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Dog psychology: Report on Phoebe from Massey University

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File Number: 57030

Owner Name: Alan & Taeko Ireland
Animal Name: Phoebe
Address: PO Box 2052, Palmerston North 4440

Contact Method: In-clinic consult
Primary Patient or Secondary/referral: Referral from Susan Tomlin, Pet Doctors
Present: Alan, Taeko, Rachael, Phoebe
Date of Consultation: 20th June 2012
CC: Susan Tomlin, Pet Doctors

Date: 29/06/2012

Dear Alan and Taeko,

Thank you for presenting Phoebe, your 18-month-old, black neutered female miniature poodle to me at the Massey University Veterinary Teaching Hospital on 20/6/12 for a behaviour consultation. Pertinent case details are as follows:

Presenting problem: Chewing and swallowing stones/scoria; fearful behaviour; aggressive behaviour; detachment from owners.

HISTORY:

Detailed history is recorded in pre-consult questionnaire and case notes.

EXAMINATION:

Previous clinical exam by primary vet did not find any significant health abnormalities. Systems history does not indicate a likely physical cause. At Massey Phoebe appeared tense within the clinic and did not relax during the 1.5 hour consult. She was willing to sit and lie down, although still alert, until a trigger was presented. When people or other animals passed nearby she displayed mostly anxious behaviour, except for one dog and infant, which she attempted to approach. She did not investigate or solicit attention from me. She did attempt to solicit attention from Alan on occasion. She was very motivated by chicken, and would sit/look. Snatches and mild bites when taking food from hand.

ANCILLARY TESTS:

No laboratory samples were taken at this visit. It is advisable to perform basic blood tests (complete blood count and biochemistry panel) on any dog with behaviour problems. An emerging and controversial area is the role of sub-clinical hypothyroidism and forms of aggression in dogs; further research is required to clarify. A blood test can be done to check the level of thyroid hormone; however the specificity of this test in the absence of clinical signs is low, so interpretation of a low thyroid level can be difficult. Blood tests should be performed prior to starting long-term medication.

DIAGNOSES:

1. Anxiety and fear — Cats, children, adults, vehicle noises, change in routine. Leads to aggression (growl, snap/bite) during daily grooming (eyes, ears, feet), standing over/reaching toward/over head or when attaching lead if not performing complete/usual routine. Otherwise, avoidance behaviour is seen (escape/run home, cower). Fear of adults and vehicle noises have improved a little, tolerance for grooming or change in routine has decreased. Ear related fear aggression may have been initiated by ear pain from past infection.

2. Compulsive disorder — Pica (stones/scoria, grass clippings), banging shoe rack, grabbing/holding object in mouth, frenzied destruction of objects/furniture. If interrupted or prevented, attempts to perform behaviour increase or behaviour diverts to another object, sometimes aggression results. Has become progressively worse.

3. Detachment — Doesn’t seem to bond with people, doesn’t value attention, prefers to be on own, noticed since first obtained.

4. Resource guarding aggression — Food/bowl, toy related, possibly sleeping spot. Snarl, growl. Very food motivated.

5. Incomplete or regression of toilet training — Urinates on carpet if unsupervised.

DISCUSSION:

Phoebe is unable to cope with any change in routine and has a narrow comfort zone. She does not seem to appreciate human contact or attention from her owners. I would usually expect the opposite problem, with separation anxiety being common.

It would be good to see video of a typical day for Phoebe and when she is performing compulsive/destructive behaviours to confirm the diagnoses. This also serves as a benchmark for assessment of treatment progress.

Whilst some apparently compulsive behaviours can have physical causes, e.g. pain, neurologic disease, metabolic abnormalities, and disorders of sensation, this seems unlikely in Phoebe’s case. However, blood tests should be performed to check for signs of metabolic causes (e.g. hypothyroidism, portosystemic shunt).

Anxiety and compulsive behaviour are often linked. They are thought to be associated with altered levels of neurotransmitters such as serotonin and dopamine which lead to problems coping with arousal, anticipation and frustration. Causes are not definitively known, however there may be a heritable component. It is not likely that you have caused these problems in Phoebe.

Phoebe’s underlying anxiety problem and compulsive behaviour are likely to be permanent; however, medication may have mitigating effects and enable behaviour modification to take place. She is unlikely to be completely comfortable in all situations, especially those that she currently finds challenging like going for walks outside the yard, interacting with unfamiliar people/children or dogs. Her repetitive behaviours may improve with medication. I do not know if her human attachment will improve with treatment or not.

Phoebe’s bite inhibition is uncertain as no one (person or animal) has so far been bitten.

TREATMENT PLAN:

1. Rehoming — We discussed that rehoming Phoebe was not likely to be easy or advisable. New owners would need to be fully aware of Phoebe’s problems, willing to attempt treatment, and have the skills, time and money to enable treatment.

2. Euthanasia — Euthanasia is a serious consideration in Phoebe’s case given the guarded prognosis and most likely life-long behaviour modification and medical treatment, the challenges she presents for home life/management, and crucially, the lack of bonding/attachment she displays to people. We do not know what her bite inhibition is like based on previous bites, however, I don’t consider Phoebe’s aggression to be especially dangerous if it can be managed well and triggers are avoided or retrained.

3. Treatment — Involves realistic goal setting, risk management, medication, behaviour modification/retraining, environmental management, and regular follow up.

a. Goals — Safe handling of Phoebe at home during daily grooming, feeding; improvement in compulsive behaviours e.g. decreased frequency, decreased severity/frenzy; able to be left unsupervised at home for short periods; improvement in anxiety in situations that can’t be avoided.

b. Risk management — Involves first of all ensuring that Phoebe cannot harm anyone or any animal. Avoid all situations that trigger her anxiety or aggression until behaviour modification can be done. This includes taking her for walks. Exercise her at home instead using toys/play and use training as mental stimulation. Do not let children be around her. A dog can be difficult to control and Phoebe can be unpredictable, so can children. If you have visitors, tell them to wait at the door/gate and put Phoebe in her safe place before letting them in.

c. Medication — Anxiolytic medication is advised given the severity, chronic nature and multiple compulsive behaviours displayed. Without treatment, compulsive behaviour and anxiety is likely to get progressively worse. Many medications have been tried for treating compulsive disorders. The most consistently successful are the SSRI (Selective Serotonin Reuptake Inhibitors) group. The best response is seen when medication is used in conjunction with behaviour modification and environmental management as described below. Relapses can be common and some dogs benefit from lifelong treatment.

Medication is likely to take 4-6 weeks to start to take effect, although side effects can be seen earlier. Side effects can include gastrointestinal disturbance e.g. inappetance, diarrhoea, constipation, nausea, and urinary retention. These usually wane within 7-10 days. Starting at a lower dose for the first 1-2 weeks can help alleviate side effects.
I would prescribe fluoxetine, starting at 0.25mg/kg, ie 2.5mg (1/4 a 10mg tablet), once a day for the first week, then increasing to 0.5mg/kg, ie 5mg (1/2 a 10mg tablet), once a day. The dose will be reassessed after 6 weeks and could be increased if no/insufficient response is seen. Tablets may be given with or without food, but given Phoebe’s biting behaviour and motivation for food, I’d advise hiding it in a small cube of cheese or similar tasty treat.
Fluoxetine is metabolised in the liver and also excreted via the kidneys, hence it is essential that we monitor function of these organs during treatment. Blood and urine tests need to be done prior to starting treatment and at intervals e.g. 6 weeks, 3months, 6 months, then 6 monthly.

Some animals display a disinhibition of pre-existing aggression with medication such as fluoxetine. I advise special caution with interaction in the first 4 weeks. If in doubt, use higher risk management, use a muzzle or do not engage in potentially injurious activities. I would advise that Phoebe does not go to the groomer during this period.

Pheromone therapy — I also advise using a DAP (dog appeasing pheromone) diffuser for indoors and the spray for going outdoors and off the property. DAP is a synthetic form of the pheromone that is produced by a lactating bitch. It decreases anxiety and calms dogs. It is odourless to us. There are no side effects and it starts to work within 1-2 days (diffuser) or immediately (spray). Package directions should be followed.

d. Behaviour modification and retraining — Using gradual habituation with counter-conditioning, and positive reinforcement (using small amounts of food, or perhaps 1minute with a favourite toy). For now avoid negative reinforcement (e.g. lead/collar pressure and release). The only punishment used will be time out for 5-10minutes. This may be equivalent to ignoring as Phoebe is not very attention motivated, but that’s OK. Physical punishment is likely to exacerbate anxiety and fear and may provoke a defensive aggression response. Avoid inadvertent reinforcement of any undesired behaviour e.g. aggression, snatching food, anxious behaviour. Withhold the treat if she does any of these, wait, then ask her to do something simple to get a treat (e.g. sit, lie down, or look).

You can carry out modification/training yourselves but we also offer a service to help with behaviour modification and retraining through our behaviour nurse. Sessions cost $50/30mins. We can teach you how to train these things, or can train your pet for you and then show you the commands (day training). Some things need to be taught at home e.g. toilet training.

• The following could be started now:

    Learn to earn — Through positive reinforcement dogs quickly learn that they can get rewards for performing behaviours. Phoebe probably already knows this, but may need reminders. Used in conjunction with NILIF below. Provides consistency in interaction for Phoebe — the rules are the same.

    NILIF (nothing in life is free) — Everything Phoebe values (food, toys, access to places, sleeping spots) has to be earned (perform a behaviour on cue, solve a food puzzle). Do not feed from a bowl anymore — daily diet is given as rewards or in food puzzles.

    Attention — Teach “look” as demonstrated in clinic, repeat over and over so it becomes a habit. Once learned, it can be used to get Phoebe’s attention when she is anxious or displaying undesired behaviour e.g. compulsive behaviour.

    Food — Teaching Phoebe to take treats gently from the hand, start:

    Calm/relaxation — Repeated passive association of the word “settle” spoken in soft/soothing tone with when Phoebe is lying down and is calm and relaxed. Try ear slides but she may not like it if she is sensitive about having ears touched. It may then be possible to induce a calm/relaxed state by saying “settle” when Phoebe is mildly anxious.

    Bed/mat — Teach her to go and stay on her bed by putting her on it, say “bed” or “mat” and rewarding her for staying for gradually increasing length of time. Make sure to use a release command so that she gets off it when you say, not whenever she feels like it.

    Release — E.g. “OK” or “way go”, is the command that she can go. Use this to signal end of training, end of play.

    Muzzle — Teaching Phoebe to wear a muzzle so that this can be used in situations where she is likely to bite, eg painful ears, veterinary examination, grooming if painful/knots or to ensure safety during desensitisation to people/children. This is done using a basket muzzle (not a cloth/Mikki type). Small amounts of food are placed in the entrance to the muzzle and Phoebe is allowed to eat it. Gradually place food further into muzzle. When she is happy to place nose/mouth right in to the end, then place peanut butter at the end, let her start to lick it and gently pull straps behind head but don’t do up clip. Work up to longer periods holding muzzle strap behind head. You can ‘post’ small food piences in through sides of basket. Eventually do clip up and keep positing in treats or peanut butter through the end. When removing muzzle, reward calm behaviour. Do not reward if she is pawing at muzzle or shaking her head.

• The following would be started once medication is helping (after approximately 4-6 weeks):

    Desensitisation & impulse control — Gradually expose to triggers (using distance and sound as a gradient), rewarding calm, attentive behaviour with food. If anxious/fearful, do not reward, reduce stimulus (go further away, decrease volume/intensity) until calm and have attention again and progress more slowly. If get aggressive behaviour put in time out – do not say anything or look at dog, just pick up or lead to time out area/crate/pen. Phoebe’s triggers are going out of the yard, seeing/hearing children, adults, vehicles, having feet dried, having eyes wiped, ears brushed, lead applied. We want Phoebe to form a positive association with these things and perform a behaviour (sit/look, settle) that is incompatible with her current undesired behaviours (fear, aggression). The common mistakes are pushing too far too fast, and inadvertent reinforcement of undesired behaviour (giving the treat at the wrong time).

    Car — The goal is for Phoebe to be calm in the car. Many dogs find being in the car and car travelling arousing/exciting. Phoebe may be excited or anxious, I’m not certain. However, the treatment is fairly similar. Get Phoebe used to wearing a harness that can be attached to seat belt to limit her movement, make her safe in the event of accident, and prevents her from becoming a projectile that would hurt you or someone else. Habituate her to the harness with a similar process to that described under desensitisation. Form a positive association with food/treats. Once she is comfortable wearing the harness, start putting her in the car when it is stationary and not going. Do some sit, look and settle exercises with her. If she is calm/settled, then start the car but don’t go anywhere. Then next step is to drive up and down driveway, have one person drive while you are doing training initially from the back seat, then from front seat. The next step is drive around the block, gradually build up distance as long as she is calm and remains attentive to you. If she becomes restless/excited, then pull over and stop the car, wait until you have her attention again (look), before driving off.

    Grooming eyes, feet and ears — Using a similar process gradually get her used to and positively anticipating drying feet, wiping eyes and brushing/wiping ears. Start with habituating to the equipment that you use and the place you usually do this by using look and treat. Gradually move hand/equipment closer, and continue rewarding calm behaviour.

    Attaching lead — Phoebe may have formed a negative association with having the lead attached and going for walks, or with grabbing her collar for restraint. Use a similar process to change this to a positive association.

    Adults and children — It may be possible to habituate Phoebe to the presence, noise and approach of adults and children. A similar process will be followed but careful selection of stimuli people is essential. They need to not try to interact with Phoebe at all and follow instructions explicitly. I can give you more guidance on this process if and when you chose to do it.

    Noises — Vehicles, etc. Can use distance from a busy road. Alternatively, use the Sounds Scary or Sounds Sociable CD recordings of various noises.

    Toilet training — Retraining Phoebe to toilet outside, in a particular area, can put on command (e.g. “toilet”, “be quick”). This is done using association with a place/command and rewarding desired behaviour. Animals usually need to go to the toilet (urine/faeces) when they wake up, after a meal or big drink, and after/during a walk/exercise. At these times, every time, take Phoebe outside to the place you want her to use as a toilet, put her lead on to help keep her in that place. Wait 10 minutes. If she urinates or defecates, then say the command if using (once an association is formed, you can later use to command to cue toileting), and give her a treat. If she doesn’t go to the toilet, don’t worry or do anything. If she has urinated/defecated inside the house, do not acknowledge her or punish her, as punishment will only make it worse. If you happen to catch her urinating/defecating, clap your hands to startle her and hopefully shut off the flow, then take her outside to the toilet spot and proceed as above.

    Stroking — We could see if Phoebe will learn to tolerate and perhaps enjoy stroking once the medication has effect. It may be that she has an innate lack of interest in human attention/affection, or that she has formed a negative association between grooming and stroking.

e. Environment — A consistent routine helps anxious dogs cope better. Try to maintain consistency in daily activities and in interactions. Schedule regular, short training sessions throughout the day and night. TV advert breaks are useful as they are short and you don’t need to find any more time.

Provide activities for mental stimulation, e.g. food puzzles (homemade — ice cream container with holes in it, ice blocks with meat in it or bought — kong, buster cube etc), food treasure hunts. Can teach to do things and tricks to also provide mental stimulation. Give appropriate objects for chew/holding in mouth (Fesheze ball, Kong, other robust toys, rope chews, homemade toys, large rags), remove when get frayed/dangerous, give 2-3 at a time, rotate/change daily, if goes to grab/hold or destroy something else the substitute for one of these toys, do not prevent chewing/holding as it is a kind of coping mechanism – divert it to more appropriate thing.

Provide a safe place, e.g. kennel and run for outside, crate for inside. You could use the conservatory that you currently use; there are advantages to a crate in that it’s portable, you can move it to the lounge/where you are, so she can be in the same place as you. You could also use it for passive desensitisation to people and eventually children, and noises, if you want to do this.

f. Follow up — A time span for assessment of treatment progress and whether to continue or not, or change treatment protocol should be agreed. I suggest three months initially and if progress is being made, then reassess at 6, then 12 months. I advise you to start a diary (a sheet of paper pinned to the fridge might be convenient) to record Phoebe’s behaviour and training. Start now, prior to starting medication, so that we have some baseline data to compare to. Record incidences of undesirable behaviour, the date, approximately how long it continued for (relevant in the case of compulsive behaviours), any suspected triggers/situation, how you reacted, and how interruptible the behaviour is or what the outcome was.

Follow up and monitoring of medication can be done through me or your usual vet if they are happy to do this, although they may be happier taking over management once response therapy in the first 3 months has been established. I encourage you to email me with a short summary of how things are going on a weekly basis for the first 4-6 weeks while medication is starting to take effect, then at 3 months. If things are not going well, then please get in touch sooner. Blood tests will need to be repeated at 6 weeks, 3 months, 6months, then 6 monthly if all is going well to check for side effects.

g. Prevention — Appropriate socialisation and habituation during the socialisation period (1-3months of age) can help dogs cope better with normal everyday and potentially stressful situations later in life and is thought to reduce the occurrence of behaviour problems, including anxiety and compulsive behaviours. There can be a heritable basis to anxiety, so careful selection of a puppy is also important.

Thank you for the opportunity to meet you and Phoebe. Please contact me once you’ve had time to digest this report or if you require further clarification.

Kind Regards

Rachael Stratton BVSc
Behaviour Veterinarian

Institute of Veterinary, Animal and Biomedical Sciences
Massey University
Private Bag 11222
Palmerston North 4442
New Zealand

Web: http://ivabs.massey.ac.nz

See also my earlier report.

Written by hourglassera

July 6, 2012 at 3:22 am

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