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Behavior Jacqui Neilson, DVM, DACVB Portland, Oregon Feline Elimination Problems Introduction: Feline elimination problems are the leading behavioral complaint of feline owners to referral behavioral practices. As with any presenting problem, it is important to first arrive at a diagnosis before implementing treatment. When presented with a feline elimination problem there are three main diagnostic categories: medical problems, marking or toileting problems. Elimination in Cats and Kittens: The queen stimulates the kittens to eliminate by licking the perineum until about 5-6 weeks of age. (Beaver, 1992) Then kittens naturally seek out sand-like material for elimination purposes. An adult cat without elimination problems will use the litterbox on average 5 times per day (Crowell-Davis and Sung 2000). Urine marking is considered a normal communication behavior in both male and female cats. Sexual sterilization drastically reduces the incidence of urine marking (Hart and Barrett, 1973). Diagnostics: It is important to first perform diagnostic tests to rule out and/or address underlying medical issues. Medical problems that could be involved in an elimination encompass include a wide range of diseases including pathology of the bladder, gastrointestinal tract, endocrine system and musculo-skeletal system. All feline housesoiling patients should initially receive a comprehensive physical examination. If the cat is urinating inappropriately, the diagnostic work-up should include:
A complete history is essential for the proper diagnosis and treatment of feline elimination problems. The history should include the information about: the frequency and pattern of elimination or marking (e.g., number of episodes per week; only when owner goes out of town); locations (e.g., cat only sprays near one window); substrates (e.g., cat only eliminates on carpet); elimination behaviors (e.g., whether the cat digs prior to elimination, tries to cover elimination); litterbox history (e.g., type of litter, any changes in litter, type of box, location of box); corrections and cat's response to corrections (e.g., the owner yells at the cat and the cat hides under the bed); social environment and history (e.g., a new cat in the neighborhood; a new baby in the family); cleaning strategies; diet history (e.g., type of food, feeding schedule and any dietary changes) and a medical history. All of the historical information is valuable and important, however, it is extremely important to ask questions about litterbox cleanliness and social interactions. In addition to asking the client how often they scoop the litterbox, the client should be specifically asked how often they dump, wash and replace the litterbox with new litter. Social interactions between cats can often be one of the precipitating factors for urine marking or toilteing problems. A cat may avoid the litterbox because he gets attacked when he attempts to use the litterbox or is trapped after using the box. This cat may just develop a safer elimination area (toileting problem). Alternatively, a cat that lives in a hostile environment may start urine marking secondary to territorial issues/anxiety. The client should be carefully questioned regarding relationships between animals and for signs of covert tension such as staring and overt tension such as hissing, growling and fighting. Since social tension between cats may be very subtle and therefore missed by owners, first-hand observation of the cats or detailed questioning may be necessary to properly assess the social atmosphere in multi-cat households. Behavioral Diagnosis: When the elimination problem persists after a medical problem has either been ruled out or remedied, a behavioral diagnosis should be obtained. The primary distinction that must be made in a behavioral diagnosis is whether the cat is engaging in marking behavior or selecting a spot other than the litterbox for elimination (a toileting problem).  The motivation for urine marking may be due to territorial behavior or anxiety/stress (reactionary marking). Urine marking is a normal behavior that is considered unacceptable in our homes. About 10% of prepubertally castrated male cats and 5% of prepubertally spayed female cats show problem urine marking (Hart and Cooper, 1984). Territorial marking behavior may be stimulated by multiple cats sharing a common living area, breeding season or the arrival of new cats into a territory. Situations that evoke anxiety or stress in a cat such as the addition of a new family member or a dramatic change in work schedules, may also lead to urine marking. Toileting problems are often triggered by medical causes, aversions, preferences or anxiety. Any disease that causes polyuria may result in a cat urinating outside the litterbox because of the frequency or urgency associated with elimination. Geriatric cats with arthritis may have problems associated with access to the litterbox. For example, the arthritic cat may have trouble climbing over the edge of a high-sided litterbox. Litterbox aversion is a common cause of inappropriate toileting. Cats are known for their fastidious nature. Therefore if the litterbox is dirty, cats will often choose another, cleaner, spot to eliminate. Each cat will tolerate a different level of litterbox cleanliness. However, in a cat whom you suspect litterbox aversion, the litterbox should be kept scrupulously clean. In addition to litterbox cleanliness, other aspects of the litterbox environment can result in litterbox aversion including the location of the box, the style of the box and the brand of litter. Preferences may involve substrate preferences and location preferences. When a cat develops a substrate preference it is selecting a substrate (e.g. carpet) that is more pleasing to the cat than the substrate that the owner is providing in the litterbox. If the historical information suggests that the cat is always choosing a certain substrate for elimination then this possible cause should be explored more carefully. Finally, anxiety is sometimes the cause of inappropriate elimination. Cats that have been ambushed by another household pet when previously using the box may be nervous about placing themselves in that situation again. A cat that is uncomfortable with the presence of a new boyfriend or infant in the house may be too anxious to walk past those new family members to access the box. In both of these examples, the cat has developed a litterbox aversion due to social anxiety. To discern between the two main behavioral diagnosis of urine marking and toileting problems there are several diagnostic criteria. Marking is a communication tool that often involves urine sprayed on vertical surfaces or small puddles of urine deposited on horizontal surfaces with special social significance. One tends not to see a particular pattern of substrate use, in fact the urine is often found in areas with different substrates underfoot. Inappropriate defecation is rarely involved. The cat continues to use the litterbox for both urination and defecation and there is no evidence of litterbox avoidance. Social problems between cats are often present with urine marking. In contrast, the cat with a toileting problem usually deposits significant quantities of urine and/or feces on horizontal surfaces. A substrate-use pattern is often identified. For example, the cat always targets a certain type of carpet. The cat shows avoidance of the litterbox and decreased or absent usage of the litterbox. Historical collection may reveal a pattern of inappropriate litterbox cleaning, box type, litter type or box placement. Treatment for Urine Marking: In some situations where the culprit is unknown, you may need to identify the culprit(s) so that the treatment is targeted at the correct cat. Confinement may help to identify the guilty cat. Alternatively, the fluorescein dye test can be used. In the literature, it is advised to place six large (9 mg fluorescein/strip) fluorescein dye strips in a gelatin capsule and give orally to cat. The cat will eliminate bright yellow-green fluorescent urine for 24 hours after administration when viewed with a fluorescent black light (Hart and Leedy, 1982). Since untreated urine will also fluoresce, the owner must become familiar with normal fluorescence so they can appreciate the enhanced fluorescence. In recent trials conducted by the author, variability in results between cats given fluorescein doses ranging from 5-40 mg/cat was present. Since the fluorescent qualities of sodium fluorescein vary with solution pH, this may significantly impact fluorescence. Be aware that the fluorescein treated urine may be visible to the naked eye on certain fabrics. To identify the culprit of inappropriate defecation, shavings of different colored non-toxic crayons can be added to the food of each cat. For example, in a two-cat household, Cat A can be given purple crayon shavings and Cat B green crayon shavings. If the feces deposited on the carpet has green crayon shavings in it, Cat B is a confirmed participant. Marking animals should be neutered. Ninety percent of intact males show a significant decrease in marking behavior after castration (Hart and Barrett, 1973). Since estrus female cats show an increase in urine marking, ovariohysterectomy will minimize this marking. To treat urine marking the clinician should be trying to reduce conflict and stress in the environment. Stray cats and neighborhood cats should be discouraged from entering the territory of the resident cat. For example, if the owner feeds stray animals in the yard, this should be discontinued. The owner may need to block the view from windows if their cat is aroused by the presence of other cats outside the home. If there is tension between cats in a household, the cats may need to be separated for time periods during the day or one cat may need to wear a bell so that the other cat can avoid interactions. An "environment of plenty" should be created in multiple cat households. This involves creating multiple feeding areas, multiple elimination areas and multiple single cat sleeping perches at different vertical heights throughout the home. Positive interaction time (e.g. playing with a feather, grooming) should be spent with each cat on a daily basis. Adequate environmental management of soiled areas and litterboxes may help to reduce marking. The UC Davis Behavior Service examined the effects of environmental management on the frequency of urine marking (Pryor, 2001). Forty-seven cats exhibiting vertical urine marking were enrolled in the study. Owners collected baseline frequency of urine marking for two weeks without making any changes in home management. Owners were then given instructions to clean urine marked spots with an enzymatic cleanser (Anti-Icky-PooTM, Mister Max Quality Products 1-800-745-1671) for 2 weeks. Additional instructions included providing one litterbox per cat plus one additional, scooping the box daily and changing the box weekly. The number of urine marks recorded during the baseline phase (11.7 +/- 1 marks) was significantly higher than the number of urine marks recorded during the environmental management phase (9.7 +/- 1.3 marks). This indicates that environmental management should be implemented as part of the treatment for feline urine marking. If there are only a few target spots then the owner can attempt to make those areas aversive by covering them with aluminum foil, placing upside down contact paper (sticky side up), placing vinyl carpet runner (nub side up) or potpourri at the sites. Alternatively, the cats' food and water can be placed at the soiled site after proper cleaning. The owner should be cautioned that making the areas aversive may just result in the cat choosing another location to mark. Other forms of marking such as bunting (facial marking) and scratch marking should be encouraged. To encourage scratch marking, scratching posts and/or pads should be placed around the home, with the highest concentration in areas where the marking is occurring. To encourage facial marking, there is a product available called Feliway. Feliway is a synthetic analog of the feline facial pheromone. Pageat, the veterinarian that developed Feliway, has proposed that there are three principal functions of facial pheromone: 1)spatial organization 2)relationships with other cats and 3)emotional stabilization. He also maintains that cats will not urine mark in locations where they have previously performed facial marking. It is proposed that by increasing emotional stabilization Feliway results in the resolution or decrease of urine marking. Treatment is performed by spraying the facial pheromone directly on places soiled by the cat and also any prominent locations in the environment. A daily application is necessary until the cat is noted to exhibit facial rubbing on the site. If the cat does not exhibit facial rubbing, then daily application to the environment should be continued for one month. Pageat reports 96.7% efficacy in eliminating recent onset (less than 3 months duration) urine marking with Feliway treatment in a clinical trial involving 61 cats (29 castrated males, 22 spayed females, 9 intact females and 1 intact male). Environmental treatment with Feliway was done for 28 days and the cats were monitored for an additional 21 days after treatment had ceased for signs of relapse. It was noted that most cats had significant decreases in urine marking after 7 days of treatment with Feliway (Pageat, 1996). White and Mills (1997) performed a similar study examining the effectiveness of Feliway in treating 57 cats with chronic (greater than 4 months duration) urine marking. After 35 days of treatment with Feliway the owners reported a decrease in urine marking in 91% of the cats. 57% of the cats had did not exhibit any urine marking during the last 7 days of the trial. Hunthausen (2000) reported the results of using Feliway in a open label fashion to treat urine marking. Fifty-seven households were included in the study. The mean number of urine marks per week prior to treatment with Feliway was 13.9. After 4 weeks of daily treatment with Feliway the mean # of urine marks 2.9/week, a significant decline in number of urine marks. Although the overall number of urine marks decreased, 2/3 of the households continued to experience some urine marking. Feliway has recently been released in another form, that of a plug-in diffuser. The Feliway diffuser is plugged into a standard electrical outlet and provides a constant slow diffusion of the pheromone into the environment. The plug-in should last for about a month and covers 500-650 square feet. A double-blinded, placebo controlled trial was conducted to evaluate the efficacy of the plug-in diffuser in the treatment of vertical urine marking in multi-cat households (Mills and Mills, 2001). Compared to a baseline week, the cats receiving the Feliway plug-in diffuser had a greater reduction in frequency of urine marking than did the cats in the placebo plug-in group. Drug therapy has been long used to help control urine marking (Table 1). However, to date, no drugs have been licensed by the FDA to treat urine marking in cats. Recent studies have furthered our knowledge about the most appropriate treatments. Lately, the concentration of experimental efforts has been using the serotonin enhancing drugs to manage urine marking. Prior to instituting drug therapy a physical examination, complete blood count, chemistry panel and urinalysis should be conducted on the cat. Although there is anecdotal information about the efficacy of amtriptyline, there are no published controlled studies documenting its efficacy. One limiting factor when using amitriptyline is the extremely bitter taste, making it difficult to orally administer the medication. Another drawback to treatment with amitriptyline is the significant sedative side effects. Owners are often unhappy with the "drugged" appearance of their pet while taking this medication. Clomipramine has received attention as a possible treatment for urine marking in several independent studies and the results have been promising. Although none of these studies have employed the "gold-standard" double-blind placebo controlled protocol, they make attempts to account for bias. Dehasse (1997) published a paper in investigating 23 vertical urine spraying cats. All cats were put on a placebo (5 days)-drug (7 days)-placebo (3 days) trial with the owner being blinded as to what phase of treatment the cats were receiving. During the drug phase (clomipramine 5 mg/cat once daily) the average number of urine marks per day dropped significantly from the first placebo stage (first placebo stage average number of urine marks = 2.16 marks /day; drug phase average number of urine marks = 0.49 marks/day). Eighty percent of the cats had a significant (>75% reduction in urine marking) during the drug treatment phase. Of those, 35% completely ceased urine marking during the treatment phase. A study by Landsberg (2001) examined the effects of clomipramine dosed at approximately 0.5 mg/kg once daily on vertical urine marking in cats. The treatment duration was one month. Twenty-one of twenty-five cats enrolled in the study had a significant (>75%) reduction in urine marking during treatment with the medication. The remaining four cats showed a 50-75% reduction in urine marking. Side effects reported included lethargy, decreased appetite, stool and urine retention and decreased affection. There were no changes in blood or urine parameters comparing pre-treatment to post-treatment samples. Kroll and Houpt (2001) performed a double blind crossover study in eighteen client-owned cats evaluating the comparative efficacy of clomipramine (5 mg/cat/day) versus cyproheptadine (2mg/cat/day) in the treatment of urine marking. Treatment with clomipramine was significantly more efficacious in reducing/resolving urine marking than was treatment with cyproheptadine. A double-blind placebo controlled study evaluating the efficacy of fluoxetine (1mg/kg/day) in the treatment of urine marking behavior in cats was presented by Pryor (2001). Seventeen cats completed the study and there was a significant reduction in weekly number of vertical sprays in the drug group (8.6 marks per week pre-treatment to 1.4 marks per week while receiving drug) as compared to the placebo group (no change in average number of urine marks between pre-treatment and treatment phase). A recent prospective double-blind, positive control trial using either fluoxetine or clomipramine to treat urine marking in cats showed no difference in efficacy between the two drugs in the first 8 weeks of treatment (Tynes, et. al. 2002). At 16 weeks of treatment the cats receiving the fluoxetine showed significantly greater reduction in urine marking than cats receiving clomipramine. The recommended route of administration for the medications discussed above is oral. Since most of these medications are quite bitter and you expect the owners to dose daily for several months, it is important to provide with them with instruction and tools to aid in medicating. Dispensing size no. 5 empty gelatin caps to insert the pill into prior to pilling can help eliminate problems with bitter pills. Getting the medication compounded into a fish flavored liquid and having the owners mix it with canned cat food will sometimes work with the less bitter meds (fluoxetine). Although transdermal gels are gaining popularity for ease of administration, little is known about actual absorption rates of medications given by this delivery method. If a medication is effective at controlling the urine marking, it should be continued for 2-4 months. Then one can attempt to wean the cat off the medication over 2-4 weeks via dose reduction or reduction in frequency of dosing. If there is a relapse in marking during the weaning process, return to the lowest effective dose and maintain treatment for another 2-4 months before attempting to wean the cat again. Some cats require long-term treatment to control the problem behavior and they should receive regular (every 6-12 months) physical exams and laboratory evaluations. Treatment of Toileting Problems: The treatment for toileting problems should focus on providing a very attractive litterbox while reducing the attractiveness or accessibility of inappropriate target spots. The soiled areas should be cleansed with an enzymatic cleanser. Sometimes the cat will have to be confined away from areas in the house where s/he has chosen to eliminate. Alternatively, those soiled areas can be made aversive with plastic, upside down contact paper, aluminum foil, food, etc. If the cat has chosen one or two areas in the house to eliminate, the new attractive litterbox should be placed at those locations. If the cat uses the box, it can gradually (1 inch per day) be moved to a more appropriate location, if necessary. If anxiety is associated with the inappropriate elimination, anxiolytic drug therapy may be instituted. However, in most cases of toileting problems, drugs are not necessary or indicated for successful treatment. Educating clients about proper litterbox cleanliness is imperative. Boxes should be scooped at least once daily, preferably twice daily. The frequency of complete litterbox changing (dump, wash with soap and water, fill with new litter) depends on the type of litter, the number of cats and the individual cat(s). However, a minimum cleaning schedule involves changing clay litters weekly and scoopable litters once every other week. The minimum number of litterboxes in a home should equal the number of cats plus one. The litterboxes should be the correct size. For example, a 16 lb. cat will need a jumbo- sized litterbox. Uncovered litterboxes are preferable to covered boxes because "out of sight is out of mind" and owners will often forget to clean the covered boxes. The litterboxes should be placed in easily accessible locations around the home. It may be beneficial to identify the favorite litter by conducting litter trials. Cats are offered a choice of litters and the litter that is preferentially chosen is then used in the boxes. One study (Borchelt, 1991) showed that unscented, finely particulate matter ("clumping" or "scoopable") litter is preferred by most cats. To help determine the attractiveness of the new silica ("pearl") litters a preference study was conducted on shelter cats (Neilson, 2001). Fifty-four shelter cats were given two novel litter options (clumping and pearl) for a 12-hour overnight period and usage was recorded. A total of 74 uses were recorded, 58 (36 urination/22 defecation) were in clumping litter, 13 (11 urination/2 defecation) were in pearl litter and 3 (1 urination/2 defecation) were out of the litterbox. These results suggest that most cats prefer a clumping type litter compared to pearl litters for elimination. Identification of a favored location or box style can also be determined by giving the cat multiple options. Uncovered boxes are recommended. Finally, owners should be cautioned against disturbing the cat when it is using the litterbox. Owners should not attempt to give medications when the cat is using the litterbox. Children and other pets should not be allowed to harass the cat when it is using the litterbox. With both marking and inappropriate elimination, the owner should avoid punishing the cat when soiled areas are discovered. If the animal is caught during the event, the owner can use a startle technique to stop the behavior, but realize that this will not solve the problem. Conclusion Although getting the cat back into the litterbox is challenging, it is possible. The cat should have a complete historical evaluation and physical examination. After a diagnosis is made, a rational therapeutic plan can be pursued. Veterinarians should be providing preventative educational information to clients during the initial kitten visits to help avoid the development of these problem behaviors.
*partial list of potential side effects Table 1: Drug therapies for urine marking References: Beaver BV. Feline Behavior: A Guide for Veterinarians. WB Saunders, Philadelphia, p. 203, 1980, 1992. Borchelt PL: Cat elimination behavior problems. Vet Clinics of North America: Small Animal Practice 21: pp.257-264, 1991. Borchelt PL, Voith VL Aggressive behavior in cats. Comp Contin Edu Pract Vet 9 pp. 49-56, 1987 Crowell-Davis SL, Sung W. Advances in Understanding Feline Elimination Behavior Problems in AVMA Convention Notes, Boston, 2000. Dehasse J. Feline Urine Spraying. Applied Animal Behavior Science 52: pp. 365-371, 1997. Hart BL, Barrett RE: Effects of castration on fighting, roaming and urine spraying in adult male cats. JAVMA 163: pp.290-292, 1973. Hart BL, Cooper LC: Factors relating to urine spraying and fighting in pre-pubertally gonadectomized cats. JAVMA 184: pp. 1255-1258, 1984. Hart BL, Leedy N: Identification of source of urine stains in multi-cat households. JAVMA 180: pp. 77-78, 1982. Hunthausen, W. Evaluating a feline facial pheromone analogue to control urine spraying. Veterinary Medicine, pp. 151-156, February 2000. Halip JW, Vaillancourt JP, Luescher UA. A descriptive study of 189 cats engaging in inappropriate elimination behaviors. Feline Practice; 26(4):18-21, 1988. Kroll T, Houpt KA. A comparison of cyproheptadine and clomipramine for the treatment of spraying cats. Proceedings of the Third International Congress on Veterinary Behavioural Medicine. Eds. Overall KA, Mills DS, Heath SE and Horwitz D. Universities Federation for Animal Welfare, Herts, UK. pp. 184-5, 2001. Landsberg GM Effects of clomipramine on cats presented for urine marking. Proceedings of the Third International Congress on Veterinary Behavioural Medicine. Eds. Overall KA, Mills DS, Heath SE and Horwitz D. Universities Federation for Animal Welfare, Herts, UK. pp. 186-189, 2001. Mills DS and Mills CB, Evaluation of a novel method of delivering a synthetic analogue of feline facial pheromone to control urine spraying by cats. The Veterinary Record, vol. 149, no.7, pp. 197-199, August 18, 2001. Neilson JC. Pearl vs. Clumping: Litter preference in a population of shelter cats. Abstracts from the American Veterinary Society of Animal Behavior. Boston, p 14, 2001 Pryor PA, Hart BL, Bain, MJ, Cliff KD. Causes of urine marking in cats and effects of environmental management on frequency of marking. JAVMA ; 219 (12): pp. 1709-1713, 2001 Pryor PA, Hart, BL, Cliff KD et al. Effects of a selective serotonin reuptake inhibitor on urine spraying behavior in cats. JAVMA; 219: pp. 1557-1561. 2001 Pageat, P Functions and use of the facial phermones in the treatment of urine marking in a cat, interest of a structural analogue. Proc. 21st Congress World Small Animal Vet. Asoc. Jerusalem, Israel pp.197-198, 1996 Tynes V, Hart BL, Cliff KD, Bain M. Treatment of urine marking in cats: a comparison of fluoxetine and clomipramine. Proceedings American Veterinary Society of Animal Behavior, Nashville, p. 29, July 14, 2002 White and Mills. Efficacy of synthetic feline facial pheromone analogue(Feliway) for the treatment of chronic non-sexual urine spraying by the domestic cat. Proc. 1st Int. conf. Vet. Behav. Med., Universities Federation for Animal Welfare, Potters Bar, Great Britain, p. 242, 1997. Reconsidering the "Dominant" Dog Dominance aggression is frequently diagnosed in the canine population, ranging between 20-59% of behavioral caseloads. In cases of dominance aggression, family members are usually the targets of the aggression. The dog is described as having a superior position in the social hierarchy and the dog uses aggression to manage situations where his/her status is threatened. The dominant animal in a group setting is usually a very confident animal. However when cases of "dominance" aggression in dogs are examined, these dogs are often fearful or submissive. Owners report signs that are ambivalent or submissive surrounding attacks. Many owners describe these dogs as "trying to make-up" just after an attack. This behavior is in conflict with a truly dominant/confident personality. If the dog is not dominant, then what is occurring? Perhaps a better term to describe the behavior is "conflict" aggression. The dog is put in a confrontational situation or feels as though it can't predict the owner's response due to past inconsistencies in the owner's behavior. This results in motivational conflict/anxiety and the dog uses aggression to get himself out of the uncomfortable situation. Since aggression is often very successful at terminating the uncomfortable situation, the dog learns that aggression is a good way to manage situations of conflict. If the motivation behind the aggression is anxiety and not an overly confident/dominant dog, then the treatment plan must reflect this. Domination techniques (e.g. alpha roll over) in response to conflict aggression is contraindicated, as they would only serve to increase the anxiety of the dog. Many owners report an escalation in the aggression when they attempt these domination techniques and this is understandable if the dog is truly in a state of anxiety/fear. Employing these techniques will only serve to escalate the fear/anxiety and subsequently escalate the aggression. Important treatment principles for the dog with conflict aggression include: avoiding confrontation, having a safe way to handle the dog and establishing consistent dog-owner interactions. If there is a specific trigger situation, desensitization to that trigger can be implemented. Many owners are concerned that if they avoid confrontations, they are letting the pet "win." However, this is not the case. Any animal in a highly aroused emotional state is not a good candidate for learning. The dog will be taught acceptable behavior when he is calm and relaxed. The owners also want to avoid being placed in situations where the dog's aggression is successful, thereby reinforcing the unwanted aggressive behavior. By avoiding triggers for aggression, this unwanted learning will not occur. To avoid aggressive situations, sometimes the owners will have to modify their behavior (e.g. don't get near the dog when he is eating) or modify the environment (e.g. if the dog has been aggressive with toys, remove them from environment). Having a safe way to remotely control the dog is important. A head collar with a drag line attached is very helpful in many cases. The owners can pick up the line at a distance from the dog and direct the dog into a more appropriate behavior when necessary. To establish consistent dog-owner interactions, it is often necessary to terminate all casual interactions between the dog and the owner. Predictable, structured interactions can become the mainstay of owner-dog interactions. Generally, owners are instructed to give the dog a command prior to all interactions. If the dog responds appropriately to the command, the interaction can proceed. If the dog does not respond, the owner should ignore the dog. In addition to these lifestyle interaction changes, the dog and owner should practice obedience training that rewards obedient relaxed behavior in the dog. Obedience provides a structured, predictable interaction where the dog is reinforced for relaxed, obedient behavior. If a specific trigger for the aggression is identified, a gradual desensitization to that trigger can be implemented. For example, if the dog is aggressive when disturbed when resting, the owner can use a light ball to roll and gently tap the resting dog. When tapped by the ball, the owner can call the dog and ask him to sit, rewarding non-aggressive, obedient behavior with a treat and praise. The intensity of the tap can be gradually increased by selecting slightly heavier balls to roll at the dog until the dog is no longer anxious about being disturbed when resting. It is important for clinicians to consider the fact that most dogs presenting with aggression are not confident/dominant dogs since it has a huge impact upon the treatment plan. Kind, gentle and consistent handling will reap more rewards than harsh, challenging and threatening behaviors in these dogs in conflict. Feline Anxieties, Phobias and Compulsive Disorders Introduction: Anxiety is defined as the "anticipation of dangers", while fears and phobias are "the feeling of apprehension resulting from the nearness of some situation or object." The concept of fears, phobias and anxieties has become quite accepted in the canine world with many dog owners versed in syndromes such as separation anxiety. Fears and anxieties may actually be highly adaptive - the animal that is wary of novel things is more likely to survive. With any behavioral change, the entire animal should be considered. Underlying medical issues can present as fearful behavior. For example, the cat that is hesitant about jumping may have musculo-skeletal disease. Visual impairment or auditory impairment may present as anxious/phobic animals. Changes in auditory capabilities may alter the sounds and reaction of the pet to those sounds. Poor night vision may present as nighttime anxiety. Although we may be recognizing fear and anxiety more readily at the phenotypic level, we are still far from understanding the intricacies of fears and anxieties at the neuroanatomical and neurochemical level. It is known that a functional amygdala is required to learn fear and a functioning forebrain is required to unlearn fear. It has been hypothesized that the development of fears are a result of the inability to inhibit a fear response, simplistically a mal-functioning amygdala. Compulsive behaviors are defined as "a repetitive, purposeful, and intentional behavior performed in a stereotyped fashion". To be considered a compulsive behavior, the stereotypic behavior has to interfere with pet's ability to function normally. It is hypothesized that anxiety plays an underlying role in the development of compulsive behaviors. Zoo animals are often cited as examples of animals living in a deprived, stressful environment that develop stereotypic behaviors. Compulsive behaviors are not fully understood at the nueroanatomical and neurochemiscal level. Research in humans suggests that compulsive disorders are the result of genetically controlled dysfunction of genes involving regulatory systems. Aberrant serotonin systems have been a focus of research and treatment in both the human and pet models, however more information needs to be gathered. Feline anxieties/phobias Social anxiety toward humans: While the sociability of canines is often very important in their daily lives, the feline patient does not sustain the same social pressures. Most cats acclimate well to family members but many respond in a fearful manner to unfamiliar people. The vast majority of cats will elect the "flight" option instead of the "fight" option when faced with and anxious social situation involving humans. Usually this response is non-problematic for the feline owner and therefore they don't seek consultation. The "flight" option could pose a problem with housesoiling if the cat elects to hide instead of trekking to the litterbox when company is visiting. This is easily resolved by providing a safe area for the cat with all necessary resources until the company leaves. Social anxiety towards unfamiliar people becomes most problematic if the cat is anxious about all people (including the owner) or a specific family member. This creates a situation where the cat is in a constant state of anxiety and may not be able to "escape" the fearful stimuli, thus developing other behavioral problems (housesoiling, compulsive disorders) and perhaps turning to the "fight" option, especially when cornered. Systematic desensitization and counterconditioning is the best approach to manage these types of situations. Patience is paramount, as it may take a significant amount of time to resolve the anxiety. Veterinary visits: Most cats don't seem to enjoy the veterinary visit. Often times the level of anxiety/fear has been heightened by all of the preparatory steps (e.g. put in carrier, car ride) before arrival at the hospital. The scents, sounds and actions that occur at the hospital are likely to send most cats into a state of fear. The cat that "freezes" in response to the fear actually is an easy patient for the veterinarian and staff to work on since the cat remains immobile through most of the examination/procedures. However, the cat that tries to flee or fight can be more problematic. Recognizing that fear is probably the underlying issue in most aggressive animals in the veterinary setting can help in proper management. One of the basic principles in managing the problematic pet in the hospital is to avoid punishment. When a pet is fearful or anxious, direct interactive punishment will serve to increase the fear/anxiety of that pet, therefore compounding the problem. The most appropriate method of dealing with an anxious pet is to try to engage them in an alternative behavior that is incompatible with the fearful/anxious behavior. Fearful cats can be encouraged to chase a string/feather toy. Of course when fear/anxiety is very pronounced it is unlikely that a pet will respond to other activities. In these situations you must also try to minimize/decrease the fear evoking stimuli. There are many aspects of the veterinary visit that may trigger fear/anxiety including the odors, the staff uniforms, the other animals, etc. The veterinary staff can minimize some of these fear-evoking stimuli. Some cats respond well to minimal restraint and, if possible, this should be the first course of action when handling a cat. Allowing a cat to hide its head may help to keep the cat from darting away. The pheromone spray Feliway, available through medical distributors and retail pet stores, may provide stress reduction in the cat. A study conducted at the Ohio State University used 20 cats to test the benefits of treating the kennel with a facial pheromone (FeliwayTM, Abbot Laboratories) in both healthy and ill cats. A towel to be placed in the kennel was either treated with the pheromone or vehicle 30 minutes prior to placement in the kennel. The cats were then placed in the kennels with the towels and videotaped for 125 minutes. No differences in behavior were detected between the two groups for the first 30 minutes after placement in their respective kennels. However, in the subsequent 95 minutes the cats in the pheromone treated kennels showed significantly more grooming and interest in food as compared to vehicle-treated kennels. This may suggest that pheromone treatment to the kennel reduces stress and anxiety in the patients. Since anorexia is often a problem in hospitalized or boarding cats, this study indicates that it may be beneficial to pre-treat the kennels with FeliwayTM. Another pheromone spray, Felifriend, is not yet available in the states. Felifriend is applied to people to enhance relations with cats. For extremely fractious cats, sedative administration may aid in management. These cats ideally should be sedated prior to getting extremely anxious. Oral diazepam or alprozolam given 1-2 hours prior to the visit may help but be particularly cautious when handling these cats as they may suddenly lash out. In clinic injectable or inhalant anesthetic agents may be necessary, recognizing that administration should be done with caution in cats that are extremely upset. Home visits should be seriously considered for cats that get upset in the veterinary setting. Cat to cat social anxiety: The domestic cat appears to be fairly flexible in its socialability. It is suspected that the variability in social contact between cats is a function of available food resources. Cats that hunt small prey tend to live alone with limited social interactions. Concentrated food sources bring free-ranging cats together. Historically these groupings have been characterized as simple aggregations. However research has elucidated non-random social interactions and structure within these groups of cats. This information is helpful in defining feline social organization as well as rebuking the myth that domestic cats are asocial creatures. Perhaps the most striking and influential social structure is that which exists between the female cats. In free ranging domestic cats, there is a matriarchal society, with adult females forming lineages of related females and their offspring. A large group of cats (colony) may support several female lineages, with the largest lineages securing the best of the available resources. Within a lineage, there are usually amicable interactions between members, which are in direct contrast to the hostile interactions that are often seen toward outsider cats. Female cats within a lineage spend more time in close proximity with each other than compared to non-lineage members. Communal kitten care is noted within a lineage. Paternal care of offspring is rare. Although lineages are fairly stable, they can change in composition. This will usually involve a split and may be secondary to influences such as lineage size or death of a matriarch. Free ranging male domestic cats have temporary attachments to the female lineages/colonies. The males may have loose relationships with several colonies, thus allowing them to spread their genetic material. When present, the males do receive a significantly larger proportion of attention from the female members. As kittens, the offspring become automatically integrated into the female lineage. As kittens and juveniles, they tend to prefer affiliations within their littermates as opposed to kittens of a different age group or more distantly related members. The male cats will disperse as they mature usually between 1-2 years of age. However, unlike lions, the domestic cat does not form a male coalition, but instead the males disperse separately to establish a new territory. In our households, this information may suggest that closer relationships may exist between littermates in comparison to non-related cats. With social maturity, cats may have a desire to disperse, thus creating social conflict between resident cats that have previously gotten along well together. In a survey done by Voith and Borchelt, results indicated that 80% of household cats hiss at each other, 85% swat at each other and 70% have an occasional fight with another household cat. This social stress may present as a primary problem, or more likely, the presenting complaint may be an elimination issue with the social strife being the underlying cause of the elimination problem. In some extreme cases, one cat is terrorized while the other cat(s) is/are the antagonist. When examining these situations, the clinician should try to determine which cat(s) are behaving abnormally, remembering that it could be the victim, the aggressor or both. Often times if we can reduce the anxiety of the victim cat so that it no longer runs/hides, the aggressor cat loses interest in the chase. For serious situations a complete segregation rule should be instituted. The sties of segregation should be alternated so that each cat can acclimate to the smells of the other cat. Structured introductions using a barricade (e.g. screen door) to prevent full access should be done on a daily basis. During these initially short introductory periods each cat should be engaged in a positive activity (e.g. eating/playing/petting) so that a positive association is made between the two cats. With each successful period, the duration of these introduction periods and the proximity of the cats can be gradually increased. A common cloth can be used to pet both cats, thus transferring scent. Environmental application of Feliway may aid in stress reduction. The victim cat may appreciate an advanced warning system on the aggressor cat - a belled collar can provide a very valuable auditory signal. Houses with feline-feline social stress should be set up so that there is an "environment of plenty" - plenty of resources in plenty of locations. This means that there should be multiple litterboxes, multiple feeding areas and multiple resting perches scattered around the living space. Drug therapy can be helpful at reducing anxiety. The drug therapy is targeted at the abnormal cat, whether it is the aggressor or the victim. Generally serotonin-enhancing medications are recommended. Buspirone is usually avoided by the author due to reports of increased intercat aggression in some cats receiving this medication. Fluoxetine (0.5-1.0 mg/kg SID), paroxetine (2.5mg/cat SID to EOD), clomipramine (0.5 mg/kg SID) and amitriptyline (5 mg/cat SID to BID) are all treatment options. Anxiety toward dogs: It is fairly adaptive for cats to be frightened of dogs. If an owner anticipates a mixed canine-feline household, attempts should be made to socialize the kitten to dogs. If you are dealing with introducing an adult cat to a dog, systematic desensitization is advised, similar to that proposed for cat to cat introductions noted above. In this case the dog should wear a auditory signal (belled collar) and there should be plenty of escape routes for the cat. If the dog is exhibiting any aggressive or predatory tendencies towards the cat, complete segregation is advised. Noise phobias: This is not a common presenting complaint because most cats just hide until the aversive noise abates. They tend not to inflict lots of property damage when nervous, unlike their canine counterpart. However, one should consider noise phobias as an underlying issue for elimination problems. Litterboxes are frequently located in laundry rooms. The buzzer on the machines may startle a cat while it is eliminating, creating a negative association with the box. This could account for the "sudden" onset of a problem in a cat that has reliably used the box for several years. In most cases, one can manage feline noise phobias by protecting the cat from the noise. Another option is to implement desensitization and counterconditioning to problematic noises. Separation Anxiety: Cats may suffer from separation related anxiety exhibiting signs of depression, inappropriate elimination, destruction and anorexia. As with dogs, the clinical signs should only be present when the cat is separated from the attachment figure. Cats that specifically seek out materials with the scent of a particular individual may be doing so out of anxiety related separation issues. Management should include desensitization and counterconditioning to owner departures. Anxiolytic drug therapy may be helpful. Compulsive behaviors: Obsessive-compulsive disorder (OCD) is defined by the Psychiatric Association as a persistent idea, thought or impulse that is intrusive and senseless that results in the performance of a repetitive, purposeful and intentional behavior performed in a stereotyped fashion. Since we are unable to interview pets regarding the presence potential obsessive thoughts, a diagnosis of OCD is made on the observation of an excessive stereotypic behavior that interferes with normal routine and functioning of the animal. Between 2-3 % of the human population is estimated to suffer from obsessive-compulsive disorder. It is difficult to determine the incidence of this disease in our companion animal population since it often is unreported or mis-diagnosed. An impoverished environment, anxiety, stress or conflict appears to be associated with the development/severity of OCD. A genetic predisposition is evident with OCD. OCD's generally will present as abnormal manifestations of grooming, eating and drinking, locomotion, vocalization or hallucinatory behaviors. Typical behaviors that may be OCD's include tail-chasing, fly-biting, flank-sucking, wool-sucking, wool-chewing, pica, pacing, vocalization and acral-lick granulomas. Compulsive disorders often appear at the onset of social maturity in animals (in humans they are often seen at adolescence). In cats, the range extends from 24-48 months with the average age of onset being 30-36 months of age. In one study it was found that most of the affected cats manifested their particular compulsive behavior after physical trauma or social upheaval. Concurrent complaints in these compulsive cats included aggression and elimination problems. Abnormalities in neurotransmitter function specifically dopamine, serotonin and opioids have been implicated in the pathogenesis of OCD. Variation in presentation and response to treatment may suggest that OCD's may have distinct etiologies that are yet to be identified. As with any presenting complaint a complete physical examination with neurological evaluation is necessary to identify any underlying medical problems. Pruitis, pain, inflammatory neurological disease, toxins, etc. may present as stereotypic behaviors. A CBC, chemistry panel, urinalysis and viral testing are a minimal data base. Radiographs and other imaging may be indicated based upon the presenting complaint. CSF evaluation along with advanced imaging (CT, MRI) may be valuable. Historical information is critical in determining a diagnosis for the presenting complaint. Signalment of the animal can identify possible breed predispositions for certain compulsive behaviors. Onset, duration and frequency of the behavior should be determined. Average bout of the behavior should also be identified. A video of the pet engaging in the behavior can be invaluable. Factors that trigger the behavior as well as discontinue the behavior should be identified, if possible. Of critical importance is determining if an audience must be present for the pet to engage in the behavior. Discuss any types of corrections/interventions to eliminate the behavior and the response. A social/environmental history of the owner should be gathered and the 24-hour routine of the pet should be established. Differential Behavioral Diagnosis: Attention seeking behavior Attention seeking behaviors can take many different forms and some may present as stereotypic behaviors. A typical history may involve a pet that started to engage in an unusual or bothersome behavior that the owners either rewarded or reprimanded. The pet then continued to engage in the behavior to obtain the attention of people. The critical piece of information that can help to determine if the behavior is attention seeking is whether or not an audience has to be present for the pet to engage in the behavior. If an audience must be present then increased consideration should be given to the diagnosis of attention seeking behavior. It is possible that the presence of people triggers an OCD because they cause anxiety/conflict to the pet so this must be differentiated from attention seeking behavior. The treatment for attention seeking behavior is fairly simple, when the animal engages in the undesirable behavior, everyone must exit the area, only to return when the animal has discontinued the activity (the animal should stop shortly after departure if it is an attention seeking behavior). Advise owners that the behavior will probably worsen before it extinguishes. Other anxiety related conditions: Animals with anxiety related conditions may perform stereotypic behaviors in response to the anxiety provoking event. For example, a dog that suffers from intercat social anxiety may groom excessively as a displacement behavior. In this situation resolution of the grooming will only occur secondary to resolution of the intercat aggression. Historical information will help to determine if OCD is the correct diagnosis. Feline Psychogenic Alopecia Psychogenic alopecia is described as a the loss of hair secondary to over-grooming that is not related to an underlying medical condition such as pruitis, parasitism, etc. The cat grooms excessively, creating hair loss in areas that it can reach for grooming activity. Stressful events may initiate and maintain this compulsive behavior. Dermatological conditions should always be on the rule out list of abnormal grooming behaviors. A full dermatological work up is indicated when presented with a animal that is showing aberrant grooming behaviors. In a recent presentation by Landsberg examining psychogenic alopecia in cats, the vast majority of cases presented with psychogenic alopecia had an underlying treatable primary dermatological disease that was determined on dermatological screening. And even if the dermatological condition is a secondary condition, it will require aggressive treatment for adequate resolution. A sensory neuropathy may cause mutilation. Sensory neuropathies have fewer cells, degenerative fibers and decreased fiber density of the spinal cord. These animals are thought to mutilate because they have improper feedback associated with their sensory stimuli. Tail chasing: Tail chasing behavior could be associated with pain or discomfort. A rectal exam, anal gland examination and dermatological evaluation should be conducted. In addition, a musculo-skeletal evaluation should be performed to rule out neuropathic or muscular pain. Imaging studies of the tail and lower spinal cord should be performed to identify any contributing lesions. A neurological examination should be performed to identify any central lesions that may contribute to the stereotypic behavior. If no underlying medical issue can be found, it may be considered a compulsive disorder. Feline Wool-Sucking Some cats will present with the complaint of sucking or ingestion of fabric. Oriental breeds are more likely to present with this complaint, Neville and Bradshaw reported 55% of fabric-eating cats were Siamese and 28% were Burmese in a study of 152 cats with the disorder. There does not appear to be an identifiable nutritional deficiency in these cats. The behavior appears to involve stereotypic oral movements. Over 93% of cats with this disorder started with wool as the target in the Neville and Bradshaw study thus resulting in the name "wool-sucking". However, many of these cats generalized to other fabrics including cotton (64%) and synthetics (54%). Some cats will target non-fabric (i.e. plastic). Sex and reproductive status do not appear to be correlated with incidence of the behavior. The role that early weaning plays in the development of this behavior is not clear. While early-weaned kittens appear to be over-represented in this population of fabric-sucking/consumption cats, a causative relationship has not been substantiated in studies. Cats that actually ingest the material are at much greater risk of serious complications, specifically intestinal blockage or owner relinquishment. Management of these cases includes restricting access to target items, providing a high fiber diet, providing other acceptable items to chew (grass, rawhides, jerky), increasing environmental stimulation, decreasing stressors and removing any outside reinforcement for the behavior. Serotonin enhancing drug therapy is indicated for refractory cases. In discussing prognosis of compulsive disorders with clients it is suggested that the clinician focuses on management and remission instead of implying that the animal will be cured. Since many animals experience relapses, especially during times of heightened stress or anxiety, it is important for all involved to have realistic expectations. Family Fueds: Interdog Aggression Introduction When presented with interdog aggression there are two typical scenarios: aggression from a dog targeted at unfamiliar dogs and aggression occurring between known dogs in the same household. Regardless of the scenario, the basic question that needs to be answered in order to arrive at an appropriate treatment plan is whether the dog is behaving normally, and, if not, which dog involved in the conflict is exhibiting the abnormal (ill) behavior, thus requiring treatment. Diagnosis To determine if the dog is behaving normally, the clinician needs to be an astute observer and a good interviewer/listener. The clinician should observe the dog(s) in question. Special attention should be given to the body language of the animals. Is the dog showing signs of overt fear including trembling, ears flattened, crouching, panting, pacing etc. or are there more subtle signs of anxiety such as lip licking and yawning? Or is the dog apparently confident and offensive in its encounters with other dogs? Ideally the owner can present the clinician with a video recording of the dog in its natural setting or the clinician can observe the dog in its natural setting. However, the clinician can still evaluate the dog during a consultation in the veterinary hospital recognizing that many dogs will exhibit some level of anxiety due to the clinical setting. It is also important to observe the sequence of behaviors that a dog exhibits. In normal animals, there is a predictable sequence of events that includes an initiation, a pause and chance for response, an action and a termination. An abnormal or ill animal may leave out some of the steps in a normal behavioral sequence. For example, a normal conflict between two dogs may present as an initial threat such as a growl from one dog to another, then a pause and opportunity for the other dog to respond (growl back or turn away), another action from first dog depending upon response from other dog until there is an end to the interaction. Abnormal dogs typically leave out steps - perhaps instead of giving an initial threat and chance for reply they just attack the other dog. Abnormal dogs may also continue to attack or threaten even when the other dog has given clear signs of deferral; essentially they don't interpret the response properly. During the owner interview it is critical to establish the context during which the aggression occurs since context is vital to establishing normal vs. abnormal (ill) behavior. A dog that gets into a fight with another dog over a valuable food item that neither dog is willing to relinquish may be normal, especially if a normal sequence of behaviors occurs prior to the fight. A dog that suddenly and severely attacks that same dog when it is sleeping is likely abnormal. A dog that lunges at other dogs without any form of communication /interaction is probably abnormal (ill). The intensity of the aggression is another factor that may help the clinician to establish normalcy. Many dog-fights appear to be serious but both dogs walk away without injury. In those scenarios, the dogs are inhibiting their aggression. If the dog inflicts severe injury in a context that doesn't warrant it, that dog is probably ill. For example, if an adult dog seriously wounds a puppy during a correction, that adult dog is probably abnormal (ill) since puppies represent a low threat to an adult dog. Treatment Once the clinician has established if a dog is abnormal (ill), then treatment can be implemented. In most situations of abnormal aggression to unfamiliar dogs, the ill dog has a problem based in fear/anxiety. There may be a clear history to support this; maybe the behavior has only been exhibited since the dog sustained an unpredictable attack from another dog. Or perhaps there is a history of limited socialization to other dogs. Sometimes the behavior of the dog is clearly anxious around other dogs but, more often than not, owners report that their dog initiates an offensive attack on other dogs. Many owners report that their dog only exhibits the problem behavior on leash. That may be explained by the fight or flight response. When fearful, animals will pursue one of the options: fight or flight, if the dog recognizes that its flight option is removed due to leash restriction, the fight option may become its default response. To treat these dogs, a behavioral modification protocol of desensitization and counterconditioning is recommended. First, the problem dog needs to learn to be calm, relaxed and obedient in response to an owner cue without other dogs present. Typically the dogs are trained to sit/watch owner with for gradually increasing periods with gradually increasing distractions. It may be helpful to coach the owners to watch the dogs breathing pattern (regular slow pattern, no panting) and eye focus (watching owner, relaxed gaze) to evaluate the dog's level of relaxation. Other signs such as overall body tenseness and overt signs of aggression are also used to evaluate comfort. The owners are coached NOT to reward anxious/aggressive behavior. They only reward the desired behavioral response - that of a calm, relaxed, obedient dog. The reward used depends upon the dog, but food treats and praise are common rewards. When the dog has achieved success in these exercises without other dogs present, then other dogs are introduced in a gradient fashion. This may include first introducing them to the tape-recorded sounds of other dogs in a volume gradient and eventually progressing to actual dogs using a distance gradient. Ideally the dogs used in training would have low levels of reactivity and be normal. Since you can't assume that dogs will generalize, a variety of dogs may needed to be used in training. Although they should be instructed to avoid eliciting anxiety or aggression, it is important to coach the owners what to do if anxiety/aggression occurs: punishment or comforting is contra-indicated, instead owners should try to expediently remove the dog from the situation and when far enough away, engage the dog in a series of commands. Ancillary tools that may be helpful in the treatment of an anxious dog include a head halter (Gentle Leader), pheromone therapy (DAP, Comfort Zone) and drug therapy. Serotonin enhancing medications such as amitriptyline at 2.2-4.4 mg/kg once daily or clomipramine 1.5-3.0 mg/kg twice daily or fluoxetine 0.5-1.0 mg/kg once daily are typical drugs used to treat anxiety. Complementary therapies such as acupuncture, touch therapy, anxiety wraps and herbal supplements have some anecdotal reports of success. When two dogs in the same household are fighting, dominance or social status issues may be the underlying problem. Although aggression between household dogs can occur at any time, dominance aggression often develops when a new dog is introduced into the household or when one of the dogs in the household reaches social maturity (12-36 months). Other inciting factors may include a change in the social situation or one animal becoming debilitated. Dogs will usually fight over valuable resources including resting spots, toys, food and attention. Well-meaning owners often complicate the problem by trying to enforce equality in the household. Often owners report that the aggression only occurs in their presence indicating that their behavior plays a role in the initiation of the aggressive episodes. When dealing with dominance problems it is important for the owners to understand that canines are pack animals and it is normal for them to develop social hierarchies within the pack. Normal dogs are able to figure out hierarchy with minimal aggression and/or injury. Having everyone live as "equals" is not natural and by forcing this issue, the owners can create serious problems. If the clinician identifies a situation where the owners are creating problems, instruction to owners may resolve the problem. Usually these instructions involve having the owners support the normal, dominant dog with preferential treatment. When an abnormal (ill) dog is involved in the fighting, owner instruction regarding pack hierarchies is not likely to be successful. Complete segregation of the dogs may be necessary to prevent injury. The level of segregation will depend upon the severity of the specific case. Barricades, basket muzzles and tie downs can all be helpful at managing dogs that have serious aggression issues. The dogs can then be introduced gradually in controlled situations. It is important to instruct the owner how to break up a fight if one occurs. Remote methods are advised as inadvertent injuries may occur to humans if they put their hands in the middle of a fight. Some products that may help to break up a fight include canned foghorns, water, cardboard or plywood wedged between the two dogs or a blanket thrown over the dogs. If nothing is available and the owner must separate the fight, pull apart the dogs from the rear quarters, not the collars. Fights should result in social isolation of both dogs in separate locations To treat this problem, it is important to identify triggers for the aggression and try to remove or minimize these triggers, if possible. Then the clinician must identify the normal dog have the owners show support of the normal dog both in general interactions and regarding specific resources that trigger aggression. They may institute a program of desensitization and counterconditioning for the ill dog to teach it how to behave in a relaxed manner in certain situations. Once again, drug therapy, a head halter and pheromone treatment may be helpful in management of an abnormal (ill) dog. Clear structure and a predictable routine with plenty of exercise are imperative for all abnormal (ill) dogs. Canine Housesoiling and Urine Marking Introduction House-soiling problems in dogs can occur at any age but the young and elderly have an increased incidence of problems. The clinician must first gather historical information about the housesoiling problem. Onset, frequency, quantity, location and triggers should all be A wide variety of medical problems can contribute to canine house-soiling including diseases causing polyuria/polydypsia, diseases of the urinary tract, congenital malformations, neurological problems, arthritis or senility. A medical work up should include a thorough physical examination, a urinalysis via cystocentesis, fecal examination. If the presentation warrants, then a full CBC and chemistry panel as well as imaging studies should be performed. After medical problems have been ruled out or addressed the following behavioral problems should be considered. Anxiety related elimination Description When a dog experiences extreme fear, it may urinate, defecate and express its anal sacs. One of the common presenting clinical signs of separation anxiety is elimination when the owners are absent. Other anxieties can also present as elimination related problems including noise phobias, fear of people, fear of certain situations (e.g. veterinary clinic). If fear is the motivating factor for the inappropriate elimination, there should be other signs consistent with fearful behavior such as panting, pacing, avoidance behavior or vocalization. The clinician should try to identify the fear evoking stimuli so that a treatment plan can be established. Treatment The first step of treatment is to identify the anxiety-provoking trigger. Once identified, exposure will need to be avoided unless part of a systematic desensitization program. If the dog doesn't have basic obedience, then teaching sit/stay is the initial step in training. Once the sit/stay is mastered, the owner can work on having the dog sit/stay and pay attention to them with various distractions other than the anxiety-provoking trigger. Owner created distractions such as taking a few steps away from the dog, clapping the hands or doing jumping jacks can be incorporated easily into the sit/stay training in a gradient fashion. The dog is only rewarded for obedient, calm, relaxed behavior. Rewards should include praise and food treats. This foundation work, sans trigger, will help the dog to be successful when the trigger stimulus is introduced. The time spent on this foundation work varies upon dog's background obedience and response but most dogs spend 2-4 weeks on this phase before progressing to the actual trigger stimuli. While implementing this foundation work, it can be helpful to introduce a head collar to the dog. Head collars can help to relax the dog. The owner is also instructed to put the dog on a "nothing in life is free" program - simply asking the dog to do a command prior to giving it any rewards, including attention, treats, food, etc. The next step is to specifically desensitize the dog to the anxiety-provoking stimulus. This is done via systematic desensitization and counterconditioning. The stimulus is presented in a modified version so that the dog doesn't experience the anxiety. The dog is rewarded for remaining calm and relaxed in the presence of this modified stimulus. With success, the intensity of the stimulus is gradually increased until the dog no longer responds with anxiety even when the stimulus is at its full intensity. In some situations, it is impossible to avoid the full-strength stimulus. In these cases it is sometimes necessary to find other means of reducing the dog's anxiety including drug therapy or pheromone treatment. There are two categories of medication that are frequently used in behavior medicine to reduce anxiety: serotonin enhancing medications and benzodiazepine therapy. The serotonin enhancing medications often have a lag phase of 1-4 weeks until results are noted. These medications are usually continued on a daily basis for several months while the owners are implementing the behavioral modification. Examples of serotonin enhancing medications include fluoxetine (Prozac) canine dose 0.5-2.0 mg/kg SID; amitriptyline (Elavil) canine dose 2.2-4.4 mg/kg SID or split BID; clomipramine (Clomicalm) canine dose 1-3 mg/kg BID. The only serotonin enhancing medication licensed for use in the dog is Clomicalm, it is FDA approved to treat separation anxiety. The benzodiazepine drugs (e.g. diazepam, alprazolam) work quickly (30-90 minutes after administration) but are not ideal for long-term use. Often the benzodiazepine drugs are given at the start of the program to help manage severe anxiety until the serotonin enhancing medication has a chance to take effect. Pheromone therapy is available as a plug in diffuser called D.A.P. or ComfortZone. This pheromone is a synthetic analog of the pheromone released by the mammary gland of the lactating bitch when the pups nurse. It is supposed to have a calming effect on the dogs. Placement in the home may reduce anxiety in some dogs. Cognitive Dysfunction Syndrome Description Loss of housetraining can be one of the clinical signs associated with cognitive dysfunction syndrome (senility). These dogs will urinate/defecate in the house, often in front of the owner after a recent outdoor elimination opportunity. Other signs of cognitive dysfunction syndrome include disorientation, change in sleep/wake cycle and a change in social interaction. Treatment Treatment for cognitive dysfunction involves returning to basic housetraining principles (see below). Dietary therapy (diets enriched with anti-oxidants) and drug therapy (Anipryl, 0.5-1.0 mg/kg SID in am) can also help reverse clinical signs and slow progression of this disease. Excitement Urination Description During times of high excitement, such as owners returning home or company entering home, the dog may dribble or squirt small amounts of urine. This behavior is more likely to occur in younger dogs and many outgrow the behavior. Treatment The first step in treating this program is decreasing the level of excitement so you can prevent the undesirable behavior from occurring. This may be something as simple as having the owners avoid emotional greetings. Then the dog can be desensitized to exciting events but exposing the dog in a gradient fashion to the event and rewarding calm/relaxed behavior. The dog is also taught to do an alternative behavior to perform that is incompatible with escalating excitement (e.g. sit, down). In very severe cases, drug therapy that increases urinary sphincter tone may be helpful. Lack or break in housetraining Description A dog that has a lack or a break in housetraining will urinate and/or defecate in the house often regardless of the presence or absence of the owner. Some dogs do learn to avoid eliminating directly in front of the owner due to previous punishment for this behavior. The dog may find the indoor location more readily available or attractive. They will often have a preferred substrate or location for the indoor elimination. Long periods without access to an appropriate elimination spot can contribute to this problem. Inclement weather can also contribute to the development of the problem. Treatment The first step in treatment is to prevent further indoor elimination from occurring. To do this, the owner should institute close supervision or when unable to supervise, the dog may be confined to a den-like area or an area where elimination is appropriate (outside in yard). The dog then needs to be accompanied outside frequently for outdoor elimination opportunities. Initially these may be as frequent as hourly outdoor opportunities. The dog is to be praised for outdoor elimination, if it occurs. With success the time intervals between owner-initiated outings can be gradually increased. When the dog has learned to hold elimination for a period that is typical of owner's longest departure, the owner can then start to relax supervision. When supervision is relaxed, owner initiated outings should be increased in frequency again. This vacillation between frequency of outdoor opportunities and intensity of supervision should continue until the dog can be free in home without soiling. Other treatment suggestions include having the dog on meal feedings and exercising the dog several times per day with a walk to stimulate outdoor elimination. If caught in the act of indoor elimination, the dog can be interrupted with a startling sound. However, if elimination is found after the fact, it should just be cleaned up and no punishment should be given. Submissive urination Description In an attempt to communicate a submissive status to a person, usually associated with a greeting or a reprimand, the dog may urinate. The dog exhibits other body postures that convey submission including ears back, avoidance of eye contact and cowering or rolling over. Submissive urination is more common in young female dogs. Most dogs outgrow this behavior by a year of age. Treatment Owners/people that trigger the behavior should be instructed in techniques to appear less threatening to the dog. This may include having them kneel down, avert gaze, pet under chest instead of overhead or they may need to ignore the dog for a few minutes upon arrival. Owners can engage dog in another activity incompatible with urinating when submissive urination is likely for example on greeting instead of petting the dog, toss a ball for the dog. If the dog only submissively urinates during a correction, toning down or completely avoiding the interactive correction should eradicate the behavior. Owners should be counseled that any type of correction given during the act of submissive urination is only likely to escalate the problem, not inhibit it. In cases that are resistant to behavioral modification, use of alpha-adrenergic medications that increase urinary sphincter tone may be helpful. Urine marking Description Urine marking involves small quantities of urine usually deposited vertically on socially significant targets. Urine marking occurs despite adequate access to the outdoors. Triggers for marking behaviors may include addition of another pet, female dog in estrous, new item or person in household. Sexually mature, non-castrated male dogs are most likely to engage in urine marking behavior. Treatment Neutering is the first treatment suggestion for urine marking dogs since 80-90% of dogs stop urine marking when neutered. If urine marking persists post -neutering, then owners must try to identify any stimuli that trigger urine marking and remove them from the environment of the dog. If interdog aggression or other behavioral problem is contributing to the marking, the underlying problem may need to be addressed in order to resolve the marking. Sometimes anxiolytic medication can reduce urine marking: fluoxetine (Prozac) canine dose 0.5-2.0 mg/kg SID; amitriptyline (Elavil) canine dose 2.2-4.4 mg/kg SID or split BID; clomipramine (Clomicalm) canine dose 1-3 mg/kg BID. | |||||||||||||||||||||||||||||||||||||||||||||
