It sometimes feels like the dog world is polarized between people who “get” anxious and reactive dogs and people who don’t. Worse, the people who don’t can be dismissive and unkind, not to mention make it difficult for you to navigate the world with your dog by not respecting personal space.

Lately, however, people are coming to realize that completely calm, bombproof dogs are closer to the exception than the rule. Many dogs have something they’re not good with, whether it’s alone time, storms, cats or children. This increased awareness has translated into more and easier tactics to help anxious dogs than walking them at 5 in the morning. Here are eight ways to make life with your anxious or reactive dog better for both of you.

1. Seek out a PR trainer. In recent years, modern trainers have learned that an overwhelming majority of dogs who lunge at, bark at and fight with other dogs and humans aren’t doing so because they’re “dominant” or because they want to be “pack leader.” They’re doing it because they’re scared. A frightened dog, especially one who feels like she can’t escape, will turn to aggression to “get him before he gets me.” Once we know that aggression is rooted in fear, we know to avoid trainers who “rehabilitate” aggressive dogs by dominating them. Hurting a dog doesn’t stop her from being scared, it just makes her shut down. Change the emotion, on the other hand, and you’ll change the behavior. A dog who isn’t scared of other dogs has no need to bark or fight. Find a good trainer, ideally one who follows positive reinforcement principles and is certified by CCPDT, and you can work wonders together.

2. Make her visible. This might sound like the last thing you want to do with an anxious dog—I’ve certainly spent my share of time hiding around corners and not opening my door until I’ve checked that the coast is clear—but drawing attention to your dog’s anxiety is a good way to tell other people not to approach. Put a yellow ribbon on your dog’s leash, or buy a bandanna or harness that says “nervous” or “no dogs” and you’re giving people a heads-up without having to yell at them.

3. Muzzle up. If your dog is reactive and big enough that you could lose control if she lunges, consider a good quality muzzle. A muzzled dog is still seen by most people as a dangerous dog, which can lead to some unpleasantness for the owner, but thankfully, the Muzzle Up! Project is trying to get rid of that prejudice and spread the word that a muzzle is a sign of a responsible owner and a safe dog. By making those with aggressive dogs feel safer, muzzles allow both people and dogs to get more enjoyment from being outside.

4. Consider changing your vet if he/she isn’t tuned in to your dog’s needs. While some vets are great with nervous and aggressive dogs, others are still very old school; they don’t listen to owners and use invasive and rough handling. There are, however, new techniques out there for vets dealing with anxious dogs. Dr. Sophia Yin has developed a program for vets that focuses on low-stress handling, which can make a huge difference in your dog’s anxiety levels. And Dogs in Need of Space has a list of vets who go the extra mile for anxious dogs; if you do want to change your vet, it’s a good place to start.

5. Learn your dog’s body language. Your dog constantly communicates how she’s feeling, and the better you understand what she’s saying, the easier it can be to avoid stressful situations. Something that was fine for her last week might be too much for her to cope with today due to a phenomenon called trigger stacking (an increase in anxiety-related behaviors caused by the dog experiencing repeated stressful events without enough time in between for the associated stress hormones to leave her system). Avoid this by keeping an eye out for signs that tell you how your dog is feeling.

There are lots of resources for learning the basics; Lili Chin has made some lovely posters, and there’s even an iPhone app, so you needn’t run out and buy a textbook. Just remember that every dog is an individual, so you might not see all the signs of stress all the time. My dog only pants when she’s hot, for example.

6. Try medication. When I tell people, “My dog’s on Prozac,” most of them laugh; they think it’s a funny way of talking about her anxiety. It’s not: she really is on Prozac. Many of the same antidepressant medications that millions of humans use have been proven to help dogs with anxiety have the confidence to try new behaviors. A conversation with your vet is the first step on this route. Your vet can refer you to a veterinary behaviorist, a DVM who is knowledgeable about both training and medication; a vet behaviorist can give you a complete prescription tailored to your dog’s needs and, ideally, liaise with your trainer or applied animal behaviorist (a professional who specializes in dogs with behavioral problems but is not a vet).

Making the decision to try medical intervention can seem like a big step, but there is a lot of specialist information designed to make it easier. A good place to start is Debbie Jacob’s website, fearfuldogs.com. There are also numerous over-the-counter pills and products marketed to help anxious dogs, but be careful if you choose to experiment with them. Most “calming supplements” haven’t been tested, and evidence for the ones that have been is sketchy at best. Ultimately, it’s a personal choice, but do remember that treatment has its own kind of placebo effect.

7. Find a shared interest. It’s okay to be disappointed that your dog doesn’t want to go to the dog park, agility trials or pavement cafés. Try focusing on what you guys can do together instead. Set up indoor obstacle courses, go on quiet wilderness hikes, take nose-work classes or just chill at home. Don’t try to force the dog you have to be the dog you wanted. In the end, you’re likely to make her problems worse, not to mention strain your relationship.

8. Know your limits. If you’re really out of your depth, or your dog represents a serious danger to you or your children, it’s okay to consider rehoming. Training and medications are expensive, and anxious dogs often require a lifetime commitment. In some cases, it’s safer for you and better for the dog to find a new home where she can get what she needs if you don’t have the resources or the situation to provide it. You’re not a bad person or a failure—you’re making the wisest, kindest choice in the circumstances.

With these options, life with an anxious dog doesn’t have to be lonely!

See those beautiful lilacand plum-colored hills, dotted with darker stones on what looks like pathways? And the slopes that dive into valleys lined with translucent pebbles? But wait. These aren’t lavender-f lowered furrows. They’re a close-up view of the intestines in cross-section. The purple polka dots are inflammatory cells, out of place and infiltrating the tissues. This is inflammatory bowel disease, or IBD, as seen under a microscope.

These histological views, thin slices of stained tissue, are collected via endoscopic or surgical biopsy. They might be small but they reveal a lot, particularly about the kinds of inflammatory cells that are cramming the villi and crypts—the steep hills and valleys— of the GI tract. Crowds of lymphocytes, plasma cells, eosinophils, macrophages and/or neutrophils cause the bowel to thicken, and hinder its motility. They also block the gut’s ability to absorb nutrients, properly manufacture mucus to line the tract and originate hormonal signals.

What causes the GI tract to host the wrong type of cells? It’s not completely clear. Broadly speaking, the immune system overreacts, perhaps to diet, parasites or bacteria. The visiting immune cells then send signals, called cytokines, which create more inf lammation. The end result is an altered intestinal architecture and a host of symptoms: weight loss, diarrhea, vomiting, mucus and/or blood in the stool. The particular symptoms depend on where the inflammation lives, which can be anywhere from the stomach to the rectum.

Diagnosis begins with blood work, which may show protein loss, anemia, dehydration, altered B12/cobalamin and folate levels, elevated liver enzymes, and sometimes pancreatitis. For a definitive identification, a GI biopsy is the gold standard, but when possible surgical risk or cost is a factor, an abdominal ultrasound can provide a presumptive diagnosis; thickened bowel loops usually indicate IBD. (In rare cases, they may also indicate a cancer such as lymphoma; it can be difficult to suss out the subtleties between it and IBD on ultrasound. It’s important to be sure that lymphoma’s not in play because starting prednisone—a common steroid used to treat IBD—without ruling out lymphoma can make an accurate diagnosis difficult later and can create future chemotherapy resistance.)

Medical Treatment Options
Assuming that IBD is the most likely cause of your dog’s GI problems, there are definitely things you can do to help your friend feel better. For mild cases, diet change is often the first step. An easily digestible, low-residue diet or a novel-protein food, such as duck, rabbit, fish or venison, is a good place to begin. Another option is to feed a hydrolyzed-protein diet, in which the proteins are already broken down and can thus slide unrecognized past the immune system. Lower-fat diets may help as well, as fat can be hard to digest.

Dogs who do not respond completely to diet change may be placed on steroids, antibiotics and, sometimes, stronger immunosuppressive drugs like cyclosporine or azathioprine. Each medication comes with its own list of possible side effects, so the goal is to try to taper the medication to the lowest effective dose. To cover all bases of possible inflammatory triggers, many veterinarians will also deworm dogs with suspected IBD.

Integrative Options
A dog who isn’t tolerating medications will often urinate in the house, and changes will be seen in his liver-related bloodwork. In those cases, we still have tools to use. Daily pre- and probiotics, such as Herbsmith Microflora, can help realign proper bacterial balance in the gut, and B12 shots given under the skin can help replace lost cobalamin.

Traditional Chinese Veterinary Medicine (TCVM) is another excellent tool. TCVM includes acupuncture, Chinese herbs, food therapy and tui na (a form of therapeutic massage). Rather than treating a dog for a list of symptoms, TCVM creates a picture of his health based on patterns. From indicators such as the dog’s tongue color and coating, pulse strength and character, time of day of the signs, personality, and preferences for cold or warm places, a TCVM vet develops an individualized treatment plan.

These specifics matter. Herbal formulas for chronic early-morning diarrhea are different than those used to treat acute bloody diarrhea. Formulas for acute diarrhea may only be used for a week, but herbs for chronic GI issues are usually given for one to three months. It’s important to use highquality, domestically manufactured formulas from suppliers like Jing Tang Herbal to guarantee low toxicity and uniformity. Herbs are medicine, with possible side effects and interactions, so it’s best to have a TCVM vet prescribe the correct formula for your dog.

Combining acupuncture and Chinese herbs is another powerful way to assist in the resolution of both acute and chronic GI issues. Acupuncture points are located in areas where nerve endings, blood vessels, mast cells and lymphatics are concentrated, and activating those points helps to strengthen the immune system, lower inflammation, increase circulation and reduce pain. Studies have documented that point stimulation also releases neurotransmitters such as beta-endorphin and serotonin.

A TCVM vet will choose a series of points to relieve pain, vomiting and poor appetite, as well as to address heat in GI tract (blood) or a yang deficiency (warm-seeking). Thin, single-use, sterile needles are placed at specific sites, and are left in place from one to 30 minutes. The number of needles used depends on the dog’s age, personality and level of disease. Most dogs relax, yawn and even fall asleep after about 10 minutes. As with any chronic disease, it takes time to steer recovery in the right direction. For acupuncture, a good place to start is three to five treatments spaced at 10- to 14-day intervals.

When all goes well, combining Western and Eastern medical treatments results in weight gain, eagerness to eat and a reduction in GI pain. Not to mention the return of those wonderful, broad doggie smiles and whole-body tail wags.

There is an astounding amount of research on dogs—academic studies, medical research, social and psychological testing, not to mention reams of data gathered from our everyday lives. Thoughtfully assimilated, all of this information can help us and our dogs live better lives together.

I was reminded of how fortunate dog enthusiasts are to share in this wealth of information upon my return last week from Purina’s Better with Pets Summit (November 3). The annual event, this year presented in Brooklyn, NY, was a gathering of pet experts sharing their latest findings with the media. The theme for the day was “exploring the best ideas for bringing people and pets closer together.” It was an apt description.

The day started out with an inspired presentation by Dr. Arleigh Reynolds, a veterinarian and research scientist who studies the impact of nutrition on performance on sled dogs. A champion musher himself, Reynolds’ talk focused not on a program he’s involved with in the Alaskan village of Huslia. This small coastal community was the home of George Attla, a famed champion musher and native Athabascan who ruled the sport for thirty years before retiring. In honor of his son Frank, who died at age 21 in 2010, Attla started the Frank Attla Youth and Sled Dog Care Mushing Program. The program serves many purposes—providing skills, lessons in cultural traditions, and a sense of belonging to the youth population while uniting all townspeople around a common activity, mushing. The program, as described warmly by Reynolds and in a short documentary film demonstrates the power that dogs can initiate in our lives.

Next up was a panel discussion titled “Are Millennials Changing Our Relationships with Cats?”—offering the interesting observation that a new generation of cat people have now formed a community on the internet—so as dog people connect at dog parks, cat lovers now interact online sharing their passion for felines. We met Christina Ha, the co-founder of Meow Parlour, New York’s first cat café. Can a canine café be in our future?

The most anticipated panel “Stress, Our Pets, and Us” featured animal behaviorist Ragen McGowan, PhD; architect Heather Lewis (Animal Arts) and Dr. Tony Buffington, professor of veterinary science. McGowan discussed the value of having dogs work for their food citing her studies with grizzlies, chickens and mice on the practice of contrafreeloading (working for food when food is freely available). Lewis’s architectural practice specializes in designing veterinary hospitals and animal care facilities around the country, meeting the unique needs of both workers and animals. It’s evident that good design can have an important impact on animal friendly environments—from soothing color palettes to calming lighting levels or the simple use of horizontal bars (less stress inducing) instead of traditional vertical bars. The key takeaway: Mental exercise for animals might be as important to their well-being as physical exercise.

“Raising Pets and Kids” featured Jayne Vitale of Mutt-i-grees Child Development Director; Ilana Resiner, veterinarian behaviorist; and Charley Bednarsh, Director of Children’s Services (Brooklyn). The Bark features an in-depth article in its Winter 2015 issue on Mutt-i-grees, a program developed by the North Shore Animal League that offers academic and emotional support to students from kindergarten through high school, teaching them how to be ambassadors for the humane treatment of animals. Bednarsh and her therapy dog Paz, team up to assist young witnesses of domestic violence navigate the judicial system (a similar program first reported in The Bark). We were reminded of the important contribution to the health and well-being of the children in these extraordinary programs, and also to common households. Note to self: Don’t humanize your dog—study, understand, embrace their dogness.

The afternoon offered a room full of experiential exhibits—interactive displays that provided lessons in healthy environments, cognition, reading your pet, nutrition and your pet’s purpose. Manned by teams of experts, the well designed displays presented an immersive course in Dog and Cat 101. I’d love to see the exhibits showcased to the general public, those most in need of education and guidance in the proper care of pet companions. The day was rich with ideas and notes that we’ll shape into future articles for The Bark.

Purina’s commitment to offering a forum of ideas is commendable. In a similar vein, the company hosted another notable event on November 7—a free live video cast of the Family Dog Project from Hungary—with over a dozen presentations by leading scientists and animal behaviorist exploring everything from canine cognition to sensory perception in dogs. Like the Pet Summit, it was a fascinating collection of concepts and dialogue, enriching to everybody who participated.

For more check out #BetterWithPets

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.