Tarantino, DVM, MBA, discusses signs of pain in senior canines.

Signs of chronic pain in geriatric dogs

 at the 2025 New York Vet Show in New York City, Monica Tarantino, DVM, MBA, cofounder of the Senior Dog Veterinary Society in Alexandra, Virginia, discusses signs of chronic pain in geriatric dogs. She notes that signs of chronic pain can be subtle and often mistaken for old age, but any behavioral changes in older pets should be brought to a veterinarian's attention.

In addition to cofounding the Senior Dog Veterinary Society, Tarantino is also the coauthor of 2 books for early career veterinarians—

. She is also an active animal rescuer with 4 adopted dogs, 2 rescue cats, and the occasional foster.

The following is a transcript of the video, which has been lightly edited for clarity and cohesion.

I'm Dr Monica Tarantino. I am a veterinarian and the cofounder of the Senior Dog Veterinary Society, and we're on a mission to advance the care of elderly canines in [veterinary medicine].

What are some subtle behavioral and physical signs of chronic pain in geriatric dogs?

I think chronic pain can vary quite a bit depending on the source and where it's coming from. We have a lot of the classic signs such as limping, an intermittent limp, having difficulty getting up from sitting to standing, maybe some reluctance to go for a walk, or some sort of evidence that maybe something in their musculoskeletal system is bothering them. Oftentimes, the signs of chronic pain are going to be very subtle, [and it might] look like a change that a lot of people might say is just due to old age, but every single behavioral change that you're seeing in the older dog or an older pet, you want to actually bring to the attention of your veterinarian.

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Signs of pain may be subtle and be mistaken for old age, explains Monica Tarantino, DVM, MBA, in an interview at the 2025 New York Vet Show.

Chronic inflammatory enteropathies (CIE) in dogs are defined as persistent gastrointestinal (GI) signs lasting more than 3 weeks after other systemic and extra-GI causes have been ruled out.

 As a small-animal internist practicing in a major metropolitan referral center, one of the most frequent presentations I encounter is the young dog—typically under 5 years of age—with chronic GI signs. These dogs have often already undergone baseline diagnostics with their primary veterinarian, including normal blood work and fecal screening, before being referred for advanced evaluation.

While many of these patients are referred for abdominal ultrasound or endoscopy, it is worth emphasizing that most young dogs with CIE do not require these advanced diagnostics initially. In my experience, ultrasound findings in these cases rarely change the initial treatment plan, which nearly always begins with a diet trial. For most young dogs with chronic GI signs, the disease is ultimately food-responsive enteropathy (FRE).

Dietary management: The first and most crucial step

The cornerstone of management for CIE in young dogs is dietary therapy. The goal is to minimize antigenic stimulation of the intestinal mucosa. Several studies have shown that hydrolyzed or novel-protein diets can induce clinical remission in approximately 60–88% of dogs with CIE and normal serum albumin.

 In one randomized controlled trial evaluating hydrolyzed fish-protein diets, 83% of dogs with non-protein-losing enteropathy (non-PLE) responded to their first diet, and all remaining non-responders achieved remission after switching to a second hydrolyzed diet.

When initiating a diet trial, client education is essential. Owners must understand that strict adherence is non-negotiable: the prescribed diet must be the only source of nutrition. No other animal-protein treats, supplements, chews, or table scraps should be allowed. Approved hydrolyzed protein treats or small amounts of specific non-animal foods, such as certain vegetables or fruits, are acceptable but should remain limited.

A meaningful dietary trial typically lasts about 4 weeks. However, in my experience, some dogs require up to 8 weeks to show full improvement. If a dog fails to respond to one hydrolyzed or novel-protein diet, it is not appropriate to give up and proceed immediately to advanced diagnostics. Instead, trialing a second hydrolyzed or novel-protein diet is warranted. Because our current understanding of the canine intestinal microbiome and its dietary interactions is still evolving, no single diet is universally effective for all dogs. The long-term evaluation of 60 dogs with CIE demonstrated that many patients initially classified as immunomodulator-responsive enteropathy (IRE) were later reclassified as FRE after additional dietary trials.

Prebiotics, probiotics, and fiber: Targeting the microbiome

For dogs that improve clinically but continue to have loose stools or large-bowel signs, adjunctive therapy with prebiotics, probiotics, and fiber can be highly beneficial. Soluble fibers serve as fermentable substrates for colonocytes, generating short-chain fatty acids that enhance colonic health. A study evaluating a diet rich in mixed fiber sources showed significant improvement in stool quality and frequency in dogs with large-bowel diarrhea.

Similarly, probiotics have an important role. One randomized, controlled trial demonstrated that dogs with idiopathic inflammatory bowel disease experienced improved mucosal microbiota balance when given a multi-strain probiotic.

 has been shown to promote microbiota diversity and mucosal homeostasis in dogs with CIE.

In my experience, adding a high-quality probiotic and soluble fiber to a hydrolyzed diet frequently resolves residual stool-quality issues and helps stabilize chronic large-bowel diarrhea. A diet combining hydrolyzed protein and pre-/probiotics can often maintain long-term remission without escalation of therapy. A main goal should be to avoid chronically medicating young dogs unless necessary.

The role of GI panels and cobalamin/folate testing

Even when routine laboratory results are normal, assessing for functional GI changes is crucial. A gastrointestinal panel (measuring serum cobalamin, folate, trypsin-like immunoreactivity (TLI), and pancreatic lipase immunoreactivity (PLI) can help identify malabsorption or concurrent pancreatic disease.

Hypocobalaminemia has been shown to negatively affect prognosis in dogs with CIE.

 Fortunately, both oral and parenteral supplementation effectively correct deficiencies and improve clinical outcomes.

 Hypocobalaminemia, hypofolatemia, or hyperfolatemia support gastrointestinal inflammation and CIE is likely. I typically follow the dosing guidelines provided by the Texas A&M Gastrointestinal Laboratory. Testing should be performed on a fasted sample to avoid post-prandial variability and to allow concurrent evaluation for exocrine pancreatic insufficiency and pancreatitis.

Additionally, a baseline cortisol test is often worthwhile to screen for atypical hypoadrenocorticism, even when electrolytes are normal, particularly in dogs with chronic GI signs and unremarkable standard diagnostics.

Rule out extra-GI causes with standard baseline testing.

Start with a strict hydrolyzed (or novel-protein diet trial) and enforce compliance.

Trial at least two diets before concluding a patient is non-responsive.

Add prebiotics and probiotics for dogs with residual stool issues.

Run a GI panel to check cobalamin and folate status; supplement as indicated.

Reserve advanced diagnostics for true non-responders, older patients, or those with PLE indicators.

Remember, in most young dogs, ultrasound rarely changes the initial therapeutic plan. A diet trial should always come first.

If a dog has failed to respond to multiple diet trials (ideally 2 or more hydrolyzed/novel-protein diets), pre-/probiotic supplementation, and cobalamin support, referral for advanced diagnostics is appropriate. Abdominal ultrasound is particularly indicated when there are abnormalities such as hypoalbuminemia or hypocholesterolemia, which may suggest protein-losing enteropathy (PLE).

It is also important to remember that dogs over 5 years with new-onset GI signs are more likely to have neoplasia or severe inflammatory disease. In such cases, early imaging is appropriate to assess for focal disease, such as masses. If ultrasound imaging is normal, then treating for FRE would be the appropriate next step. However, for many young dogs, ultrasound findings rarely alter the initial management plan. Dietary therapy remains the foundation of treatment.

When dietary and adjunctive measures fail, abdominal ultrasound and, subsequently, endoscopic biopsies become necessary to reach a definitive diagnosis. Histopathology often reveals lymphoplasmacytic enteritis—the hallmark lesion of inflammatory bowel disease. Only at this stage should immunomodulatory therapy be considered. Empirical immunosuppressive treatment is discouraged unless anesthesia or cost constraints preclude endoscopy.

Hodel S, Brugger D, Kook PH. Long-term evaluation of the initial response to therapy in 60 dogs with chronic inflammatory enteropathy. 

. 2024;38(5):2444-2453. doi:10.1111/jvim.17161

Mandigers PJ, Biourge V, van den Ingh TS, Ankringa N, German AJ. A randomized, open-label, positively-controlled field trial of a hydrolyzed protein diet in dogs with chronic small bowel enteropathy. 

. 2010;24(6):1350-1357. doi:10.1111/j.1939-1676.2010.0632.x

Simpson KW, Miller ML, Loftus JP, Rishniw M, Frederick CE, Wakshlag JJ. Randomized controlled trial of hydrolyzed fish diets in dogs with chronic enteropathy. 

. 2023;37(6):2334-2343. doi:10.1111/jvim.16844

Lappin MR, Zug A, Hovenga C, Gagne J, Cross E. Efficacy of feeding a diet containing a high concentration of mixed fiber sources for management of acute large bowel diarrhea in dogs in shelters. 

. 2022;36(2):488-492. doi:10.1111/jvim.16360

White R, Atherly T, Guard B, et al. Randomized, controlled trial evaluating the effect of multi-strain probiotic on the mucosal microbiota in canine idiopathic inflammatory bowel disease. 

. 2017;8(5):451-466. doi:10.1080/19490976.2017.1334754

Tamura Y. Chronic Enteropathy and Vitamins in Dogs. 

. 2025;15(5):649. Published 2025 Feb 23. doi:10.3390/ani15050649

Chang CH, Lidbury JA, Suchodolski JS, Steiner JM. Effect of oral or injectable supplementation with cobalamin in dogs with hypocobalaminemia caused by chronic enteropathy or exocrine pancreatic insufficiency. 

. 2022;36(5):1607-1621. doi:10.1111/jvim.16528

Articles

Explore effective strategies and management techniques to enhance gastrointestinal health and treatment outcomes for canines with CIE.

How to manage chronic inflammatory enteropathies for young canines, in general practice 

On this week's regularly scheduled episode of 

, host Adam Christman, DVM, MBA, welcomed Brian Hare, MA, PhD, to the show to talk about Hare's work with puppies. Hare and Christman chat about the Duke Puppy Kindergarten, socialization, and why it is so important to these young pets. They also discuss more about Hare and his research in general, including a program on Netflix. 

Below is a partial transcript, edited lightly for clarity: 

 from Disney? Everyone has a gift, a door to open. And I say this to puppy owners, [that] there [are] multiple doors and gifts that they have. It may not be the same gift that the next puppy has. Some are just incredibly well at socialization. Maybe some are great at crate training—whatever [it] is—and that's OK. Sometimes we're comparing apples to oranges...with different dog breeds. Would you say?

 Well...each dog is an individual, and part of what you know creates individuality that we fall in love with, because they all have these idiosyncratic things. If they were all the same, you wouldn't have these remarkable relationships. They're not the same. They're individuals. They're beings. 

Part of what creates that [is] these different cognitive abilities, and we've been able to measure when they come online and when they first develop some of the abilities. For instance, when a puppy is born, they don't have very much self-control, so it's not really until 14 weeks that most puppies develop self-control. But different puppies develop self-control at different times, and that shapes who they end up becoming as an adult. So we have all sorts of leads on some of the things that end up creating the individuals we fall in love with.

What about those dogs we see on social media that...have that ability to communicate with different buttons? [They're] like, "Mommy, out the door," or "[I] have to pee," or "Shut up." What are your thoughts when you see some of these dogs that use those kinds of communication tools...? Is there something to be said about that?

 One of...our big discoveries is that dogs are geniuses for their comprehension of our gestures. So relative to other species—whether it's other chimpanzees or bonobos or wolves—dogs really are special.... In fact, one of the things we further studied in the puppy kindergarten [is] that at an early age, puppies are amazing [at] understanding our gestures.

But what makes the buttons potentially remarkable—and I'll come back to why I say potentially—is that it's about production. It's about producing requests. It's about actually producing communication, not just understanding.... Very few animals have demonstrated to have flexible abilities to communicate, so the buttons have caught everybody's attention because dogs using these buttons seem to be communicating to us in a way that really resonates as a human being. 

Now, whether the science is actually going to bear out that dogs...as they begin to learn language, are they creating words? Are they creating grammatical structures that a young infant begins to make as they begin to show linguistic abilities? The jury's out on that. But should people use the buttons if they want? Absolutely. Are they fun? Are they adorable? If your dog enjoys it, go for it. It's awesome.

Podcasts

Learn more about puppy behavior on this episode of The Vet Blast Podcast presented by dvm360. 

How to decode the puppy mindset to better understand behavior

Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, explains how tight sutures and heavy gauges might do more harm than good, in this interview with dvm360.

A common GI surgery mistake that may lead to intestinal leakage

In this interview on a session she presented at the 2025 New York Vet Show, Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, an associate professor at Cornell University in Ithaca, New York, discusses the most common error veterinarians make during intestinal surgery: using tight sutures with heavy gauge material. She explains why this is a common mistake, and what veterinarians can do to prevent this error.

Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS: 

Probably the most understandable is the fear of leakage, either at the enterotomy site or at the anastomosis site. We know that the risk window for leakage kind of peaks at 3 to 5 days post-closure. I think, intuitively, as surgeons, we really worry that something we’re going to do clinically might predispose to that leakage. The natural instinct, then, is to make our sutures very tight and very close together, and maybe to use a heavier gauge suture material—all in an attempt to give a really tight feel.

Now, while intuitively that all might seem like a good idea, we have to remember this isn’t a mechanical system but rather a biological system. The healing that occurs really relies heavily on blood flow. By using lots of tight sutures that are close together, we interfere with that blood flow inadvertently, more than we intended to.

I think a lot of times, that anxiety to prevent a leak is actually what leads us to make the errors that cause the leak. So, remembering to keep those sutures to a tension that is just appositional—no more than that—using a light suture material, such as 4-0 monofilament, a taper point needle, and keeping our suture spacing reasonably generous—about 4 millimeters apart—to avoid that dreaded suture toxicity.

Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, explains how tight sutures might do more harm than good, in this interview with dvm360.

A common GI surgery mistake that can lead to intestinal leakage

A new injectable vaccine to protect dogs aged 8 weeks and older against kennel cough (

) is now available in the US. Vanguard Recombishield is the only canine vaccine with pertactin protein for an optimal immune response to 

Vanguard Recombishield was licensed by the US Department of Agriculture (USDA) on March 4, 2025. It uses recombinant technology that offers minimal pain, swelling, stinging, and sensitivity for the patient receiving the injection, according to Zoetis.

The new injectable vaccine is intended to replace Zoetis’ Vanguard B Injectable product for protecting dogs against kennel cough. The Vanguard B Injectable vaccine is based on a nonadjuvanted antigenic extract and can continue to be used by veterinarians with remaining inventory.

According to Zoetis, most dogs infected with 

are contagious prior to symptoms showing, which can lead to outbreaks, and the disease is spread year-round. Signs of 

in dogs include sneezing, watery eyes, nasal discharge, and a harsh or honking cough.

 Infection incubation is 3 to 10 days. However, an infected dog can shed bacteria for 3 to 4 months after recovery.

“Every dog is different, and intranasal or oral delivery may not be the right fit for every dog to protect against kennel cough,” Tara Bidgood, DVM, PhD, DACVCP, vice president, head of US veterinary professional services and medical affairs at Zoetis, said in a news release.

 can spread, it is important to ensure dogs are fully protected from this potentially serious bacterial infection.”

According to one study, Vanguard Recombishield reduced coughing duration in dogs by 80% and nasal shedding duration by 23%. Another study, which enrolled more than 600 dogs, reported minimal adverse reactions, with less than 1% experiencing injection site pain and vocalization at administration, and less than 1% biting or scratching at the injection site. Other immediate adverse reactions were observed in fewer than 0.1% of cases, according to data on file with Zoetis.

immunization is not among the “core vaccines” recommended by the American Animal Hospital Association (AAHA), protection against this bacterium may be essential to patients based on their lifestyles and risks. According to AAHA, vaccines should be administered not only when they are overdue but also when the need is unknown, considering that the benefits of vaccination outweigh risks in most cases.

Vanguard Recombishield can be purchased through Zoetis' preferred US distributor partner or through Vetcove. Veterinarians and pet health professionals can also order the product directly from Zoetis.

“At Zoetis, we are committed to innovating to advance pet health. With Vanguard Recombishield, we are proud to be the only company to offer veterinarians and pet parents a full suite of innovative administration options, ensuring every pet receives optimized protection regardless of their specific needs or temperament,” Bidgood said in the release.

Another product is the intranasal formulation of Vanguard B, which was launched earlier this year following the USDA’s approval in 2024. The intranasal product is administered using a single nostril. It provides a smaller dose than the oral delivery and is indicated for dogs as young as 3 weeks.

Zoetis launches Vanguard Recombishield injectable vaccine to provide optimized 

protection for dogs. News release. Zoetis. November 10, 2025. Accessed November 11, 2025. 

https://www.zoetisus.com/news-and-media/zoetis-launches-vanguard-recombishield-injectable-vaccine/

Crossley KC. New formulation for kennel cough vaccine is available. 

. March 26, 2025. Accessed November 11, 2025. 

https://www.dvm360.com/view/new-formulation-for-kennel-cough-vaccine-is-available

2022 AAHA Canine Vaccination Guidelines. American Animal Hospital Association. August 15, 2022. Accessed November 11, 2025. 

https://www.aaha.org/resources/2022-aaha-canine-vaccination-guidelines/

Zoetis’ Vanguard Recombishield is a nonadjuvanted, recombinant injectable therapy.

New vaccine is launched to protect dogs against kennel cough

In this video interview with dvm360, Christopher Rocchio, DVM, founder and CEO of Monarch Practice Transitions, shares more on how practice owners can prepare their practice to be sold, whether they are ready now or not.

Empowering practice owners to achieve successful transitions

 at Fetch National Harbor 2025, Christopher Rocchio, DVM, CEO and founder of Monarch Practice Transitions, discusses what veterinary professionals can do to be better prepared to sell their practice, whether that is something practice owners are looking into now or plan to do down the road. 

Below is a transcript, edited lightly for clarity. 

 Hi, I'm Dr Christopher Rocchio. I am the founder and CEO of Monarch Practice Transitions. I'm a veterinarian and a practice owner, and over the past 10 years, we've been helping practice owners transition out of their practices and sell their practices, either to private buyers, to their associates and an associate buy-in, or to corporate consolidators. 

My wife and I sold our practice last year. We did a joint venture, so we're still part owners, and in that transition, we were able to get ownership for all of our associate doctors, our licensed [technicians], and some of our management staff.

What is 1 piece of advice you have for veterinary professionals currently looking to sell their practice?

It's important to have a very organized process and take your clinic out to as many of these corporate consolidators as possible. We start with [an] evaluation, organize all your financial documents, and [then] show your practice to maybe 10 to 20 corporate consolidators. So with a wide market and getting...maybe 5 to 10 offers—all different values and different structures—you're going to have a lot of options to pick and choose the deal structure you want, the price that you want, and who you're going to sell to. And I think that's more important than anything—picking a good company that's going to support you, because many times, you're going to be working for them for 3 to 5 years.

For professionals not ready to sell yet, what can they do now to be better prepared for when they are ready?

 The important thing is to find out where you are today. We would do [an] evaluation [of] your clinic, look at all the expense structures, [and] find out— are your costs of goods too high? Are your prices too low, as you're spending too much on labor? How are your vets paid? It's always nice to get a snapshot in time of where you are today. [Then] start talking about the different structures that are out there for selling your practice and develop a strategy [for] how...to not only increase the value of [your] practice but [also] how...to assure a successful sale and structure down the road.

Want to learn more from Rocchio and the Monarch team? Register for their upcoming webinar on November 18, 2025, at 7:00 PM EST 

Gain insights into practice transitions, including strategic evaluations and how to maximize sales opportunities in the veterinary industry, from this interview with dvm360.