Newsletter I May 2019: Recognizing Pain
Helping You Care for Your Senior Pet
" He's just slowing down because he's getting older. "

This is a comment we hear during nearly every hospice appointment.

And the reason we so often hear it, is because many pet parents just don't know what signs they should be looking for, and it's natural to think slowing down = old age.

When I hear this, I always think back to an incident I had with my car. It was making a loud noise every so often, and I attributed it to the fact that I had an old car with many miles.
Then one day my steering wheel froze up while driving and I lost control.
I was OK, but I still remember the mechanic giving me a loud earful,
" Didn't you realize how serious this noise was?! You are lucky you weren't killed! "

My initial thought was, "Um, no, I'm not a mechanic, so how would I know what this noise means?" As the saying goes, "you don't know what you don't know."

And the same holds true for our pets. If you are not trained, you can't be expected to know what those "noises" in your "old" pet mean, which is why I'm on a mission to help!
I want to give an education instead of an earful.

This month highlights why "thinking pain" is important and provides resources to help better recognize it - especially subtle signs that we may chalk up to simply "getting older."

Is your pet slowing down?
Are they having changes to normal behaviors?
This is Meli. Sweet, "Muffin-paw Meli" as I loved to call her (just look at those mitts!!!), and she was one of my first hospice patients when I started our practice 7 years ago.

She was also one of the first patients who taught me the importance of recognizing pain, and that unmanaged pain could be the cause of changes (and perceived decline) in our senior pets.

I initially went to see Meli for an in-home euthanasia; she was nineteen and a half years old (that's like almost 140 human years!) and her family was concerned she was no longer enjoying life.

When I asked just what that meant, mom shared that Meli was her constant shadow and what "made her day" was being in the home office, overseeing the workday from wherever the sun happened to be hitting. She was concerned that Meli no longer wanted to join her and thought the loss of one of her biggest joys in life was an indication she "was ready."

One of the benefits of seeing a pet in their home environment was the fact that I got to ask her mom to show me where the office was. We then climbed 12 steps to get there...

As it turns out, Meli was still loving - and wanting - all those things in life, she was just having difficulty doing them because arthritis made her hurt.

Did you know: 90% of cats over the age of 10 have a noticeable degree of arthritis and degenerative joint disease on X-ray?! And of those 90% of cats with arthritis disease, only 4% had mention of problems with mobility in their medical records!

Why? Because unlike dogs, lameness is NOT a common sign of arthritis pain in cats; instead, they show outward behaviors like not wanting to use the stairs. And because of this, arthritis pain often goes undiagnosed (and therefore untreated) and is something to keep in mind for any kitty over 10 who is showing a change in their normal behaviors.

For Meli, we started a pain management plan using what we call a "multi-modal" approach, meaning, we target multiple pain pathways in order to "do a better job" at managing pain all while allowing us to use lower doses of each medication. While there are many options to reach for when it comes to managing pain, for her we used buprenorphine (a mild pain medication), a very low dose of an anti-inflammatory, Gabapentin (a pain modifier that regulates signals at the spinal cord level) and Adequan (another pain modifier given as a monthly under-the-skin injection to reduce inflammation and improve joint fluid health). All 3 oral medications were liquids, and with only a small amount needed, they were easy to both give and receive.

Outcome? Mom called me 3 days later to say Meli was bounding up the stairs and acting almost kitten-like. My heart literally soared.

And this was a pivotal moment for me as a veterinarian. I could see first-hand just how vital proper pain management was in our senior pets and the importance of helping families to recognize that slowing down isn't "just due to old age."

It was shortly after Melli's 21st birthday that I returned to her home to help her pass. Proper pain management gave the gift of an additional one and a half years . To this day, Meli remains one of my favorite patients, and I thank her for the lessons she taught me early in my hospice career.

If you have a senior pet that is showing signs of slowing down or is having changes in their behavior, talk to your vet about pain management . It could really make the world of difference in your pet's quality of life and comfort!

How to Recognize Pain in Pets
Just like Meli, senior cats do not show arthritis pain in the ways we would think, such as limping or lameness.

... They show us by slowing down or becoming more withdrawn.

... They show us by no longer jumping up on the couch, bed or counter tops.

... They show us by no longer grooming or having accidents outside the litter box.

These are just a few examples, and the pain scales I developed highlight the most common signs of pain that we see in our pets. Click on the images to download. also has a learning module, " Recognizing Pain in Pets " that breaks down each sign in detail. It also has a video guide that walks you through the many nuances of using any pain scale available.

What signs of arthritis
can look like in dogs

Rocky is not just "slowing down"
because of age, he's slowing down because of arthritis pain. This video
points out some of the common signs of arthritis pain that we can see in our pets.

P.S. This was Rocky at the start of his pain plan and he is doing so much better today!
Looking for specialized care for your senior pet?
Visit our free directory to be connected with providers who offer hospice, palliative care, pain management, in-home euthanasia and pet loss support.

Would you love to have your pet featured in our newsletter?
Do you have a topic you'd like to learn about?
If so, send us an email!

Thank you for being part of the PetHospice Family!
Dr. Shea Cox 🐶🐱💜