis, diabetes, and other conditions typically associated with old age. That is, chronological age is fixed, but “old” age can be hard to pin down.
That’s part of the reason that estimating a dog’s age by employing the popular 7:1 ratio — assigning seven human years for every actual year a dog has lived — has its limitations. Because the passage of time plays out differently for different dogs and different people, it’s not possible for there to be a fixed correlation. But there’s also another issue.
The 7:1 ratio doesn’t even apply across the board as a general estimate. That’s a reasonable guide for mid-sized breeds and mutts — those dogs weighing somewhere between twenty and fifty pounds. But large dogs, such as Labrador retrievers, collies, and Saint Bernards, age more quickly, and small dogs, like Scottish terriers, Chihuahuas, and pugs, age more slowly. For instance, an eight-year-old dog who weighs fewer than twenty pounds tends to be around forty-eight in people years — squarely in middle age, with only six people years assigned for every actual year lived. An eight-year-old dog who weighs more than ninety pounds, on the other hand, is more likely to be roughly sixty-four in people years — closer to old than middle aged, with a ratio of 8:1 — eight people years for every year lived.
That’s why the bigger the dog, the shorter, on average, her lifespan will be. Almost 40 percent of dogs weighing fewer than twenty pounds live ten years or longer (sometimes as long as twenty years), while only 13 percent of giant breeds like Great Danes and Newfoundlands live at least ten years.
We say on average because, again, aging and lifespan don’t play out according to a precise formula. There are small dogs whose lives are cut short by unexpected disease and large dogs who beat the odds and live closer to twenty years than ten or fifteen. It’s like weather; meteorologists talk about the average temperature and average amount of rainfall for the month, but you would be hard-pressed to find an actual “average” day.
Given that “age” and lifespan are a bit tricky to pin down, when does a dog pass from middle-aged adulthood to her geriatric years? The question presents some of the same problems that calculating a dog’s age does, because old age is not a fixed threshold that all dogs of a certain size cross at the same time.
That said, we have established cutoff points for when a dog should be considered geriatric, or old, depending on her size. This is necessary because after a certain point, veterinarians need to monitor a dog’s health a little differently than they would a younger dog, as you’ll see in subsequent chapters. Nutrition needs change as well.
Don’t get too hung up on the exact numbers. If your dog is young for her age and the vet starts checking her more thoroughly for various conditions common in old age before it is truly necessary, she will not be any worse off for the extra care. And if your dog is somewhat old for her age, a vet who has been taking care of her for a while should be able to ascertain any changes from her baseline health and treat her accordingly. You’ll start to notice, too. Dogs, like people, often begin to slow down a little as they make their way into old age.
The longest-lived dog is said to be an Australian cattle dog who died at the super-ripe old age of twenty-nine. But that was reported in the 1930s, and there is no proof. And since Australian cattle dogs are medium-sized, weighing about thirty to thirty-five pounds, we have our doubts. The oldest dog we have on record at our clinic, where more than 100,000 dogs have been seen, is a twenty-one-year-old Chihuahua named Trudy.

WHAT HEALTHY AGING LOOKS LIKE
There’s no getting around the fact that certain diseases are much more common in older dogs. For instance, three in five dogs eventually die of cancer, kidney disease, or heart disease (the subjects of Chapters 5, 6, and 7, which will explain how to successfully manage these illnesses, often for long periods). A number of conditions that are not immediately life-threatening but are chronic and require ongoing medical therapy also strike older dogs more commonly. These include diabetes, Cushing’s syndrome, and several others (covered in Chapter 3). Furthermore, every body system is more likely to fail in an older dog than in a younger one.
But there’s no such thing as a dog (or a person, for that matter)
dying of old age or “natural causes.” A severely diseased organ is always involved.
That said, there are changes a dog goes through that have nothing to do with disease processes but, rather, are simply normal physiologic shifts. To help you distinguish aging from illness, here is a rundown of those natural, expected modifications that occur as a dog enters and passes through her geriatric years. You’ll see that many of them are similar to changes that people undergo, but which do not grip them with fear of imminent death or disability. They simply require a little more attention on the part of those caring for canine loved ones, along with an appreciation that the dog may very well need your sensitivity with regard to exercise intensity, severe weather conditions, and so forth.

Graying hair. The graying of humans’ hair is most noticeable on top of the head. A dog’s hairs, just like a person’s, also start to turn gray in her later years, but the graying normally occurs right on the face, particularly around the muzzle. Nothing to worry about. Your pet won’t even try to pluck them. (Some breeds, including golden retrievers, can go gray very early.)

Slower metabolism. Just like older people, older dogs burn fewer calories than they did in their younger years. Some of the decrease results from slower cell turnover and slower movement of bodily substances within and between cells — a decrease in activity on the biological level. And some results from the fact that dogs, like people, develop a higher fat-to-muscle ratio as they age; fat burns calories more slowly than muscle.
But most of the decrease in metabolic rate comes simply from dogs tending to become less physically active in old age. The less active they are, the more their muscle cells go unused and therefore atrophy and die off, increasing their fat-to-muscle ratio even more. Also, their heart, lungs, and the rest of their cardiovascular network become less revved, so those body systems need fewer calories to sustain themselves.
A slower metabolism, concomitant with a loss of muscle and a relative increase in fat, is not a catastrophe; metabolic decline happens. But a dog, like a person, will remain stronger and fitter — slower to become infirm — if she can hold on to muscle and retard the slowing of metabolic rate as she advances through the aging process. The silver lining here: slowed physical activity often comes from conditions like obesity or arthritis, which are more treatable than ever. Once these conditions are dealt with and the dog becomes more active again, she can build up more muscle and enjoy a renewed rise in metabolic rate, keeping her younger longer.

Difficulty adapting to hot and cold temperatures. Chicago is stuck in a deep freeze for two weeks. Houston swelters for days on end, with temperatures topping 100 degrees. In which group of people do news reporters broadcast deaths from hypothermia or heat stroke, or at least emergency visits to the hospital? The elderly.
Older dogs are also less physiologically tolerant of very hot or very cold weather. A geriatric dog left outside for a long time on a humid summer day with the sun beating down is more likely to become dehydrated and fall ill. That same dog will also have a harder time staying warm enough in frigid weather. Her body can adjust to the cold only so much.
Is it normal? Yes. Is it comfortable? No. Can it sometimes cause unnecessary illness or worse? Most definitely. It’s important to keep in mind that (1) we don’t all live in a San Diego–like climate, and (2) our dogs age a lot faster than we do. Thus, just because your dog was able to jog with you in 85-degree weather when you were thirty-two and she was two doesn’t mean she’ll be able to when you’re thirty-nine and she’s nine. That’s seven years for you, but half a lifetime for her. Go easy.
Similarly, take simple steps to ensure your dog’s comfort when it’s very cold or very hot. Put her in a fuzzy dog bed with a blanket over her when it’s cold out and you’ve lowered the thermostat to 60 degrees to conserve oil. (It’s especially important because your dog is close to the floor, and hot air rises toward the ceiling, while cold air in the room sinks.) You may even want to get her a heating pad — some are made especially for dog beds nowadays.
In hot weather, make sure your pal has plenty of water available and is near a source of coolness or at least shade. And if you fly her from one place to another once or twice a year, consider buying a climate-controlled pet carrier that can heat or cool. (See Resources in the back of the book.) One of the most stressful places for the canine body in terms of extreme heat and cold might be an airport. The belly of the plane may be temperature-controlled, but not the tarmac in frigid or blazing hot weather.

Decreased immunity. One of the most common questions people ask veterinarians as their dog gets older is whether she still needs her vaccinations. In fact, a lot of people with dogs skip the vaccinations in later years, figuring that their pet has already been vaccinated against various illnesses a number of times and has not gotten sick to that point, so why put the animal through more shots? It’s a grave mistake. Older dogs need their shots even more than when they were young and middle-aged. The immune system, like other body systems, slows down in old age, making a dog more susceptible not only to diseases such as cancer but also to infections. She simply cannot mount a sufficient immune response to illnesses she might have been able to ward off in her younger days.
Consider the following scenario, which we have seen more than once. An older dog is not kept up to date with her vaccines, but her people continue to let her romp where as-yet-unvaccinated puppies roam, or they introduce a still-unvaccinated puppy into the household. The older dog ends up with parvo virus, which attacks the gastrointestinal tract and immune system and causes severe vomiting and diarrhea. It can also cause a secondary bacterial infection that spreads from the GI tract to the rest of the body, sometimes resulting in death.
It’s precisely because of unanticipated exposure to vaccine-preventable viruses that an older dog’s vaccination schedule must be maintained. Her age is not a signal to slack off but, rather, all the more reason to make sure she gets her regular shots. Modern medicine can really be useful to counteract a normal, age-related decline, and it should be fully taken advantage of.

Decrease in heart and lung function. Aging dogs do not get coronary artery disease, and they don’t get heart attacks, as people do. Rather, as a dog ages, she does not respond as efficiently to physiologic stress — an increase in heart rate resulting from exercise, for example. She doesn’t have the needed cardiac reserve. The heart is also more susceptible to the effects of anesthesia. (This is not to say that geriatric dogs shouldn’t undergo procedures requiring anesthesia. They should. The vet simply has to take age into account when administering the anesthetic.)
It’s the same for the lungs, which function in close concert with the heart. The elastic fibers in a dog’s lungs allow them to expand and contract with each breath. But as a dog grows older, some of the fibers are replaced by scar tissue, diminishing her ability to breathe as efficiently as possible. Lung secretions also change, which translates to a diminished capacity for oxygen to cross from the air the dog breathes into her lungs and then to the rest of the body. Thus, just as those who are used to exercising with their dogs need to recognize that an older dog can’t exercise in extreme temperatures as well as when she was younger, they should recognize that, say, five years is going to change a human’s exercise capacity much less dramatically than a dog’s. A jog or brisk walk with a dog by your side may need to become significantly slower as the dog progresses through older ages. (And we don’t like to see a dog of any age tethered to a bicycle.
Imagine not being able to stop running when you needed to.)

Hormonal changes. The network of hormones and the glands that secrete them is called the endocrine system. While age-related changes vary from gland to gland, overall there tends to be some degeneration. For instance, the response of the hormone insulin to clear sugar from the bloodstream after food has been eaten might not be as vigorous. What’s “normal” for thyroid hormone values differs in older dogs, too, which is significant because the hormone coming from the thyroid gland is instrumental in the regulation of metabolic activity. These changes don’t automatically translate to disease states, but aging dogs have to be watched more carefully for hormone-mediated conditions such as diabetes and hypothyroidism, both of which affect the body cells’ ability to do what they have to do.
One study has shown that the normal thyroid level for a female beagle puppy is 4.3 milligrams per deciliter of blood, while the normal level for the same dog at age twelve would be 2.6.

Changes in the reproductive system. There is no menopause in the canine world. Female dogs never lose their ability to bear puppies. But fertility does decrease with age, resulting in smaller (and fewer) litters. Also, puppies born to older dogs often have congenital defects, and there can be complications with whelping (labor). Of course, we recommend that most dogs be spayed by the age of six months, anyway. Females are significantly more prone to developing cancerous tumors of the mammary glands if they are not spayed before their first heat (which generally occurs between the ages of six and twelve months).
Older male dogs, like older men, are prone to prostate problems resulting from enlargement. The greatest difficulty for dogs with enlarged prostates is an increased susceptibility to infections, which can lead to illness that is accompanied by fever. An enlarged prostate can also make it difficult to go to the bathroom, but whereas in men it’s about urinating, in dogs it’s sometimes about difficulty with bowel movements. The difference is likely due to differences in anatomy between the two species.
Note: Enlargement of the prostate occurs in male dogs who have not been neutered — a good reason to have them neutered before they reach their first birthdays, just like their female counterparts.