Dr. Kay Foster, Roo Core Vet
Photo by Hermes Rivera on Unsplash
“Reba” was a 7yo FS mix breed dog who presented for behavioral consultation. On physical, minor lacerations to the muzzle and front paws were noted. Physical exam revealed no other abnormalities outside of a body condition score of 7/9 and dental disease grade 2/4. Upon presentation Reba was bright, alert, and responsive. She was very friendly and well mannered within the clinic.
The owner reported the Reba had recently escaped the house and was caught running around the neighborhood by a neighbor. Reba had broken through a door in her home, and had torn up the carpet. The owner also reported urination and defecation accidents in the home. The owner said the Reba has previously not demonstrated signs of stress behavior prior. However, the owner had been furloughed from her job at the beginning of the pandemic in February. She had recently been rehired and started a new job at the time of presentation in September. The owner was very concerned for Reba’s wellbeing. These concerns were complicated by the frustration of her home being a rental home and being called out of work at her new job when Reba escaped.
Reba was diagnosed with separation anxiety. Routine blood work was performed that showed no abnormalities. A consultation with a local behavioral specialist was recommended, but due to financial concerns, had to be declined. A lengthy consultation on separation anxiety was held with the owner, with the key of treatment being behavioral remodification. Due to concern for Reba’s safety, she was started on anti-anxiety medication. Fluoxetine 1-2mg/kg PO SID was prescribed with the warning that it may take one to two months before reaching efficacy. Thus she was also started on Trazodone 8mg/kg PO BID for the first two weeks. Owner was given strict instructions to monitor for serotonin syndrome– such as dizziness, restlessness, or profound sedation– while on both medications at once.
Key parts of behavioral modification included the following:
-Creating a calm environment 15 minutes prior to departure and after return. During this time frame the owner was not to engage with the dog in any exciting or agitating manner. This time should be treated as “nothing to see here” without emotional goodbyes or greetings.
-Counter conditioning by having departures associated with a treat (unassociated with the owner). In this instance, a Kong toy stuffed with baby food and peanut butter, then frozen was to be given to Reba as a distraction.
-Habituation of departure cues such as putting on shoes, coat, and grabbing keys done throughout the day.
-When applicable* shortened duration of leave, starting with leaving Reba for a few minutes and gradually increasing to longer durations of time.
*Ideally this is done exclusively until Reba could be home for the entire day by herself. Unfortunately, the owner did have to report to work and had nobody else to watch Reba. Thus this tool was intermixed with full work days.
Three days after the initial presentation, Reba’s owner called back to the hospital stating Reba had exhibited destructive behavior within the home. Her dosage of Trazodone was increased to 10mg/kg PO BID.
A week after the initial presentation, Reba had escaped again. The owner was very emotionally distraught over Reba’s wellbeing. Both rehoming Reba due to her unhealthy attachment to the owner and humane euthanasia were discussed. Ultimately, it was determined that an additional medication would be incorporated into her treatment. As a salvage effort, Acepromazine* 1mg/kg PO BID was started with instructions that the owner may increase to 2mg/kg BID as needed. Again, the importance of monitoring was repeated. *Other anti-anxiety medications such as gabapentin or benzodiazepines were considered as well. Due to the severity of the case and depletion of resources, both emotional and financial, a physical sedative was opted for. It should be noted that Acepromazine should be considered as a physical sedative only, as there is limited evidence of actual anxiety reduction with this medication.
Reba continued on with her behavioral modifications and increased medication dosages for a total of three weeks and was then tapered off. After education with the owner, it was left to her to decide if the fluoxetine would be used long term or if she would eventually be tapered off. As of now, January 2021, she is still on fluoxetine and doing well.
As the recent release of the COVID vaccine and a new year bring a light to the end of the tunnel, it is important to remember that 2020 has left an impact on all of us. From the puppy boom brought on by more people being at home to established pets who have learned to adjust to their owners being constant companions, the return to the workforce for many will likely lead to a spike in separation anxiety cases. These cases should be navigated with compassion and patience to all teams involved– veterinary staff, owner, and patient. Behavioral modification is the treatment of choice– without it medications will fail. Medications should be used when the safety of the pet is in question. Keep in mind the longer term options such as fluoxetine and paroxetine require months to reach efficacy. Veterinary professionals should be intervening to all pets both new and old. Education on behavioral modifications prior to signs being seen is key. Intentionally planned departures can be used to teach independence to pets. Crate training from a young age is key to providing the pet with a safe zone. Great handouts on separation anxiety can be found on DVM360.com and ASPCA.org.
Sources
https://www.iowaveterinaryspecialties.com/student-scholars/serotonin-syndrome
https://www.cliniciansbrief.com/article/separation-anxiety-dogs
https://www.dvm360.com/view/home-alone-canine-separation-anxiety-proceedings
Lee, Dr. Justine Lee DVM, DACVECC, DABT. “Top Mistakes Veterinarians Make with Behavior Disorders.” VETgirl Veterinary Continuing Education Podcasts, performance by Dr. Lisa, DACVB, Radosta, Sept. 2016.
Dosages courtesy of plumbsveterinarydurgs.com
