Last month (p. 20S) this column introduced the case of a 5-year-old rescued German Shepherd that became fearful.

In the first of the two-part series, the history and diagnosis were addressed. This month, the focus is on treatment. As you may recall, this dog was diagnosed with:

* attention-seeking behavior which was really only slightly out-of-context.

* fear aggression, primarily to other dogs

* protective and territorial aggression that was mostly in-context, but could spiral into inappropriate, possibly dangerous behavior if not appropriately directed.

* food-related aggression

In need of medication?

The client asked if I thought the dog needed medication. Given this dog's history, I felt it was a toss-up in the drug department. Anti-anxiety medication both speeds the learning of any behavior modification and aborts behaviors that interfere with it.

In this case, although side effects from the commonly used anti-anxiety medications are rare, I felt that monitoring might be a big issue for the client and worsen her anxiety. We discussed this and she said that she would use drugs if I thought the dog would be better for it, but that she also worried - often irrationally - about medication. We discussed both the low-tech tricyclic antidepressants (TCAs) (amitriptyline) and the newer selective serotonin re-uptake inhibitors (SSRIs) like sertraline (Zoloft) and fluoxetine (Prozac).

In the end, we decided to try the behavior modification without the medication, and if the dog wasn't noticeably calmer within a month, we'd start meds. The client was happy with this, especially since she felt that she had not been allowed to ask adequately about her concerns when she'd previously consulted a specialist.

Modification steps

Behavior modification, meanwhile, was to include:

* The client was to ask the dog to sit quietly for everything he wanted and to relax while doing so; in fact, I taught the client, using my dog, Flash's example, to reward the dog whenever he took a deep breath (Protocol for Deference).

* The client knew exactly the types of circumstances that upset her and the dog. If she could teach the dog to sit and not react to increasingly more upsetting circumstances in the house, she could eventually desensitize him to things outside the house, and then counter-condition him to experiences in which he was reactive using food treats.

We practiced some of this and if I was there, the client's judgment was flawless. When I wasn't there, her e-mails spoke of painful uncertainty. Two trainers in the past had told her she was stupid. The damage they did to this client and any dog she'll ever have is almost unspeakable.

* If either the client or the dog was becoming anxious or distressed in any circumstance, they were given permission to leave it. Since the dog was going to be wearing a Gentle Leader for all walks, this was easy to accomplish; all they had to do was turn around in the opposite direction.

* If the client could identify another calm dog, the dogs could take walks together so that the patient could relieve her of the burden of eternal vigilance by taking his cues, in part, from the other dog.

* The dog sitter was instructed to also reinforce relaxed behaviors and was asked to do both aerobic exercise with the dog and slow massage.

* The client was instructed to ignore her neighbor who would bark back at her dog anytime the dog barked at him. In fact, I recommended that since the probability of improving the neighbor's behavior was low, she should expect the worse, and then reward her dog for any instantaneous quiet associated with the request to "look" and then get him out of the situation.

The client had two re-exams with Flash and me. Each time the dog was markedly improved, and even more effusive and "normal" in his play with Flash. During the last visit, he tackled Flash quite roughly. Flash's response was to walk away and not play with the dog again until he was sitting and quiet. Then Flash solicited him for a walk, not a tumble.

Pain memory

Also at the last re-exam the client asked me to cut the dog's toenails. They were long, but I was very concerned about the dog not having a bad experience. Apparently the inability to address the dog's nail care was a great stressor for the client. When she had consulted the previous specialist she'd been told that the dog would have to be muzzled and knocked out. The client works in a lab and is well aware of the dangers of anesthesia, and this prospect terrified her.

So, with the client holding the leash which was attached to the head collar, we took the dog outside, where there was more for him to watch, and with him just standing - and me not touching his paw or leg - I was able to clip three nails before he noticed.

When he did notice, he snapped and backed up.

Clearly, this is a dog that has had a lot of forelimb pain and who had been manhandled. So, we stopped. In my experience, manicures are seldom real medical emergencies. I sent the client home with the instructions to work with her dog sitter as we had done and take on one nail a day. A few weeks later she was frantic, because they had only been able to trim one nail. Her veterinarian was afraid of the dog. Did I know any veterinarian who would treat him gently and work with her for routine care? Yes, I did, and I provided two names. Less than a week later she and the dog sitter had trimmed most of the dog's toenails themselves.

What lessons are in this case history?

First, once the client was no longer constrained to feel that she had to cut the dog's nails, which compounded her worry about abuse and manhandling when it was eventually done, she was able to do so, because she had a way out, if needed.

Second, we manhandle way too many dogs. I am a big fan of drive-through/parking lot vaccinations with a 27-gauge needle for fractious or fearful dogs, examinations that take place in segments when you sit in a chair talking to the client, and toenail clippings that take just the tips that are touching the ground and allow the dog to be playing with a toy at the same time.

Dogs are not born struggling with and fearing veterinarians; we teach them that.

Third, this dog had never really learned to play or to interact with dogs normally. He'd been locked in a cage well through social maturity. Accordingly, his actions were way too strange for all but the calmest, most normal dogs. His play with Flash was truly too rough, out-of-context and bizarre for most dogs, so Flash taught him how to play using the same skills that allows him to teach puppies.

Fourth, everyone worries about big dogs, especially if they are German Shepherds. And when this dog growls or lunges, everyone is on alert. Ask yourself whether this dog's behaviors are relatively "normal" given his history.

For a dog that was so abused (imagine having your limbs run over and then being thrown in a cage for being too stupid to get out of the way of the tractor), his aggressions were relatively mild.

Boils down to

All of this dog's inappropriate behaviors were about uncertainty and anxiety. A clear, humane rule structure that gives him some degree of predictability has made a huge difference in this dog's life, and he will continue to improve.

Fifth, puppy mills are nightmare places for dogs.

Sixth, people matter. This client had been given so much bad advice, and had been told it was her fault and that she was stupid so often, that her concern was that she would ruin the dog. This client is insecure and a chronic worrier, and this annoys people she consults. That's the beauty of e-mail; she can worry and I can answer when I have time without rewarding the worrying.

Both client and patient are doing well. She's happier; the dog has friends, and she worked up the courage to tell her neighbor that she wanted him to stop growling and barking at her dog.