Facing fear head on: Tips for veterinarians to create a more behavior-centered practice - DVM
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Facing fear head on: Tips for veterinarians to create a more behavior-centered practice
In part 2 of this series, we equip veterinary teams to assess and alleviate fear during veterinary visits to build a more positive patient experience and stronger pet-owner relationships.


DVM360 MAGAZINE


Implementing treatment

Any dog who consistently has a score of 3 or higher needs help, especially if the scores across all three situations agree. Many dogs are fearful of moving scales, but if the dog shows consistent fear in this and the other two contexts, help is warranted. Treatment here is aimed at preventing the suffering that accompanies worsening fear and requires a four-pronged approach:

1. Protection. Protect these pups from situations in which they are overtly fearful. Explain to owners that these are not the pups that should go to soccer games, busy shopping malls or even for a ride in the car if it has to be parked in a lot. Encourage clients to identify sentinel behaviors that are good and sentinel behaviors that are not so good. For example, ask, "Does your dog pull forward confidently with his head and tail up and face relaxed, or does he pull back, ducking his head and tucking his tail?"

2. Encouragement. Encourage behavioral, mental and emotional change for the better. Help owners teach the dogs to sit, relax, take a deep breath and be calm in response to a series of cues. Start in the place they are most secure and practice a series of behaviors so that more than nine times out of 10, they can do them well and happily. Then move to another room.

The rule for expanding the dog's horizons is that you must go at the dog's pace, which may be snail-like. But if you simply force a dog to comply with you despite its distress, you will have rendered the dog worse and caused suffering. An expert (preferably a diplomate of the American College of Veterinary Behaviorists; see http://dacvb.org/) may be helpful in designing this program. Many licensed and certified dog trainers may also be helpful, but beware that operant conditioning does not require calm mental states that are desired for truly distressed pets —it just requires rewarding targeted, repeated behaviors. Help your clients find trainers who understand and act on this distinction.

3. Supplementation. Consider supplementing these dogs with polyunsaturated fatty acids to increase DHA (docahexanoic acid) and EPA (eicosapentanoic acid). Not only are these polyunsaturated fatty acids essential for normal brain development, but if the laboratory research is correct, they might protect against the oxidative damage4 that occurs in times of distress.5 Aim for somewhere in the zone of 1,200 to 1,500 mg/day/dog.

4. Medical intervention. Consider early treatment with antianxiety medication. I have treated pups as young as 5 to 6 weeks of age with such medication, and the change can be dramatic. Laboratory data show that treatment with selective serotonin reuptake inhibitors and tricyclic antidepressants can normalize neuronal migration and pruning in baby mice that either have knockout genes for certain neurotransmitters or that have been selected for more reactive or aggressive behaviors.6 This result may be due to the neurotrophic effect of continued use of such medications.

All placebo-controlled, double-blind studies of behavioral medication in dogs have shown that dogs taking medication acquire the behavior modification more quickly, which supports the concept of neurotrophic benefits. Given this finding, early combined pharmacological and behavioral treatment may be the key to engendering normal brain development and normal social behavior. And the earlier we intervene, the less suffering and damage we can expect.

We should remember that clients recognize that their animals are ill based on their behavioral changes. We are how we behave. If we use any aspect of behavioral change to inform us about somatic illness, we should also be using such changes to inform us about behavioral illness.

Yet, as so eloquently reported by Roshier and McBride,7 most veterinarians are not sufficiently comfortable with their knowledge of veterinary behavioral medicine to deliver appropriate care. Of the six veterinarians participating in the study, only two had acquired some training in veterinary behavior or behavioral medicine while in veterinary school, and only one conducted behavioral consultations. Of the 17 areas of behavioral concern about which the veterinarians were specifically asked, none of the veterinarians reported always discussing any of these issues with clients. Included in the areas of concern were aggression to people; aggression to animals; training, including housetraining; destruction of property; and issues attendant with geriatric pets.

These issues must be viewed as the lymph nodes of the canine mental health field; we must address them if the dog is not to die or to suffer and be relinquished. Interestingly, clients consider animals exhibiting these concerns to be manageable, treatable and adoptable, until the concerns are deemed severe.8 "Severe" is what happens when we fail to do our due diligence early.


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Source: DVM360 MAGAZINE,
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