Suggest temporary boarding first when confronted with behavioral euthanasia

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Nov 01, 2003

Last month, we discussed the history and treatment for Hoova, an 18-month-old female Shepherd mix, who was euthanized for her aggressive behaviors.

So, what went wrong here?

Lots. First, I had been unsuccessful in convincing the client what "abnormal" really meant...we know Hoova reacted when startled but still felt that she "shouldn't" do so.

Second, the clients really clung to the idea that she'd improve if they just loved her enough.

Third, the husband felt betrayed, although the bite was minor. (Contrast this response with that of a client I saw recently who experienced the same thing, and after the appointment volunteered that he saw now how the dog had no choice but to bite him, given her problems.)

Fourth, the referring veterinarian was willing to euthanize the dog immediately. Had the dog bitten a stranger there would have been a mandatory 10-day quarantine for rabies observation. The real value in such stop gaps is to allow the client to make an informed decision when not angry. That system failed here.

I always encourage veterinarians and clients, alike, to board any dog they are thinking of doing away with or rehoming for at least a few days so that they can see what their life will be like without the dog. The vast majority of clients usually decide to take the dog back home and successfully redouble their efforts. When clients are distressed, they need an objective external view. That opportunity was not provided here, in part, because the clients didn't consult with me. Was this reaction, in part, affected by their experience with their initial, compulsion-based trainer?

Maybe, but all I can guarantee is that the dog was made worse, not better by his ministrations. Did this shorten her window of time in the clients' repertoire of patience? It's likely.

Based on the clients' follow-up correspondence, I know that they expected to feel liberated and safe because of their decision. Instead, they felt horrible, and like they had given up on her in hurt and anger.

Had these clients already mapped out the path that would lead to a dead dog before I saw them?

Second case
The second case suggests that they might.

The patient was another mixed breed, adopted from a shelter, with almost the same diagnostic profile, but this time was a castrated male who also reacted profoundly to noises.

The dog had been my patient for the past four years and the clients had managed his anxiety and hyper-reactivity to noises, in part, by moving from a busy, noisy urban street to a more suburban area where the dog could have a huge yard.

Additionally, they placed the dog on amitriptyline, gave him diazepam when thunderstorms or fireworks were anticipated, worked with him with all the behavior modification, and had frequent re-exams.

Looking back, I note that euthanasia was a consideration before the first visit.

Increasing medication
The dog improved, and when he slid backward we increased his medication with excellent results. The client tried agility with him as a way to broaden his horizons. When the dog balked at it, she adopted another shelter dog to keep him company and to start in agility. That dog is now a star, but the original intent had been to use a much more "normal" dog as a model for more appropriate behaviors.

At some point a less-than-helpful veterinary technician, who belonged to the same training club, suggested that the dog be withdrawn from the medication because he "should" be able to do without it.

This provoked a tremendous crisis where the dog was even more anxious than he had been previously. It took months to re-stabilize the dog, and on some days when he was particular distressed he was immediately treated with diazepam in addition to the amitriptyline.

Adding another dog
Another dog was added to the household- this time a pure-bred Tervueren pup - with the intention of developing him as a dog who could trial in herding. On a visit to the household, I noted that the patient was good at taking cues from both these dogs, was tolerant of the puppy, and was somewhat reactive to noises. It took him about five minutes to come greet me, and he trembled a bit at first. He then became outgoing, solicitous and playful with the other dogs.

The client told me that she thought he was getting worse. By this point, the client had become a dog trainer, and she was seriously into clicker training. She could click to get the other two dogs to do almost anything - even the puppy - but that this dog seemed to be becoming more anxious and withdrawn. She asked if I thought he'd be happier in another home.

I could kick myself for my response in retrospect, but I told her that I didn't think anyone else could care for his needs in the way she did, and to me, he was much improved.

I asked about his noise reactivity, and she said it was about the same. I also noted to her that when he was already aroused, the clicker and the attendant expectations likely made him worse. Finally, we discussed other, more specific medications including an SSRI for his anxiety and alprazolam for his noise reactivity. At this point, I felt the dog had improved, and that the client was comparing his performance with the star performers. She watched him for a while and agreed, deciding to stay with his current drug regimen.

Many discussions
We had many discussions about the new pup over the next few months, and when I'd ask about her troubled boy, I would get the response that he was the same, but they loved him.

Suddenly, I had a series of messages left everywhere for me by the client. When we talked she told me about how the dog could no longer sit still, was frantic all the time, and yesterday while she was trying to work with him in the yard he startled at a car noise and knocked her down (he weighed about 22 kg) and really bruised her.

I asked what had suddenly provoked this change, and then learned that the change wasn't sudden: the client hadn't wanted to tell me that he was getting worse because she didn't want to keep "bothering" me.

After a 2.5-hour phone call and a discussion of reasonable expectations, we decided that we needed to add an SSRI and use alprazolam for his noise reactivity.

When the client asked me why she hadn't been on this all along, I explained that unless we openly share information, rational drug use doesn't come into play, and she had not been honest with me about her concerns and what she perceived to be his worsening behaviors. I reminded her that we had discussed these medications, but that she decided that he maybe wasn't that bad. Now, it had turned into an emergency. I immediately called prescriptions into her local pharmacy after answering one final question.

Did I think I could find another home for this dog? I told them it would be difficult to re-home him at this point. It might not be impossible, but it would take time since we were all still searching for that fantastic benevolent "farm" where all problem dogs could go.

More concerns
Because the client was so worried about side effects of drugs, I made sure she knew that even though I was travelling, she could call any time.

Imagine my surprise when on my first day home I received a certified letter from the client saying they had euthanized the dog the morning after we talked because they couldn't stand to see him suffer.

She detailed that he had been "much" worse than she had let on and that I had to know that they never denied him anything, but she felt that her last gift would be to end his suffering.

Closing thoughts
I believe in relief of suffering, but the letter never sat well with me. The use of potentially better medication was declined and then denied. The expectations for this dog's performance increased with the number of ribbons his housemates obtained. Clicker training became a religion to which progress and mental health were coupled. And all of our conversations about him "worsening" were requests for permission to give up without taking the responsibility of the decision.

A few months after this dog died, a client who attends the same herding club called because her dog was reacting more to noises and she was panicked that this was the start of him backsliding uncontrollably like my other patient.

It took every bit of willpower to calmly explain that her dog had the advantage of state of the art medication, full disclosure and realistic expectations. We were then able to move on to discuss why her dog might be more reactive, and the role a week's worth of non-stop thunderstorms might play.

I tell my clients when I am at the limit of my knowledge, and when I think we have done the best we can do as a team. At that point, the clients must decide if this is good enough for them. It certainly makes clear that treatment is not unconditional.