When I was in veterinary school, a house-call practice was far from the career I imagined. Yet years later, I found myself at a crossroads. I knew I wanted to work for myself, but the thought of opening my own vet hospital was daunting. So, I compromised, taking part-time jobs while building my in-home practice. Word spread, and within six months, I was able to focus entirely on veterinary house calls.

Though my practice was designed to offer full-service veterinary care to dogs and cats in all stages of life, it soon became clear that senior pets benefited the most. Elderly arthritic dogs with mobility issues are difficult to get into a car, and diabetic dogs with cataracts can become disoriented and anxious in a waiting area filled with young, active and noisy pets. Even routine vet-clinic check-ups can be distressing for old dogs.

In-home care guarantees a relaxed, familiar setting conducive to in-depth examination. And when dogs are at the very end of their lives, quality-of-life assessments, palliative and hospice care, and euthanasia are all most comfortably done at home. Two years ago, when I introduced Your Senior Pet’s Vet, a subdivision of my general house call practice, the response was overwhelmingly positive.

House calls for seniors don’t have to wait until dogs are in the last stages of a terminal illness. Most of the issues that arise with older animals can be addressed in the home, and when radiographs or surgery are necessary, the dog can be transported to a base animal hospital for tests and treatment. My senior house-call patients tend to tolerate less-frequent hospital care with ease, possibly because they have been conditioned to consider me a friend from home.

My clients are also much happier with this type of personalized service. Like their elderly dogs and cats, people also experience increased stress associated with vet-clinic visits. Taking the car ride, waiting-room delays and steel exam tables out of the equation is a great relief. Additionally, home visits make it possible for owners to evaluate my caregiving style on a more intimate basis than is possible with a quick hospital visit, resulting in a higher degree of trust and comfort when it comes to my treatment of their special pets.

Katie and Poppet, 13-year-old Jack Russells, lived with Patsy, who was in her early 80s at the time. She and her two terriers walked a couple of miles to the beach and around the golf course every day. I made my first visit in response to a handwritten letter Patsy left in my mailbox requesting a house-call appointment for Katie and Poppet’s routine check-ups. This was also the start of a wonderful friendship; Patsy gave me parenting advice and told me stories of her years as a nurse and a law student, and of past dogs in her life.

Eventually, Katie developed congestive heart failure that required medication and regular rechecks. Poppet survived a serious case of leptospirosis, but ultimately slid into canine cognitive disorder. After Patsy had lost both dogs, I helped her adopt a new senior Pomeranian from the local shelter. Billy moved in, and I continued to be Patsy’s on-call vet.

I share this story as an example of the benefits of in-home vet care for senior dogs such as Katie and Poppet. Whether the issue is simple old age or a chronic, debilitating problem, an objective professional evaluation and consult can make it possible for a dog to continue to live comfortably at home. Sometimes, people are sure it’s time to let their dog go, but in many cases, I am able to alleviate their worries and help them find ways to keep their dogs with them longer than they thought was possible. As dogs and cats transition into the final phase of their lives, in-home visits coupled with pain-management therapies, changes in treatment protocols and environmental accommodations (ramps, carpeting on slippery floors, support harnesses and slings) can make all the difference.

When I met Rocky, a 13-year-old, 75-pound Pit Bull mix, his family was very upset. Not only was he incapacitated by severe arthritis, he also had a large mass at the base of his tail and had been diagnosed with Cushing’s disease. Because his family couldn’t get him into the car, Rocky had not been to his regular vet in over a year. When I first saw him, he was lying on a piece of carpet surrounded by small sample-sized carpet squares, panting and wagging his tail as three adorable small children doted on him, petting him and offering him water. The children were interested in the equipment in my house-call box and asked questions about what I was doing with Rocky. The parents and grandparents waited anxiously to hear what I had to say about their amazing old boy.

The mass was large and open, and Rocky’s nails were very long. After reviewing all aspects of Rocky’s situation, we made a plan to treat the infected mass with antibiotics, cut his toenails so he would have an easier time with foot placement, and cover the slippery wood floor with larger carpeting and runners. We also started conservative but effective pain-management medications. We discussed harnesses and slings that would make it easier and more ergonomic to get Rocky from place to place within the house and yard.

He was a cooperative, friendly patient, and I was able to draw blood for the necessary full senior dog panel before putting him on anti-inflammatory medications. Rocky’s response to these interventions was remarkable. His family was delighted at his increased comfort and improved ability to get up and down, and they had a much easier time caring for him.

Eventually, his arthritis worsened, the mass grew and his overall quality of life deteriorated. We met a number of times after our initial visit, and had many email and phone conversations. Over a period of about eight months, I was able to guide them smoothly through their transition to saying good-bye to their sweet Rocky. When the decision was made to let him go peacefully, Rocky left this life on his bed, in his own home, surrounded by his loving family,

In-home euthanasia is a gift to beloved old animals and to their families as well; it makes the final goodbye comfortable and natural. Take Petey, for instance. To a man and his three daughters, the 16-year-old Bichon was not only a cherished companion, he was also a living link to the wife and mother they had lost to cancer nine years earlier. However, Petey’s quality of life had diminished to the point that he couldn’t eat and was vomiting and in pain. It was clear to the family that it was time to let him go, but they were distraught and having a very hard time with the process.

We discussed keeping the focus on what was best for Petey; what an important, special friend he was; and that they would always have pictures and beautiful memories to keep him with them. We set a time for in-home euthanasia, and when the day came, the weather was perfect. We were able to go outside to a beautiful grassy area in their back yard. After a very long goodbye, I euthanized Petey. The family agreed that I should make ink paw prints and clip some hair for them to keep. For this family, being together in the privacy of their back yard was the only way this could have been done.

Whether for routine, palliative or end-of-life care, senior dogs and cats benefit from in-home veterinary visits—compassionate support in the most comfortable environment they know. When I was searching for my niche within the veterinary profession at the beginning of my career, I never would have guessed how rewarding house calls and senior pet care could be. It has been profoundly gratifying to see the difference it makes in the lives of so many animals and their owners.

Montilius (Monty) Tiberius is our two-year-old yellow Labrador best friend and faithful companion. On March 12, 2015, he became just the 15th dog in the world to undergo a groundbreaking procedure that, we hoped, would reduce his severe bilateral hip dysplasia and give him a chance at a normal life.

How difficult was the procedure? “On a scale of one to 10, the operation was a 12,” said veterinary orthopedic surgeon Dr. Loïc Déjardin of Michigan State University Veterinary Medical Center in East Lansing, who performed it. Dr. Déjardin is regarded as one of three surgeons worldwide able to execute this delicate operation.

The surgery on Monty’s right hip took nearly four hours. “There were some difficult areas through the surgery, finding just the right depth and shaving some bone away so Monty can access total mobility. Now, we wait and see,” Dr. Déjardin told us afterward. Monty would be closely monitored at six-week intervals for six months post-op.

Taking it slowly was key to Monty’s healing process. As Dr. Déjardin pointed out, “It’s up to you to make sure Monty heals properly, and having him take it easy is important.” My wife Ann and I took his advice seriously. For the next 10 weeks, Monty went outside on a leash to “get busy” as often as necessary; otherwise, he stayed in and rested. During the first four weeks in particular, we handled Monty oh-so-carefully, and our other dogs were kept away so they wouldn’t jump on or play with him.

A New System

Dr. Déjardin had given Monty a Centerline BFX Prosthesis. This trademarked prosthetic biologic fixation “hip system,” created by BioMedtrix Company of Boonton Township, N.J., uses an implant that is approximately eight inches long and made of steel (picture a skinny, steel ice cream cone with a scoop on top).

Unlike standard canine hip replacement implants, which are inserted down the central axis of the femur itself, the Centerline-BFX is hammered into the center of the femur neck; its base protrudes from the bone, allowing it to be secured at the top, attached without being cemented into the pelvis. It’s described as a lever (femur) and fulcrum. In order for Monty to regain complete range of motion, the prosthesis had to be inserted in exactly in the right spot, which required shaving off bone in the pelvic region.

This prosthesis and the procedure required to insert it are so new that they have not yet been fully documented in medical journals. Veterinarians with patients who are candidates for such a procedure would certainly review and study Monty’s case. Particularly if the operation was completely successful, which wasn’t a given.

No Guarantees

What made Monty’s individual case special was the fact that he had severe dysplasia in both hips. The femoral head (the “ball” of the ball-and-socket joint) and pelvis area were seriously deteriorated, and he was almost completely lacking a hip socket (the acetabulum).

Before the surgery, when Monty walked, his left back leg dangled and flapped; when he ran, it was as if both hind legs vibrated. On his right side, his leg moved in an awkward semi-circle, like a leaf dangling from a branch. The right hip had the severest degree of lameness and, we were told, made Monty an excellent candidate for the procedure.

The regular prosthesis used for canine hip replacement wouldn’t work for Monty. Rather, in time, it would render him totally lame. During our initial September 2014 consultation with Dr. Déjardin, he explained Monty’s rare condition. He also made it clear that there was no guarantee of complete success. The specialized prosthetic implant would need to be precisely angled into the bone and secured around muscles that had already formed, which was risky. Additionally, the depth of the implant couldn’t be known until the actual surgery, another risk factor.

Before the surgery, Proto-Med Company in Colorado made 3D models of Monty’s hip (pelvis) and femur from CT scans. Dr. Déjardin practiced on the models, rehearsing the surgery to reduce the margin of error.

A Setback

In weeks five to eight after his surgery, Monty was walking very short distances, which we were told was appropriate in order for him to begin strengthening the muscles in his right leg. But during week nine, something seemed to be amiss. One morning, he was fine when he went outside to get busy, but in the afternoon, when it was time for his short walk up and down the driveway, I noticed that he was seriously limping on his right hind leg. When Ann came home from work, I told her about it. She asked me if he’d done anything unusual, and I made what I thought was a joke: I said he ran around the neighborhood and seemed fantastic, which nearly put me outside in our decorated antique doghouse. In reality, I took this development very seriously, and myriad “what-ifs” raced through my mind.

I immediately made an appointment with Monty’s veterinarian, Dr. Thomas Frankmann, at the Animal Clinic of Chardon, who took X-rays. “It’s not good,” were Dr. Frankmann’s first words after he looked at them. “The Centerline implant has completely moved out of the pre-made socket [acetabulum] and is rubbing against bone. This, I suspect, is causing the limp and some discomfort.”

Dr. Frankmann said that he’d never had seen anything like it. “It’s not supposed to do that—these implants are secure. It’s bewildering.”

Dr. Frankmann called Dr. Déjardin for a consultation. Over the next few days, Dr. Déjardin spoke only to Dr. Frankmann. He also scheduled Monty for emergency surgery at MSU to reattach his implant. Needless to say, Ann and I were both sick with worry. We didn’t know what to expect or what would happen to Monty—would he be permanently disabled, or worse, would he even survive another operation?

We never did find out what might have caused this problem. Prior to Monty’s surgery, we heard only from the MSU nursing assistants and Dr. Frankmann, who detailed the severity and risk of the reattachment; Monty’s decaying bone structure and pelvic deterioration raised a concern that the repositioned prosthesis might not hold.

After the nearly eight-hour surgery Dr. Déjardin finally spoke with us directly. As it turned out, he could not save the implant; as Dr. Frankmann warned, it could not be readjusted or replaced. He immediately began a second operation while Monty was still sedated, performing an FHO (femoral head ostectomy), removing the head and neck of the femur to alleviate pain. The FHO is  a salvage procedure intended to prevent total incapacitation; it basically allows Monty’s femur to “float” unattached, supported only by scar tissue that creates a false joint. Through physical therapy, he would build up muscle that would help secure the bone somewhat in place.

Two days later, during the five-hour drive to pick up Monty at MSU, I envisioned his feeble body after his first surgery two months prior and reflected on the pain he had endured. I also thought about how many pills he would now need to take; he was up to five medications at one point.

Upon seeing me, Monty couldn’t restrain himself. He tried to jump up but couldn’t because of the weakness in his right leg. He had been shaved, again of course, and seeing him was disheartening. I decided that the operations were finally over; no matter what miraculous cure/invention/procedure was discovered, I would not subject Monty to any more.

Then and Now

Monty has traveled a difficult path to get where he is today. He was diagnosed with “hip problems” as a puppy, but the severity of his condition wasn’t seriously investigated until shortly before he was a year old. Discarded and abused, he had at least three different owners before I adopted him from Joanne Dixon, president of Providing for Paws of Garden City, Mich., a nonprofit rescue organization helping animals in need. Patrons of PFP raised nearly $6,000 during the year leading up to Monty’s first surgery to help with its cost.

We received other financial help as well. Dr. Déjardin waived some of the charges associated with the first operation, and suggested Monty for MSU Veterinary Hospital’s Lucky Fund, which provides resources for specialized cases of dogs in need. The Lucky Fund donated $1,000 toward Monty’s cause.

Nonetheless, next to our home, Monty is our biggest investment, albeit a loving one, and well worth the sacrifice.

As he neared the completion of his weekly physical therapy sessions at Pawsitive Results Animal Rehab Center in Auburn Township, Ohio, his rehab vet, Kathy Topham, was absolutely astounded by Monty’s recovery and his ability to walk almost normally. “He probably won’t be great for search and rescue, but he’ll run, play, jump and maybe make a great therapy dog,” she said.

During our summer beach trip to North Carolina, Monty walked, jogged, swam and was eager to greet every beach-goer who meandered within petting distance. He has a marvelous outlook on life. As Ann said at one point, “He really has made adjustments to compensate for all his ailments; it’s amazing to witness how he moves around.” Monty plays like a normal, healthy, juvenile dog but close observation reveals his physical idiosyncrasies, the split-second adjustments he makes when he walks, runs, squats and lies down.  

Monty has changed my outlook on life. We have that dog-human telepathy that most dog people have with their companion animals. However, he’s also “training” me to meet his needs, for which I couldn’t be more grateful.

Humans are ambivalent about life, but dogs are not. Our canine companions befriend us for our greater happiness, making us better people. They elevate our quality of life (teaching us to wag more and bark less, as the saying goes), and love us unconditionally without regard to the situation they’re dealt.

 As Ann observed, he follows me everywhere, and watches and waits for me constantly. Now, she says, I owe Monty. I wouldn’t have it any other way. He’s the faithful companion every dog owner dreams about, and that’s my good fortune in this life.

It may take more skill than a belly rub, but should massage only be allowed with veterinary supervision? California is the latest state to propose regulating the field of animal rehabilitation, and it could put many kinds of practitioners out of work.

With preventive health care booming, the state’s veterinary board wants to rein in non-veterinary businesses that cater to wellness, saying they “pose a grave danger” to pets and can increase costs for owners. The rule would mean only veterinarians, or physical therapists and registered vet techs, if supervised, could perform animal rehabilitation..

Opponents of the rule say the board has defined the field so broadly, it nets the use of electricity or biofeedback right along with exercise and simple massage used to soothe aching seniors, relax dogs that play sports, and socialize shelter pups.

“It is about defining everything as rehab, even swim facilities and pet certified fitness training,” says Linda Lyman, who attended a recent public hearing in Sacramento to air her concerns. Lyman says she has a PhD in physical education, has taken a canine medical massage course, and for seven years has operated Pawssage, a canine massage practice.

 “I go to agility trials every weekend and massage dogs before, between, and after they run. My goal is always to make sure my client’s dogs can hike, walk, and do things with their owners while and when they quit agility.”

As the board’s proposal would have it, Lyman is practicing veterinary medicine without a license. Aside from the hands-on, she makes suggestions that could get her in trouble under the new law. At her recommendation, three clients bought pools for their dogs, for example.

In many states, a background like Lyman’s isn’t needed. Anyone can provide animal massage, including evaluation, treatment, instruction, and consultation. That currently includes California, where only “musculoskeletal manipulation” by the layperson is forbid. Other states call for direct veterinary supervision of the work, or allow it with a vet’s referral. Some require certification, like the state of Washington, where a 300-hour training course in general animal massage, first aid and more is needed.

Whether body workers massage humans, which calls for state licensing but not doctor supervision, or pets, “the good ones survive and thrive and the rest fall by the wayside, certification or not,” Lyman says.

In a few cases, lawsuits have accused vet boards that restrict massage of stifling competition. In Maryland, providers of horse massage successfully challenged the state vet board, and a recent Arizona lawsuit argues that massage is not a veterinary service.

Another meeting will be held on October 20-21, when the board will discuss comments received so far, and possibly vote on the final rule.

Lyman sees more at stake than massage, or any one service, she says. “This is about a pet’s access to all practitioners who can help it maintain a healthy lifestyle.”

For years, I kept a supply of phenobarbital on hand, prescribed by my vet for my mixed-breed dog's seizure. It turned out to be a one-time thing, and eventually, I disposed of the drug. But I can testify that watching her in the grip of it was both scary and confusing.

As dog-lovers, most of us hope we're never faced with a number of canine health conditions. Seizures fall into that category. When they happen, however, it's helpful to understand what we're looking at and what we need to do next.

Seizures, which are caused by abnormal electrical activity in the brain, can indicate a variety of conditions, some transitory, some longer-lasting. Our old friend "idiopathic" --or, of unknown origin--also comes into play more than either we or our vets would like. 

As explained on the Texas A&M newswire, "For some dogs, a seizure is a one-time experience, but in most cases seizures reoccur. An underlying problem in the brain could be responsible for reoccurring seizures, often resulting in a diagnosis of epilepsy. Between the many causes of seizures in dogs and the often normal lab results, idiopathic epilepsy proves to be a frequent diagnosis." Other causes include toxin ingestion, tumors, stroke, or another of several related neurological disorders.

Dr. Joseph Mankin, clinical assistant professor at the Texas A&M College of Veterinary Medicine & Biomedical Sciences, describes a typical seizure. “The dog may become agitated or disoriented, and then may collapse on its side. It may exhibit signs of paddling, vocalization, and may lose bladder control. The seizure may last for a few seconds up to a few minutes, and often the dog will be disoriented or anxious afterward. Occasionally, a dog may be blind for a short period of time.”

When a dog is in the grip of a seizure, there's little we can do, other than to keep our hands away from his or her mouth. Afterward, the most important thing we can do is take the pup to the vet for investigation into the cause. Fortunately, a number of treatments, ranging from allopathic (Western medicine) to complementary (including acupunture) exist.

Like most things, especially those related to health, knowing what we're dealing with is half the battle.

For more on this topic, read Dr. Sophia Yin's excellent overview.