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Helping Your 'Good Old Dog' Navigate Aging

Owners of aging dogs often struggle with their pets' dementia and incontinence — as well as navigating through end-of-life decisions. Veterinary behaviorist Nicholas Dodman talks about the best ways to care for your aging dog.

39:36

Other segments from the episode on November 23, 2011

Fresh Air with Terry Gross, November 23, 2010: Interview with Nicholas Dodman; Review of Harold O'Neal's music album "Whirling Mantis;" Review of the film "Love and other drugs."

Transcript

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Helping Your 'Good Old Dog' Navigate Aging

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Many dog owners who've enjoyed years of close companionship dread their dogs
reaching old age. Our guest, veterinarian Nicholas Dodman, says that of the
four million dogs taken to shelters every year, a million are given up because
their owners say they're simply too old.

Dodman says old age isn't a disease but a stage of life. He's collaborated with
other vets from Tufts University and writer Lawrence Lindner on a new book
called "Good Old Dog: Expert Advice for Keeping Your Aging Dog Happy, Healthy
and Comfortable."

The book deals with what kinds of diets and exercise old dogs need, the
diseases they'll face and how to confront end-of-life decisions. Dodman spoke
to FRESH AIR contributor Dave Davies.

DAVE DAVIES, host:

Nicholas Dodman, welcome back to FRESH AIR. Let's start with when we think a
dog enters old age. Everybody knows the old saw that one calendar years equals
seven dog years. Is that about right?

Dr. NICHOLAS DODMAN (Author, "Good Old Dog"): It's not a bad sort of middle-
ground reasoning. Perhaps it applies more to dogs in the 40-50 pound range. But
the smaller dogs live longer, and larger dogs, very large breeds, live really
quite short life spans.

So if you take dog years, for an older dog, you might want to multiply by eight
or so to come up with its human equivalent years, and for small dogs, say, you
know, 10 or 15 pounds, that number drops to six.

So if you took a young dog, a small dog who's 10, that might – he might be
equivalent to, you know, a 55- or 60-year-old person. But that same dog, if he
was a giant breed at 10 years old might be more like an 80-year-old person.

DAVIES: Hmm. OK, so size matters. Let's talk about some of the, you know, basic
things that we need to know about caring for an older dog. One of the things -
you said that they are typically more vulnerable to heat and cold. So how
should we take account of that as we take care of our pets?

Dr. DODMAN: Yes, well, they certainly are more sensitive to extremes of
temperature, and that's something to bear in mind when you take your older dog
out for a walk on a freezing cold day in a 15-mile-an-hour, ice-cold wind, that
they are unable to take charge of that.

They're really like old people. I mean, you know, older people are often the
ones who are the victims of these sudden, you know, sort of freezing bouts or
extremes of heat. It's the same thing with a dog. They're less able to thermo-
regulate, it's called.

So, you know, we have to take account of that by, you know, possibly, say in
cold weather, with a dog with short coat, making sure they actually have some
kind of blanket-like coat or contraption on to sort of help keep them warm and
not keep them out so long in cold weather.

And the same with the heat that you really don't want to leave them out in the
yard, you know, especially tied up on an extremely hot day. They can dehydrate.
They're less well-able to cope with the change in temperature, and it's a
recipe for disaster.

DAVIES: Now, you tell us that you want to certainly moderate exercise as they
get older because heart and lung function does deteriorate. But one of the more
interesting parts here was diet. And there are a lot of dog-food makers that
offer what they say is a senior-diet dog food. And you warn that some of these
could actually be worse for the animals. How?

Dr. DODMAN: Yes, that's true. You know, the fact is that while there are some
laws that govern, for example what comprises a puppy food, and while there are,
you know, recommendations and rules and regs concerning what goes in dog food,
there's no real legal requirement or definition of what constitutes a senior
dog food. So they're out there, but the composition is highly variable from
those that have fewer calories than have more calories, those that have lower
protein and higher protein.

And what the pet food companies are doing is basically trying to tap into a
market, and some of the things that they've done to these so-called senior
foods are logical, but they haven't really been tried or tested. And sometimes,
you can do more harm than good.

You might have a dog who, for example, is eating food with 400 calories per
cup, and you're feeding him one or two cups per day to try and do the right
thing by him. As he crosses some arbitrary line into what you consider to be
old age, you switch him to a, quote, "senior diet," and that may contain as low
as 250 calories or even a little lower per cup, or as high as 450 calories or
500 calories per cup.

On the one hand, if you go with a lower-calorie diet and feed him the same
amount, he's going to lose weight, and you wonder why suddenly he appears ill
and weak. On the other hand, you feed him the high-calorie food, and all of a
sudden, he starts to gain weight, which is very bad for most old-age
conditions.

So it's really bad to switch to these arbitrary diets without knowing what's in
them, without calling the manufacturer, without talking to your vet, and
basically don't do it until there's a reason to switch the diet.

DAVIES: And I guess I should ask: What about table scraps? You know, dogs love
them, and people have gotten used to giving their dogs leftovers. Bad idea?

Dr. DODMAN: Well, that's funny because, you know, I remember I did, many years
ago, sit the National Board Exams, and there was a question on the National
Board Exams to be a vet, which I sat 19 years post-grad because I graduated in
England. And I passed, I'm happy to say.

(Soundbite of laughter)

Dr. DODMAN: But one of the questions was: Should you feed your dog table
scraps? And the answers were: A, always; B, sometimes. Well, the correct answer
was whatever was answer C, never feed them table scraps.

Now, I don't believe that for one minute. So my dog does get table scraps, and
I'm proud of it. But the thing is you can't do this too much. I mean, it has to
be regulated, especially if the dog is on some diet.

I mean, you can really mess it up by feeding too much human food because the
dog food actually is pretty well-designed to meet all the requirements for
carbohydrate, fat and protein and all of the additives and amino acids and
vitamins and stuff that they need. And the more of something else you give
them, the more you can unbalance that equation, Plus, you don't want a dog that
sits at the side of the table and begs all mealtime.

DAVIES: Now, arthritis is common in dogs. I mean, a lot of people have dogs who
will occasionally limp or just get stiffer with time. And I was interested to
read in your book that the cause is different than in humans. Explain.

Dr. DODMAN: It is. You know, with humans, well, there's two types of arthritis
in dogs and humans. There's osteoarthritis, which is, you know, kind of the
bones get kind of rusty, as it were. You know, they've got little spikes on
them and rough edges, and they grate and grind, osteoarthritis. And then
there's rheumatoid arthritis. Well, both humans and dogs get both types, but
the common type in old age is the osteoarthritis.

In humans, osteoarthritis is almost exclusively a wear and tear lesion, just,
you know, been using these bones and joints for so long that they get a bit
sort of creaky, cranky and, you know, there are actually architectural changes
that lead to stiffness and soreness and so on.

In dogs, that isn't usually the case. I mean, most frequently, arthritis arises
because of some condition that the dog had when it was very young which has now
progressed.

I mean, one condition, for example, is hip dysplasia, where the ball and socket
joint of the hip is not properly congruous. So, you know, the head of the femur
bone, which is the thigh bone, is sort of misshapen and doesn't fit properly
into the socket, the so-called acetabulum.

And so there's a bit of moving around of this over the course – and over the
course of years, you find these osteoarthritic changes that you can see on an
X-ray. They, you know, it's just like it's corroded, and this becomes
progressively more painful.

There are other conditions, elbow dysplasia and shoulder dysplasia, too, which
also lead to arthritis. Sure, you can get an occasional wear and tear lesion
lower down on the legs, you know, the carpus, the wrist, that is. But it's
different from humans, like you mention. Not all wear and tear, mostly due to
the things the dog had younger that weren't fixed and then cause a problem
later on.

DAVIES: And it seems like it's just more typical for dogs to have limbs that
simply don't fit together very well.

Dr. DODMAN: Yes, I don't know how common it is in people. I know that hip
dysplasia, for example, is more common in women than it is in men, but I'm sure
it's not as common in people in general as it is in dogs.

And sometimes, you know, the line breeding that they call the inbreeding of
certain breeds, like for example the epitome would be the German shepherd, has
produced a dog that is prone to this disorder, I think partly due to giving
them this low-slung appearance. That's a sort of modern look for a German
shepherd, relatively modern, where they sort of slope from front to back. And
in the process of going for the slope, I believe they've caused some issues
with the hips not fitting properly into the – the hip bones not fitting
properly, and then that leads to this lesion down the road.

So a lot of genetic problems with line-bred - which really is a kind of
inbreeding - dogs. That causes these kind of issues.

DAVIES: And when people have a dog whose joints seem creaky, or they may be
limping, you know, you wonder how much pain the animal's in, and people will –
some people will think well, just give him an aspirin or something anti-
inflammatory. What – how do you treat these issues?

Dr. DODMAN: Well, we outline that in the book, and, you know, one of the big
things, as is the case with people, is weight loss. So if the dog is marginally
or even more so, very common these days, overweight, you need to bring the
weight down because the large, you know, mass or weight of the dog will stress
the joints further. And you can often get a lot of relief from reducing the
weight by an equivalent amount or whatever to get him to his fighting weight.

Also, moderate exercise is good because muscles that are in proper shape, as
opposed to being allowed to become flaccid and unused, proper development of
muscles around joints can help to stabilize them.

So these are two big sort of really fairly conservative things that can be
done. There are also aspirin-like drugs, so-called non-steroidal anti-
inflammatory drugs, and there are some very good, very powerful aspirin-like
drugs on the market in veterinary medicine that can make night and day
difference for a dog with joint pain.

DAVIES: We're speaking with veterinarian Nicholas Dodman. We'll talk more after
a break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you're just joining us, our guest is veterinarian Dr. Nicholas
Dodman. He's collaborated with other vets from the Tufts School of Veterinary
Medicine on a book about how to care for senior dogs. It's called "Good Old
Dog."

A lot of older dogs get cancer, you tell us in the book, and you outline the
different kinds. But it was interesting for me to read that the goal of
treatment is in some ways fundamentally different from treating humans with
cancer.

Dr. DODMAN: Yeah, cancer is the leading cause of death in dogs, which is, you
know, different from the situation in humans. And over 50 percent of dogs 10
years old or greater will acquire this dreadful disease, and oftentimes, you
know, it will result in death. So the actual stat is something like one-half
million dogs per year in this country die of cancer. So this makes it a major
cause of death.

And there are a number of different types of cancer that can occur, which we
outline in the tome, from cancer of the lymph system to cancer of the bones,
especially in very large dogs. They get osteosarcoma, mass cell tumors, tumors
of blood vessels and breast cancer, all biggies.

DAVIES: But when they're treated, you say that they're often not really aimed
at curing the illness, as it is with people.

Dr. DODMAN: Yeah, that's true. I mean, it depends a bit on the cancer, its
location, whether it's benign or malignant, you know, how easy it is to get at,
whether it's amenable to surgery, for example.

But, you know, if we take a benign cancer, say a lipoma, it's a fatty tumor,
somebody doesn't like this ugly-looking lump, the vet can remove it, it's gone,
that's the end of the problem. So that would be perhaps the same as in humans.

But when it comes to these more advanced treatments like radiation or
chemotherapy, you know, in people, the goal is to completely rid the body of
cancer. This is the objective, to get rid of it because, you know, a person
who's 50 or 60 or 70 years old can have another, you know, 10 or 20 or 30 years
to live.

But then when you think of a dog, you know, first of all, if you're going to
give him, say, chemotherapy, a lot of people don't want to make their dog that
sick that they're going to give them monster doses of chemotherapy. They just
don't feel right to impose that on their dog when they cannot understand that
there's a light at the end of the tunnel.

And secondly, the dog is not going to live that long anyway. If you've got a
12-year-old dog, and you extend his lifespan by two years with moderate doses
of chemo or radiation, it's more palliative and sort of extending the course of
life rather than trying to actually eliminate every last cancer cell. That is
the strategy for veterinary cancer treatment.

DAVIES: There was an interesting case that you describe in the book of a dog
owner who chose to get a fairly, you know, expensive treatment for cancer after
considering the options, and the dog lived about another six months, and that
they felt great about that decision because that was the equivalent of a couple
of more years in life or more, were it a person.

And it struck me that, you know, it's still six months. Does it make sense to
aggressively treat a disease if a dog is that close to the end?

Dr. DODMAN: Well, there certainly are a number of things to consider when you
are presented with an option of treating an older dog with cancer or any other
condition.

You know, the first of them is, you know, how much longer is he going to live?
Second of them is, you know, what sort of pain or suffering are you going to
put him through in the way of treatment? You know, cost is a factor for a lot
of people, too, quality of life and so on.

So, you know, if, for example, you had a relatively non-invasive procedure that
wasn't going to cause your dog a lot of pain, and it was going to buy him an
extra six months, and you could afford that treatment, and those six months
were quality life, the dog's running around happy and eating and so on, you
know, why not, if you can afford it?

But, on the other hand, just to drag out an existence – which some people, I
have known in the past, who have done that. Owners, with cooperating vets, have
just gone step after step after step, when really you're on a hiding to
nowhere. And, you know, if the dog is, you know, in chronic pain and doesn't
have long to go, you know, sometimes I question the wisdom of that approach.

DAVIES: The book is filled with all these advances in veterinary medicine, and
there's a lot of expensive stuff here, tests and medications and even surgery
and physical therapy. You know, and it takes us into a very different age from
when people had pets, and if they died, they died.

Should somebody be prepared to commit thousands of dollars to a dog's medical
care? And that raises a question of whether, you know, poor and working people
can afford a pet's companionship.

Dr. DODMAN: Well, that's certainly something to think about ahead of time. I
mean, you know that as we get older, we need more and more medical care. I
mean, after the age of 50 years old for a person, you're going in for annual
physicals and having this measured and that measured, and things start to go
wrong. And it's the same with dogs.

So the book does teach about the expense of keeping a dog and how to prepare
for it, including things like health insurance for pets, or even you could be
your own insurer and just put away a small amount of money per month to make
sure you're ready for that contingency plan, that is, for something bad
happening down the road.

I mean, invariably it will. I mean, all of us are going to run into a brick
wall, and our dogs, at some point. And it's either a sudden demise or a
protracted one, and a protracted one is often very expensive.

So I think it's good to gird one's loins and prepare for that day. And if it
doesn't happen, you have an extra fund available to you, and if it does happen,
you know, if it's not a – you know, if the dog dies suddenly, you wouldn't have
to spend that money, but if it's drawn out, at least you're covered.

DAVIES: Yeah, but if somebody comes in, and, you know, they have, you know, a
middle-class job and are struggling to keep their family together, and the dog
needs a $1,500 treatment, and they say I just can't afford a $1,500 treatment
right now, do you judge them?

Dr. DODMAN: Well, I would do if they were, you know, smoking three packs of
cigarettes a day, driving a BMW and filling it up with expensive gas. I mean,
you know, I think that, you know, you shouldn't get a pet if you're not
prepared to make some kind of commitment to it.

But I must admit, on the other side of that, there are some treatments that
are, you know, violently expensive, and, you know, how do you deal with that?

Well, I mean, I met a dog like that yesterday. It wasn't as old as some of the
books – dogs we're talking about in the book, but this dog had a heart murmur,
and the owner was advised to have an ultrasound exam. They couldn't even afford
the ultrasound.

So they took the dog not to the shelter, where he would have a two-thirds
chance of a death sentence. They took him to his breed rescue group, where they
actually managed to find a home for him several states away. So, you know, the
people saved the dog, they saved their pocketbook, and the dog found another
home. So sometimes there can be a happy ending even in that difficult
situation.

We do talk in the book about resources like angel funds that are available for
people who are in difficult trouble. We have one at our hospital for truly
needy people. So there are all kinds of ways of weaseling it: second homes,
angel funds and so on. But I must admit, you know, some of the numbers that are
mentioned in the book, like a person who spent $60,000 on their dog, I mean,
there's a time when it's going to out-price even reasonable citizens.

GROSS: We'll hear more of Nicholas Dodman's interview with FRESH AIR
contributor Dave Davies in the second half of the show. Dodman is a
veterinarian and an animal behaviorist. He's a professor at Tufts University's
Cummings School of Veterinary Medicine. His new book is called "Good Old Dog."
I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross. We're talking about taking care of
aging dogs and dealing with chronic conditions and difficult end-of-life
decisions. Our guest Nicholas Dodman is a veterinarian and animal behaviorist.
His new book is called "Good Old Dog." Let's get back to the interview Dodman
recorded with FRESH AIR contributor Dave Davies.

DAVIES: So let's talk about some of the behavioral problems that the owner of
an older dog confronts. One of them is incontinence, they just, they don't hold
it. They're starting to go in the house. Can you do anything about it?

Dr. DODMAN: Yes, there's a lot of things that can be done and one of the common
causes of incontinence in an older dog, especially a female, is just a
looseness of sphincters, which are the little muscles that hold urine in. So
they just kind of dribble and leak. So the epitome might be, say, a 10 or 11-
year-old, sort of larger breed, female, spayed earlier in life removing all
these reproductive hormones that help to maintain tone, and sleeping away
quietly. Gets up and there's a puddle of urine. That can easily be fixed with
medicines that increase tone in the urinary tract.

One of the common one that's used is the acronym is PPA. That's
phenylpropanolamine. You can also supply very low dose missing estrogens,
another acronym, DES, for basically stilbestrol, which is the female sex
hormone. I've heard people fix this problem with treatments even as simple as
adding canned pumpkin to the diet, because pumpkin and actually various soybean
extracts and so on contain phytoestrogens which are the - with a PH - the
plant, estrogens and these things can all tone up the sphincter so that one
really is pretty easy to fix.

DAVIES: And those were cases where you're not seeing the dog squat and do its
business. It's simply leaking when they are not aware of it.

Dr. DODMAN: That's right. So it's not house soiling as such as just
incontinent, which is literally just unable to control the flow of urine
properly.

But then, you know, you can also have, you know, various medical conditions so,
you know, one would not want to miss out the fact that, you know, a 10-year-old
dog who started to soil in the house, you wouldn't want to miss out the fact
that he might have kidney disease, he's producing too much urine, he's drinking
a lot. He's urinating a lot, he gets caught short more often or he has some
kind of diabetes and all of these medical things can be ruled out and or
treated as well as this post-spaying incontinence we just talked about.

But when all that is ruled out and it isn't any of the above, and you have a
mystery case, say, a 10 or 11 or 12-year-old dog who previously was completely
housetrained and there's been this breakdown of housetraining. He just kind of
lost the place. That is a cardinal sign of dementia, so-called canine cognitive
dysfunction which is the canine equivalent of human Alzheimer's disease.

DAVIES: You know, I wanted to talk about that because I, my family just put to
sleep a dog about two years ago, a terrific little corgi mix that we had for
many, many years named Buddy, and I think he suffered from dementia. And for a
quite a long time he would exhibit this behavior where he would pace around the
house, just walk and walk and walk and walk for hours and hours, and then
occasionally you'd realize you didn't hear him walking and then you would hear
him howl. And you would find him with his nose in a corner. He would get into a
corner of a room and somehow be unable to reverse himself and kind of howl out
in frustration. What was going on?

Dr. DODMAN: Well, that does sound very much like dementia. That's exactly the
kind of behavior that you would expect to see. First of all, I must say, like
in humans, it's a diagnosis of a certain constellation of signs that are not
accounted for by any other physical finding or disease. So it's a diagnosis of
exclusion or rule-out.

To make the diagnosis of canine Alzheimer's or canine continence dysfunction,
there is a helpful chart on the Pfizer Animal Health website where it divides
the signs that a dog with Alzheimer's - I'm calling it, loosely - might have.
If you can go down and check the boxes and you might find you've got, you know,
six checks in the box - in the various boxes. Then a month later you do the
same thing again. If you find the number of checks is increasing that's a very
good sign that you are on the Alzheimer track.

But that dog that you described, this aimless wandering, increase in
purposeless activity, especially if accompanied by sleep disturbances and
especially if accompanied by house soiling with no other medical explanation,
that really does sound very much like it.

DAVIES: And, you know, one of the things that we wondered is, what's his
quality of life? What's going on in his head? I mean when he used to love to
greet us and to, you know, chase balls and look forward to his meals, I mean
he's at least still eating. How do we know what kind of quality of life he's
experiencing? What's going on in that little pooch's head?

Dr. DODMAN: Well, you never do know what's going on exactly in a dog's head and
that is the art of the science of veterinary medicine is, you know, sort of
reading the signs when you can't, you know, have no language and you can't
communicate in that way.

But, you know, judging by what happens to people, it's not so much the people
with Alzheimer's themselves who are affected as much as their relatives. I mean
that may not be true in the early stages where they get very angry with
themselves because they can't remember things and they can feel themselves
slipping. But there comes a point where, you know, really the issue is more for
the family. And this is somewhat true with the dogs too is that the dog doesn't
seem to be unhappy, will eat, might enjoy some things.

My mother had Alzheimer's and she would really enjoy singing nursery rhymes,
you know, with my sister or myself. And it was kind of, you know, back to
childhood. She wasn't suffering at all. She just had this - it's almost like
reversing the clock of time. You sort of go back in years. And I think she
thought, you know Winston Churchill was the prime minister of England. And it
was very strange this sort of retrograde - except that she wasn't unhappy. And
I think that's the same with dogs.

I think they just kind of lose the place and they're wandering around. But, of
course, if they start to have accidents in the house this is when the owners,
you know, oftentimes the husbands I'm afraid to say, say, you know, out, damned
spot. We can't suffer this. And it's a sad fact that something like 20 percent
of all dogs that are brought to shelters and pounds are brought there because
they are quotes, "too old," and I suspect that house soiling as a result of
dementia may be one of those reasons.

DAVIES: We're speaking with veterinarian Nicholas Dodman. We'll talk more after
a break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you're just joining us, our guest is veterinarian Nicholas Dodman.
He's collaborated with other vets from Tufts University to produce a book about
caring for older dogs. It's called "Good Old Dog."

I want to talk about end-of-life decisions. I mean these are so difficult. And
in many cases, you know, they are medical matters where a dog is unable to, you
know, rise or support itself. But the book says that there may be a time when
the dog indicates by its behavior that it's time to let go. That it's showing
no interest in life, not being itself even though it may not appear to be in
pain. How do you help people sort through that?

Dr. DODMAN: Well, it's really done on a case-by-case basis but, you know, and
it's very, you know, so really it is an art, again, of the science of
veterinary medicine that well, we listen carefully and we - to what the people
are telling us about the dog's life and we look carefully at the dog. And the
fact is if they have reached a point where they've almost given up, which some
people do too, they just quit. So they are just basically lackluster, you know,
not enjoying life, not playing, not interacting, haven't responded to any
therapies, especially if they are losing interest in food and in any social
interactions and nothing that you do can bring them back. You know, you have to
think very seriously about what is the quality of life because it's not about
for humans I would believe too, it's not about how long you live. It's a think
what they call at the Tufts Nutrition Center, which is dedicated to aging
humans, you know, solving - they talk about a health span.

So I think all of us want to live as healthy a life as we can for as long as we
can but there comes a point when at least for dogs it's too much. You know, the
rest of life, you know, after a certain point - and like I say, it's a judgment
- is really a hiding to nowhere. You have no interest. You're not responding to
any treatments. You're losing your appetite. And that's the point where in
humans they might put in a feeding tube and keep them going longer but, you
know, mostly people with dogs just say I think enough is enough and with the
help of their veterinarian they make the difficult decision and then it's
curtains.

DAVIES: You know, I guess one of the things underlying my question is how much
do I think of the dog and how much do I think of the family? I mean he's not
the same animal that we loved. On the other hand, does he deserve another day?
Does he deserve another week? And yeah, it's a pain to clean up when he messes
in the house but, you know, it can be done. To what extent should people think
of themselves in this decision?

Dr. DODMAN: I don't think they really should be part of the decision. I mean
they are because they own the dog and they are his, you know, caregivers, his
guardians and whatever and they must get involved in the decision. But, you
know, as a veterinarian, I always think of the dog and advise the people
accordingly.

So, you know, if I think that the dog is doing fine and has, you know, has some
quality of life, you know, I listen to what they say and incorporate what they
say, and then I give them my opinion. I say I think this dog is actually doing
pretty well and he seems to enjoy being petted and he has a lot of fun when you
do this and that and he's enjoying a good meal, you know, I think he's in good
shape, relatively speaking, although he is on a slippery slope. And they often
listen.

But people are strange because some people, you know, at the first accident or
the first sign of a problem they pull the plug and say that's it. He's old.
He's gone. And that was that shelter statistic I mentioned earlier, he's too
old, take him down to the shelter, which I really can't understand. And other
people go the exact opposite extreme. They keep their dog alive despite the
fact he can't walk. He's lost the place. He's sitting in a pool of urine and
feces and there's really nothing left. And they'll just keep going because they
can't make that final decision and I don't think that's kind to the dog.

I think there comes a point - I mean, it's always difficult to pinpoint the
precise day and once you know it, that day, you decide is the last day all of a
sudden there will be a momentary perking up and then it isn't the last day and
you leave it another week. It can get very tricky. But there's a case where it
clearly is too early and there's a case in my opinion where it clearly is too
late, and deciding what the right time is is between the family and a good
veterinarian.

DAVIES: In cases where there's been a decision to euthanize the dog, the book
advises that owners, if they're up to it, that it's good for them to be
present. What about kids? Do you think it's good for kids to be there?

Dr. DODMAN: I think it's a good idea for, you know, anybody who's close to the
dog to be there and that would include children. As a matter of fact, children
often deal with the decision to put the dog down better than the parents
expect. And it's, you know, death is part of life and it's an education for
them - not that we're doing that for that reason but, you know, there's no
point in hiding their eyes from things that go on.

And for the dog's point of view, you know, it's like a person. I mean you often
hear in the news that such and such a person passed away peacefully surrounded
by his family and, you know, it's the way that most people would want to go and
I extrapolate that, you know, a dog would want to have his near and dear ones
around.

I mean if there's some kid who really hates the dog and doesn't get on with it
I wouldn't force that kid to sit in on the euthanasia, but anyone who's close
to it, including children, family, by all means. It's better I think for the
dog and it's something that - well, that's my yardstick really; it's better for
the dog and not bad for the children.

DAVIES: And do you advise families to get another dog soon after they lose a
dog?

Dr. DODMAN: Probably not. You know, I think that's kind of getting a dog on the
rebound. I think it's a good idea to take a breather. You know, maybe to have
six months or so and just really think out whether you want to have another dog
and, you know, if you did, what kind of dog and whatever. And I would really
hope that people would put a shelter dog in the equation when they're thinking
of, you know replacing an old friend six months later when everyone's had a
chance to get over the grieving and it's not an impulse buy.

There's so many dogs these days are put down in shelters. It's 2.2 million per
year. We should be helping to recycle these dogs and especially the older ones
because if you go to a shelter or pound, you'll find that the younger, smaller
dogs are easily adopted and the larger dogs who are older, you know, they
often, you know, just are put down for no reason of their own and they got
there because homes split up, owners die. They need, you know, you can replace
an older dog with a well, other older dog and do another old dog a good turn. I
think adoption is the way to go.

DAVIES: Well, Nicholas Dodman, thanks so much for speaking with us again.

Dr. DODMAN: Thanks very much, Dave.

GROSS: Nicholas Dodman spoke with FRESH AIR contributor Dave Davies. Dodman's
new book is called "Good Old Dog." You can read an excerpt and find a link to a
checklist for the signs of canine Alzheimer's on our website, freshair.npr.org.
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Harold O'Neal: 'Whirling' Jazz Moves

TERRY GROSS , host:

Our Jazz critic Kevin Whitehead has a review of a new album by pianist Harold
O'Neal. He was born in Tanzania and raised in Kansas City where he played and
recorded with hometown saxophonist Bobby Watson. He's also an actor, karate
teacher, shiatsu therapist, a break dancer, and a former kick boxer known as
Harold Make em' Kneel O'Neal. O'Neal's new quartet album is called "Whirling
Mantis." Jazz critic Kevin Whitehead says the pianist could give up all his day
jobs.

(Soundbite of song, "Whirling Mantis")

KEVIN WHITEHEAD: The title track from Harold O'Neal's "Whirling Mantis" named
for a defensive move in karate. The martial-arts reference suggests one way to
look at how O'Neal's music operates: The players react to each other's moves,
deflecting one another in stylized interaction. It's about whirling and split-
second responses; of surging and then letting the other spinning tops come to
you.

(Soundbite of song, "Whirling Mantis")

WHITEHEAD: Pianist Harold O'Neal with Jaleel Shaw on alto sax. O'Neal and
drummer Rodney Green have recorded together before, like Green and bassist Joe
Sanders. This session was the first time they'd all played together - not that
you'd know it. Jazz musicians pull off the miracle of quick cohesion all the
time. One reason it works here is the players share a broad frame of reference
that takes in bop, funk and freestyle, without giving any of them the upper
hand.

Here's O'Neal's "Motion M."

(Soundbite of song, "Motion M")

WHITEHEAD: I love the cool pulsation of that track. Harold O'Neal's best tunes
slink like a panther: The players ride a groove, even as they circle each
other. His "Neptune Dream" uses a ploy carried over from the last tune: The
pianist's left hand doubles a tricky bass part for a fatter bottom end.

(Soundbite of song, "Neptune Dream")

WHITEHEAD: Harold O'Neal wrote these pieces over a number of years, and they're
not all equally strong; his ballads can be a little diffuse, and he leads off
with a too-blatant nod to John Coltrane's "Giant Steps" called "Aint G." But on
any material, the band delivers the goods, and O'Neal shows his cunning as a
player. Like many pianists, he's influenced by Herbie Hancock's jitters behind
Miles Davis and McCoy Tyner's ocean waves with Coltrane. But O'Neal's phrases
take odd turns and side trips, making it hard to tell sometimes where he's
headed from one second to the next. Which is what you'd expect from a gyrating
martial-arts master.

(Soundbite of music)

GROSS: Kevin Whitehead is a jazz columnist for eMusic.com. He reviewed
"Whirling Mantis," the new CD by pianist Harold O'Neal on the Smalls label.

Coming up, film critic David Edelstein reviews "Love and Other Drugs," starring
Anne Hathaway and Jake Gyllenhaal.

This is FRESH AIR.

(Soundbite of music)
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'Love And Other Drugs': A Worthy Prescription

TERRY GROSS, host:

In the new romantic drama "Love and Other Drugs," directed by Ed Zwick, Jake
Gyllenhaal is a salesman for a drug company who meets Anne Hathaway, a young
woman with early-onset Parkinson's disease. The film is based on the memoir
"Hard Sell" by Jamie Reidy, a former pharmaceutical rep for Pfizer and Eli
Lilly.

Film critic David Edelstein has a review.

DAVID EDELSTEIN: "Love and Other Drugs" is brash and manic and sexy, then grim
and weepy and self-consciously inspirational. It's madly uneven. But it's also
one of the few romantic movies in the last few years with strong and insightful
satirical undertones.

It's set in 1996, which wasn't the dawn of our psychopharmacological era, but
it was certainly the morning, and Big Pharma sales-dude Jamie Randall, played
by Jake Gyllenhaal, is an early riser. He's a supple, smooth-faced, blue-eyed
cutie whom women fall for even when they know that his ingenuousness is an act:
It's more winning than other men's genuine ingenuousness.

Under the tutelage of a company mentor played by Oliver Platt, Jamie gets more
and more accomplished at sweet-talking physicians and receptionists. His goal
is to get doctors to prescribe his antidepressant, Zoloft, instead of his even
slicker competitor's, Prozac.

Even set in the past, the first half of "Love and Other Drugs" is a state-of-
the-art zeitgeist sex comedy, and it's even more of a kick when Jamie's company
comes out with the Holy Grail: Viagra. Suddenly, he doesn't have to labor to
get physicians' attention. He's the most popular guy in town.

Not that Jamie needs the drug. He has sex all the time and no particular
hankering for a relationship. But one woman brings him up short, an artist
named Maggie Murdock, played by Anne Hathaway. They meet cute, or cute-slash-
icky: He pays a doctor, played by Hank Azaria, to let him pretend to be an
intern to observe how physicians operate, and Maggie is a patient with early-
onset Parkinson's disease. She's furious when she discovers what Jamie really
does, but he bugs her until she meets him for a date.

(Soundbite of movie, "Love and Other Drugs")

Ms. ANNE HATHAWAY (Actor): (as Maggie) What's your game?

Mr. JAKE GYLLENHAAL (Actor): (as Jamie) My game?

Ms. HATHAWAY: (as Maggie) Oh, right, this is the part where we talk about where
we come from and what we majored in in college.

Mr. GYLLENHAAL: (as Jamie) You have beautiful eyes.

Ms. HATHAWAY: (as Maggie) That's it? That's the best you got?

Mr. GYLLENHAAL: (as Jamie) I'm serious. They're beautiful.

Ms. HATHAWAY: (as Maggie) Well, let's go.

Mr. GYLLENHAAL: (as Jamie) Excuse me?

Ms. HATHAWAY: (as Maggie) Well, you want to close, right? You want to get laid?

Mr. GYLLENHAAL: (as Jamie) Now?

Ms. HATHAWAY: (as Maggie) Mmm. Mmm. Oh, right, right, right. I'm supposed to
act like I don't know if it's right. So then you tell me that there is no right
or wrong. It's just the moment. And then I tell you that I can't. While
actually signaling to you that I can, which you don't need because you're not
really listening, because this isn't about connection for you. This isn't even
about sex for you. This is about finding an hour or two of relief from the pain
of being you. And that's fine with me, see, because all I want is the exact
same thing.

(Soundbite of crashing)

EDELSTEIN: Those last noises were the pair in her apartment, frantically
removing clothes, and there's no getting around it: Gyllenhaal and Hathaway are
beautiful specimens. Once or twice they're buck-naked, which is the film's
come-on. They're even on the cover of Entertainment Weekly without their
shirts.

Director Edward Zwick made his name with the TV series "Thirtysomething" and
then moved on to Oscar-bait war movies. With "Love and Other Drugs," he has
rediscovered his inner Jason Reitman. Like Reitman's charismatically
irresponsible protagonists in "Thank You For Not Smoking" and "Up in the Air,"
Zwick's Jamie must develop a social conscience and learn to love.

The film's tone turns darker, as you know it will. It doesn't take much to see
that Maggie is so tart and commitment-averse because she has a degenerative
disease. And Jamie, though he desperately tries to help her, is powerless. He
watches Maggie shepherd elderly men and women in a bus back and forth from
Canada, where they can fill their prescriptions at a fraction of the prices set
in the U.S., and he realizes that, as a drug rep, he's a cog in a machine he
can't fully trust.

I think the movie would have been more on point if Maggie were depressed
instead of afflicted with Parkinson's. With a more defined illness, the movie
is on the soapy side. The surprise goes out of it, and the air, too. Hathaway
is impressive in the first half, hard in a way that subtly signals her
vulnerability. But in the second half, Zwick should have dialed her down.

In the end, half the audience will be drying their eyes and the other half
rolling them. I was mostly in the latter camp, yet I like the movie's scope. It
should also be said that romantic-comic weepers are drugs, too, and for all the
mood swings this one induces, I feel reasonably confident prescribing it.

GROSS: David Edelstein is film critic for New York Magazine.

You can download podcasts of our show on our website, freshair.npr.org.

I'm Terry Gross.
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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