VetInfo Digest           December 2001

This Month:

Behavioral Medicine

        Specialists

        Rules of Thumb

        Behavior Medications

        House Training

        Car Sickness

        Separation Anxiety

        Feline Elimination Behavior Problems

 

This Month's Note:

December is a strange month for many veterinary practices. The pressure to spend money on holiday shopping and time spent enjoying the events of the holiday season tends to make optional health care for pets get pushed aside for more convenient times. Yearly physical examinations, routine vaccinations, spay and neuter surgeries and similar health care activities are all less common in December, and sometimes even January.

This is my favorite time of the year to practice, though. I get to spend more time with patients who do come to the office. I can't say this is true for all veterinary practices, but I think that if you have a pet that has more complex health care needs than most pets, such as an elderly dog or a cat who has feline immunodeficiency virus, December and January might be the best months to schedule routine physical examinations because your vet is likely to have the lightest work load during these months and can therefore spend a little more time with pets who really need the care. I'm sure there are variations on this theme that apply to other geographic areas, as well. A tourist driven economy might make certain seasons slower than others and one strong business in a community can dictate the economy's busy seasons and its slow ones. Turn these times to your advantage if your pet needs a little more attention from your vet!

 

Behavioral Medicine is a Specialty

I can not talk about the practice of behavioral medicine without pointing out that it is a relatively new field of study and that most veterinarians have no formal training, or have limited training, in treating behavioral disorders. There were no behavioral medicine lectures, let alone courses, that I can remember having in veterinary school. My wife, who graduated from veterinary school ten years after I did (1989) also had no courses in this discipline. This means that most veterinarians are relying on information from their journals, their textbooks, continuing education seminars and their own personal experience in dealing with behavioral problems. Some general practitioners are very interested in behavioral problems and are very capable of helping pets and their families lead happier lives. Many veterinarians are so uncomfortable giving behavioral advice that they simply won't do it. Ask your vet for help, but be aware that you may not get it and that you must evaluate like you would advice from anyone else unless your vet does have advanced training in the field. If your vet can't help, there are veterinary behavior specialists. There are two certifying bodies that I know of for behaviorists.

The first is the Animal Behavior Society. Their web site is http://www.animalbehavior.org . It is not necessary for a member of this society to be a veterinarian but they must meet certification requirements, including postgraduate college level work and experience in the field of animal behavior. This is an international organization. The American College of Veterinary Behaviorists is the North American certifying body for veterinarians who have pursued training in behavioral medicine. I am not sure that this is an entirely accurate comparison, but I think of these groups as similar to psychologists and psychiatrists in human medicine. Board certified veterinary behaviorists can provide medications where appropriate in helping resolve behavioral problems. Your veterinarian can find the specialist nearest to you by contacting the:

American College of Veterinary Behaviorists
Dr. Bonnie V. Beaver, Executive Director
Department of Small Animal Medicine & Surgery
Texas A&M University
College Station, TX 77843-4474
E-mail: bbeaver@cvm.tamu.edu

A board certified veterinary behaviorist in North America will usually list their name in the phone book or in publications as "Jane Doe", DVM (or VMD), Diplomate A.C.V.B. , or D.A.C.V.B.

In many areas of the country it is very difficult to find a board certified veterinary behavior specialist to work with. An alternative is to work through your vet with a specialist they contact online or by phone. If your vet is not able to help, there are two online behavior consultation services that I know of:

1) Tufts University Veterinary Hospital, http://www.tufts.edu/vet/petfax, fee based veterinary behavior consultation.

2) http://www.petbehaviorproblems.com/ Dr. Amy Marder and associates, fee based behavioral consultation

In addition, there is some good behavioral information on these sites:

www.novartis.com (manufacturers of Clomicalm Rx)

www.alpo.com (Dr. Ilana Reisner D.A.C.V.B. answers some questions on this site).

 

General "Rules of Thumb" for Behavior

1) When working with dogs, you need to have at least one command that your dog can respond to appropriately. "Sit" is generally the easiest command to teach a dog.

2) It is hard to overemphasize the importance of consulting with a behavioral specialist when a behavioral problem is proving difficult to resolve or when a pet's behavior presents a danger to humans. Even if you have to take a long trip once or twice to get to the behaviorist it is likely to be worthwhile.

3) Medications alone are only likely to cure a very limited number of behavioral problems.

4) If a behavioral therapy program doesn't make sense to you it is likely that you won't be able to make it succeed. Ask enough questions to be sure you understand why a behavioral program is being recommended, as well as how to apply it. If there are differences of opinion or ability to follow behavioral modification plans among household members it is best to resolve these, if possible, before attempting to start the behavioral modification process.

5) Changing natural behaviors is extremely difficult and in some cases impossible. Sometimes the best you can do is to learn how to work around difficult behaviors that are deeply ingrained. Building a fence is a reasonable solution to stopping car chasing, for instance.

6) All behavioral modification programs have to be tailored to the particular pet, the particular pet owner and the particular problem, for the best chance of success.

7) Almost all behavioral medications take time to work, from a week to a month or more, depending on the medication. Do not give up on medications until they have had time to help.

8) Plan carefully so that you can reward your pet for good behavior instead of punishing it for bad behavior, as much as possible.

Treating Behavioral Problems

There are two major categories of behavioral treatments. The first is behavioral modification. There are many different ways to attempt behavioral modification and some of the advice that is available is good and much of it is bad. Behavioral modification programs that work for one person and one pet may not work for a different person or their pet. One of the most important things to remember about behavioral modification techniques is that you can really only do them well if you believe that you can -- so starting out on a behavioral modification plan that you know you will not be able to follow through on makes no sense.

Medical therapy is available for treatment of many behavioral problems. Medical treatment rarely works all by itself, though. It can make it much easier to achieve success with behavioral modification to use medications but they don't make a very good substitute for behavioral modification training. Despite this, the possibility for an easy cure makes using medications alone, without providing behavioral advice, very tempting for veterinarians and pet owners. Veterinarians often justify providing these medications when behavioral training isn't possible by rationalizing that they are the pet's best hope for maintaining its home. Make sure your veterinarian understands that you want to work with your pet to achieve a cure for behavioral problems so that you get good advice on how to help your pet learn to change disruptive behavior along with any medications. Your vet may have a hard time finding dosages for some behavioral medications, so the following chart may be helpful to keep on hand.

Behavioral Medications

Generic Name Brand Name Notes/ Footnote # Dog Dose Cat Dose
 
acepromazine PromAce May be helpful for car sickness 0.1 to 2 mg/kg every 8 hours same
alprazolam Xanax Best medication for panic situations 0.02- 0.04mg/kg every 6 to 12hr 0.125- 2.5mg/cat every 12 to 24 hr
amitriptyline Elavil 1 0.25 to 1.5mg/kg every 12 to 24hr 2.5 to 10mg/cat every 24 hours
buspirone Buspar May increase aggression 1.0mg/kg every 8 to 12hr 2.5 to 7.5mg/cat every 12 to 24hr
clorazepate dipotassium Tranxene   5.6-22.5mg/dog every 6 to 24hr 1.875-3.75mg per cat every 12 to 24hr
clomipramine Clomicalm

Anafranil

 2 1.0 to 3.0mg/kg every 12 hrs 0.25 to 0.5mg/kg every 24 hours
diazepam Valium 7 0.55 to 2.2mg/kg every 6 to 24hrs 1.25 to 2.5
doxepin Sinequan   3 to 5mg/kg every 8 to 12hrs no published dose
fluoxetine Prozac 3, 4 1mg/kg every 24hrs 0.5 to 1mg/kg every 24 hrs
imipramine Tofranil 1 2.2 to 4.4mg/kg every 12 to 24hr no published dose
megestrol acetate Ovaban, MegAce 6 1 to 2mg/kg at longest dose interval possible same
melatonin   5 0.1mg/kg every 12 to 24 hours no published dosage
oxazepam Serax     0.2 to 0.5mg/kg every 12 to 24hr
paroxetine Paxil 3, 4 1mg/kg every 24 hrs 0.5 to 1mg/kg every 24 hrs
sertaline Zoloft 3, 4 1mg/kg every 24 hrs 0.5 to 1mg/kg every 24 hrs

Footnotes:

1) Tricyclic antidepressants can be fatal when ingested in quantities as little as 10 times the usual dosage, so store these medications very carefully. 2) Clomipramine is the ONLY approved drug for any behavioral use (separation anxiety) in dogs or cats. 3) Use cautiously in diabetic pets. 4) Must not be used with other monoamine oxidase inhibitors (MAOIs). Ask your vet about any other medications you are using for your pet prior to starting these medications. 5) Used for thunderstorm anxiety, 3mg is a reasonable maximum dosage. 6) May cause diabetes and mammary tumors 7) Diazepam causes severe acute liver failure in some cats. This is a rare problem but important to keep in mind.

Treatment Plans for Specific Problems

For the rest of this newsletter I am going to try to present the highlights of various treatments only, in order to give an overview of the steps necessary to correct certain behaviors and to present as much information as possible in the limited space available. Hopefully, over time, we will be able to revisit the treatment of many of these disorders in more detail.

House Training for Puppies:

Start house training as soon as you acquire your puppy or by 8 weeks of age if you are raising puppies.

Pick a spot that will work long term for defecation and urination. Take the puppy to this spot as soon as it wakes up from naps, a few minutes after meals and frequently during the day (at least hourly). Do not paper train unless you intend to allow your pet to urinate and defecate on paper as an adult.

Watch carefully to figure out how your puppy signals the need to go outside or work to teach an appropriate signal, such as sitting by the door.

You must watch a puppy constantly in order to consistently respond to urination and defecation that occurs in the house. When you can't watch the puppy it should be confined in a crate or small area that discourages elimination behavior.

A sharp "NO" or other loud noise when the puppy is caught urinating or defecating is usually sufficient to discourage the behavior. Take the puppy to the appropriate spot to eliminate and stay with the puppy until it does so that you can immediately reward it (praise or even a food treat) for the appropriate behavior. You must be there while the puppy is "in the act" for both good and bad behaviors to teach your puppy what you expect from it.

If you have an older dog who is well house trained, let it help your puppy learn appropriate behavior by taking the puppy and the older dog out together at times the puppy needs to urinate or defecate.

Do not forget that a puppy can not learn from any form of punishment or reward that occurs more than a few seconds after it has urinated or defecated. There is absolutely no value in yelling at the puppy or punishing it in any other way when you find urine or feces in the house. Clean it up, forget it and move on with training.

Car Sickness and Travel Anxiety

The key to reducing car sickness and travel anxiety is to make the car a less threatening environment.

Most cats and many dogs travel better in the car if they are confined to a travel crate. This is also safer for the pet.

Acclimate your pet to the car. If your dog or cat is nervous just being put in the car, start there. Put it in the car for a few seconds, in its crate if appropriate. Try to make the experience fun -- or at least as painless as possible.

After your pet can sit in the car for a few minutes without too much anxiety, go for short trips. The trips might literally have to be a few seconds long at first -- back out of the garage and drive right back in, for instance. Gradually increase the length of trips and try to go to some places that your pet will enjoy. This is usually easier when dealing with dogs than with cats.

Some pets can't relax in the car at first without some medical help. Anti-anxiety medications such as alprazolam and diazepam can be helpful by reducing anxiety to levels your pet can tolerate.

In general I don't like acepromazine much as a behavioral medication. However, it has some anti-vomiting effect as well as providing sedation and for dogs and cats who can't learn to ride in the car but who must still be taken on some trips, it is often an effective medication to stop vomiting in the car.

It really does help to drive reasonably, too. If your driving scares other people as well as your pets, then it is reasonable to assume that the fear is justified!

Separation Anxiety

Separation anxiety varies from uneasiness when alone to outright panic when a pet must stay home alone. It occurs in both dogs and cats but due to the nature of their responses to fear, it is noticed much more often in dogs than in cats.

This is the only strictly behavioral disorder for which a medication has been approved specifically for use in treating it. Clomipramine (Clomicalm Rx) is the medication and most veterinary behaviorists agree that it is helpful when used in conjunction with behavioral modification. It should be started along with behavioral modification and tapered gradually to stop when behavior is under control.

Many dogs with separation anxiety will respond very well to treatment.

For some dogs, simply decreasing the number of clues the dog gets prior to leaving will help a great deal. Change routines, pick up keys quietly or well in advance of leaving, carry coat outdoors before putting it on, eliminate or limit "good-byes".

When returning home, do not immediately pay attention to your dog. Wait until he or she calms down and then reward the calm behavior with praise, petting or a treat.

Do not punish your dog for behaviors that occur when you are away. This often increases the dog's anxiety and promotes further destructive behavior rather than discouraging it.

The behavioral treatment for separation anxiety consists of a program to teach your dog to remain calm when you can not be present.

In the beginning of the program it may only be possible to walk outside, close the door and then immediately return without upsetting your dog. Gradually increase the time that you are gone until your dog can stand for you to be gone for five to ten minutes without anxiety. After getting to this level of training, it is necessary to vary the amount of time that you are gone, so that your dog can't anticipate your return accurately. Leave for one minute, then fifteen minutes, then five minutes, then thirty minutes or some schedule like this. It may take one or two days or several months to work up to several hours away from home without problems. Since separation anxiety is often a life long problem if left untreated, putting in a couple of intensive weeks can save a lot of work over the life time of your dog.

Sometimes it is tempting just to crate or confine a pet and not worry about its feelings. For mild cases of separation anxiety this may be acceptable but in severe cases dogs have injured themselves in frantic attempts to dig out of a crate or other confinement and the terror they feel should discourage most people from treating them this way.

Digging in the yard is sometimes a sign of separation anxiety in dogs who can be left outdoors in fenced yards when their owners are away, or even when they are home but chose not to be with the dog. If this is the cause of digging the behavior will sometimes respond to treatment for separation anxiety.

 

Feline Elimination Behavioral Problems

Inappropriate urination might be due to medical reasons if:

It is important to understand that your veterinarian can not tell you with certainty that a medical problems does not exist based on a physical examination alone. Laboratory testing, especially urinalysis, urine bacterial cultures, preferably from urine withdrawn directly from the bladder through a needle, serum chemistry panels, fecal examination and specialized testing, such as tests for hyperthyroidism might all be necessary to rule out the possibility of a medical problem if it seems likely based on the behavioral clues. Doing a good job of ruling out medical problems is critical to the success of treatment for inappropriate urination.

Inappropriate urination due to behavioral causes is more likely when the following behavioral conditions are present:

Dealing with specific types of inappropriate urination related to behavior involves identifying the cause and then treating it. If one of the following causes of litterbox avoidance seems likely the outlined treatments might work.

Aversion to the litter

Insure that the litter is clean. Twice daily cleaning and total litter change at least once a week (or once a month with clumping litter). Offer several litterboxes with different types of litter. If necessary use appealing natural substances, such as sand or potting soil.

Aversion to the litterbox

Remove hoods from boxes and use large litterboxes, such as an under the bed storage box. Keep long hair around the rectum and feet trimmed to prevent stool or litter entrapment. Add litterboxes in more private areas, quieter areas or move the current litterbox to such areas. Put a litterbox at any consistently used alternative site -- it can be gradually moved after the cat starts using it again. Try to keep at least one litterpan per cat and one more litterbox than you have cats is best.

Stress Related Inappropriate Elimination Behaviors

Keep children, dogs and aggressive feline housemates away from the litterpan at least part of the day. If your cat only has problems when you are away consider the possibility of separation anxiety. Many cats will respond to anti-anxiety medications in this circumstance, making it one of the exceptions to the "behavior modification plus medication" rule.

Age Related Litterbox Problems

If your cat is older it may be necessary to move boxes to highly accessible areas, use boxes with very low sides to allow easier access and to make sure that the boxes are in well lit areas since visual acuity may be declining. Medications for arthritis and to control any conditions leading to increased urination are also helpful.

Urine Marking Behavior

Decrease stressful situations that contribute to urine marking, such as contact with or observation of other cats in the yard. Trapping and removing feral cats can resolve urine marking due to this type of stress.

Block access to preferred sites for spraying behavior, if possible. Clean spots of urine marking with an enzymatic cleanser where possible. If the cat is caught marking a loud sound or squirting with a squirt gun are acceptable punishments to deter the behavior.

Decreasing the crowding in the household works well if that is an acceptable option. For most multiple cat owners this is not an acceptable choice in controlling urine marking behavior, though.

Try to positively identify the culprit in multiple cat households. Testing all cats for urine marking is best, since more than one cat may be participating in the behavior and treatment may fail if all cats are not treated. Using fluoroscein dye ( 6 of the ophthalmic strips administered by capsule works well) to identify urine marking cats. Add bits of bright crayons to the diet to identify cats who are marking with feces.

This is the other condition in which medical treatment sometimes works without using much behavioral modification. Feliway (tm) spray can be helpful in cutting down on urine marking when used as directed. Medications that work to stop urine spraying in some cats include buspirone, amitriptyline, diazepam, fluoxetine, paroxetine, sertraline and megestrol acetate (absolutely last resort). Dosages are those listed in the medication chart.

 

Thanks for Your Support!

The VetInfo Digest is published by TierCom, Inc., P.O. Box 476, Cobbs Creek, VA 23035. The opinions expressed in this newsletter are those of Michael Richards, DVM., author. Please send e-mail for Dr. Richards to mervet@inna.net

Copyright 2001, TierCom, Inc.

This page was last edited  06/20/04

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