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Behavior Soraya V. Juarbe-Diaz, DVM, DACVB, CAAB Tampa, Florida Practical Veterinary Behavior Medicine - The Short Form Veterinary behavior medicine is a broad field that encompasses knowledge of normal and abnormal i.e. pathologic) animal behavior, learning principles and theory, neurophysiology, psychopharmacology, animal welfare and the effects that diseases can have on any of the above. Unfortunately, there is great variability among veterinary schools' offerings in veterinary behavior medicine. Veterinarians interested in veterinary behavior medicine are mostly left to their own devices. Because of this, each attendee will come to this 6 hr. program with a different knowledge baseline. An attempt has been made to accommodate all levels of expertise and resources are given for those who would like a more in-depth coverage of a variety of topics. Basics of Social Signaling Signaling is an effective way to give information about intent and emotional state in a way that allows for resolution of conflict with minimal cost to those involved. Two basic types of social signaling occur: agonistic and affiliative. Agonistic behaviors increase the distance between the participants while affiliative behaviors decrease it. Agonistic behaviors include both offensive and defensive moves, as either would accomplish an increased distance between the participants. The gestures may be overt or subtle, but they are always meaningfully performed. The family Canidae evolved behaviors that supported and maintained group functioning. They live in groups composed of related individuals with a few added members and cooperate in hunting, territorial defense and the raising of young. The parallel with human social structure made for a great fit together. Canidae interactions are based on ritualized forms of deferential behavior and its acceptance as a way of resolving conflict, defusing threats, inhibiting aggression and preventing injury. Dogs have been domesticated for over 135,000 years, making dogs as separate a species from wolves as we are from chimpanzees, even though they are our closest relatives. Modeling dog behavior strictly upon wolf behavior is about as enlightened as modeling our own after chimpanzee behavior. In addition, modeling the human-dog interaction after the dog-dog interaction would be as equal a fallacy. Agonistic and affiliative behaviors can occur in a variety of contexts, including social, maternal, sexual and territorial scenarios. In the context of a veterinary visit, the interactions could elicit a social or a fight/flight response, largely based on the patient's genetic behavioral make-up, its experiences and training but, just as importantly, our behaviors and the triggers and experiental stimuli we provide. Canine & Feline Behavioral Profiling What exactly constitutes a normal "temperament" has never been defined in the literature. Broad generalizations can be made but they constitute subjective categorizations. The degree of behavioral normalcy is predicated on how adaptive the responses are to the environment and situations experienced by the individual. It is normal to try to avoid extreme pain and stress, but there are also physiological mechanisms for adaptation to mild or short-lived pain and stress. The question arises: when does this lack of adaptability become pathologic? This is a more difficult question to answer, but extreme panic responses would fit in this category. Tonic immobility, a seeming state of motor paralysis, or extreme escape and panic behaviors with attendant sympathetic symptomatology in response to minor stimuli would not be difficult to identify as pathologic. Impulsive displays of aggression, bites that are not preceded by ritualistic signaling or threats and are excessive in their degree, such as multiple bites, would be easy to qualify as pathology. At what point behaviors cross this invisible line is difficult to establish because all the components of the experience (environment, trigger and the individuals involved) must be analyzed together and no objective measures currently exist to do so. Just as we have dogs that can adapt to stressful situations, our domestic cat is capable of some habituation to unpleasant events, however, a wider range of agonistic behaviors in the face of aversive stimuli may be normal for the domestic cat at this time. Felis Life Template Cats evolved from a different social system than dogs. Their domestication was mostly by passive association though clearly a symbiotic relationship developed: cats provided rodent control which ensured that grain stores were not destroyed by vermin and thus remained available for human consumption. Experts now agree that the cat's ancestor is the African wild cat (Felis silvestris lybica) which is a species that can form social groups if the environmental resources permit it. Because the cat's phenotype has seen less manipulation through breeding than that of dogs, similarly their behavior is more homogenous across the different breeds and may be closer to that of its wild ancestor. Even so, some degree of genetic manipulation does exist (consider breeds such as the Sphynx, American Curl, Munchkin and Scottish fold) and some have targeted not just the physical phenotype but the behavioral one as well (Maine Coon cat, Ragdoll, Ocicat.) Recent work by the behavioral group at the University of Georgia's College of Veterinary Medicine, led by Dr. Sharon Crowell-Davis, is revamping the notions we have had about domestic house cat behavior. Although more subtle in their nature, we have made changes in cat behavior as well. Communication in Dogs Social interactions between dogs follow consistent patterns. There are rituals for both greeting and conflict resolution and physical harm is not a part of either. There are a number of deferential behaviors that defuse emotionally loaded exchanges by signaling "no harm" intent on the part of the signal sender. Based on poorly collected and interpreted wolf data, a number of myths have achieved the status of "well-known fact" such as that of a hierarchy being linear and rigid and maintained by overt and physical aggressive acts. The true state of affairs in most social species is that hierarchy is established and maintained mostly with aggressive displays and low level threats and that subordinate members exhibit appeasement and deferential displays spontaneously or in response to threats. Humans, in error… assume all aggressive episodes have the same motivation and lump them into one single category think they need to "prove their alpha status" by physical means that inflict pain or fear (rationalizing it with a myriad excuses) or exacerbate the aggression read appeasement gestures as evidence of "guilt" on their dogs' part The alpha-roll is a man-made behavior that could be the most damaging bit of dog "training technique" ever to achieve cult credibility. It probably has done the most damage to the human-dog relationship, provoked the most number of dog bites of anything man has done to "his best friend" for the sake of being its "master," and led to the needless euthanasia of dogs. A dog would only pin another dog thus if it intended to kill it, so the message dogs have been likely receiving is that the person is trying to do the same. Assessing Your Patient's Body Talk Regardless of our ability to precisely categorize when a behavior becomes pathologic, assessing emotional and arousal states by reading body language is an important skill that needs to be developed. Uncertainty and ambivalence are indicated by indirect eye contact, lip licking and restlessness. Body postures that decrease the body outline indicate a desire to avoid social interaction. Sympathetic arousal and fear activation can lead to a stiff body posture, elimination, hypervigilance (constant scanning of the environment,) an easily triggered startle response, and agonistic threats. The position of the ears, tail and back, piloerection, mydriasis, dalivation and distress vocalizations convey the emotiona; state of your patient. Pupil size is a very reliable indicator of sympathetic arousal, however, it can change quickly and is sometimes difficult to assess at a distance particularly in animals with dark irises. It should be noted that hissing and spitting in cats signal defensive aggression. Patient Handling Pheromone analogs have been developed that mimic the actions of naturally appeasing pheromones in the domestic dog and cat. D.A.P ®. (Dog Appeasement Pheromone) is an analogue of the pheromone produced by intermammary glands in the ventral midline of the bitch and secreted by the bitch as she nurses her puppies. Two fractions of feline facial pheromonal have been isolated. Feliway® is an analogue of the F3 fraction used in marking objects while Felifriend® (available in Europe but not in the United States) is the F4 fraction used in allogrooming for marking of conspecifics or preferred social associates. Anecdotal reports and unpublished data suggest that D.A.P.® and Feliway® can be used to decrease low to mid grade stress in places such as the examination room, in patient wards and runs, and travel carriers. Feliway® can be sprayed on table surfaces to facilitate examination, radiography and ultrasound procedures. Spraying Feliway® on your doctor's coat sleeves may prove ineffective as the F3 fraction does not carry a social message although some veterinarians feel it helps. The electric diffuser versions of both Feliway® and DAP® are available over the counter as "Comfort Zone." Safety and Protection Because of the nature of our profession, we encounter dangerous situations from time to time. I say dangerous situations because I would like you to reconsider the blanket labels of vicious dog or mean cat. Ask yourself whether you are vicious or mean and what you would do in a similar circumstance. Our patients are mostly scared, in addition to painful in some cases, and pushed into self-defense mode. Hospitalized patients are in a strange environment, with strange noises, smells, people and other animals, away from their familiar humans and not feeling on top of the aforementioned stressors. Compassionate care, a new buzz phrase in veterinary medicine, should not neglect the mental well-being of our patients. Muzzle use is sometimes necessary to protect the veterinary staff from injury while trying to provide medical care. Traditionally, cloth and leather muzzles have been used in veterinary hospitals. While they serve the single purpose of allowing procedures to be performed without harm to the humans involved, consider the potential effect in your patients. There is no data showing the degree of stress that muzzling produces. Muzzled dogs can show a number of behaviors including continued struggling, attempts at muzzle removal or tonic immobility. How many dogs eventually habituate is not known. As it restrains the mouth, which is used for signaling, defensive and offensive aggression, inhibition of the dog's ability to use it for conflict-resolution strategies may increase anxiety and force it to use alternative coping mechanisms. They included heightened attempts to get away, attempts at muzzle removal, urination, defecation or anal sac expression as more urgent signaling of fear and panic or tonic immobility due to a state of leaned helplessness. Compliance or interruption of a behavior does not equal obedience or acceptance. Vinyl basket muzzles still protect staff, likely do not exacerbate anxiety, allow for evaluation of the mucous membrane color, are safer for brachycepahlic breeds and allow for rewards for good behavior is the dog is food motivated. If the owners desensitize their dog to wearing the basket muzzle and pair its use with a pleasant reward, the dog's attention can be redirected while the veterinary staff goes about its business. They come in different sizes, including those that fit "square-muzzled" dogs like Staffordshire terriers and similar breeds. They can be obtained form www.upco.com, www.petedge.com, and www.campbellpet.com Cats are easier to trigger into a fight or flight response. The effects of devices such as cat bags and muzzles also have not been studied and may also increase stress in some of our feline patients. Remember, tonic immobility is an extreme response to an inescapable aversive stimulus or situation: though you can carry out your procedure "successfully," you are compromising welfare and in cats, could lead to falsely elevated serum glucose levels secondary to cortisol and epinephrine release. If glucose is the parameter you are interested in, you've just invalidated your test results. The effects of situational stress on the feline leukogram have not been studied, but given that endogenous cortisol has effects on neutrophils and lymphocytes, it would be difficult to interpret a stress leukogram with precision (is it disease or is it handling stress?) A reduction in visual stimulation anecdotally decreases physical activity. Observation of the respiratory rate and heart rate are easy ways to determine if sympathetic activation is decreasing and if the reduction in visual input is indeed helping your patient. Cat muzzles that cover the eyes may work in a similar way although they also restrict mandibular movement which the Calming Cap® does not do. In a recent study (Kronen PW, et al, Vet Anaesth Analg. 2006 Jul;33(4):258-65 ) Feliway®) it was shown that Feliway® exposure had an additional calming effect in cats given acepromazine and, to a lesser degree, helped to calm cats that were not given acepromazine prior to venous catheterization prior to an anesthetic procedure. Handling the Fearful Patient Handling animals is a skill that you need to develop for the sake of your and your staff's safety and for the safety and mental well-being of your patient. Enter the examination room slowly and avoid direct eye contact. Let them habituate to your presence by taking the first few minutes gathering the history from the owner. After assessing the overall message that the body language conveys, let the pet start the social interaction by offering a closed fist for the pet to sniff. Start with the least intrusive areas (the back of the body in dogs and some cats) for your initial exam. Taking breaks from handling to write notes on the record serve as a reward for tolerating the exam. Cats have specific areas that they offer for greeting. The underside of the chin is the most "public" place to rub in greeting; the area above the eye ridge is more intimate (think of a hug vs. a hand shake) and finally, the tail base area, when presented, indicates a degree of comfort with the social interaction. Pets that are very comfortable will offer interactions voluntarily. In a study from Texas A&M University that studied pigs' response to forced handling procedures it was found that some pigs never habituated to a forced swimming task. Forcing procedures when fear is present risks teaching your patients to fear you. In dogs predisposed to anxiety disorders you risk triggering phobias or very long-lasting effects specific to hospital visits or handling procedures. Finally, owners can react negatively to the experience and may judge your clinical competence on your table-side manners rather than your clinical expertise. Ask yourself: What will hurt your patient more, leaving without a nail trim or leaving with an enduring fear of being handled by you? Desensitization to exam and routine procedures in anticipation of veterinary visits will save you time and the owners and their pets hardship and unpleasant experiences. This includes wearing a plastic basket muzzle as a safety measure while the dog is desensitized to veterinary procedures. Many dogs can have their attention redirected to pleasant events during procedures with food, toy or attention used as rewards. Steady pressure delivered via the "Hug Box" is successfully used to assist in the treatment of the body tension and anxiety that many people with autism suffer from. Developed by Temple Grandin, an associate professor of animal science at Colorado State University, it is a device that applies deep pressure to the body and serves to destress people. Similar effects may be achieved with the use of blankets and hugging. Small dogs and some cats can be held in arms to provide this supportive contact. The hold should be steady and firm without being restrictive. When restraint is needed, less is more, letting the animal feel that he is not trapped. Jugular venipuncture in a large number of cats can be achieved with no restraint by using one hand to hold the head up with the index finder while occluding the vein with the thumb. The other hand manipulates the syringe. Using high quality, sharp needles is essential - it should slide through the cervical skin with minimal pressure. Practice with calm cats first, until your confidence builds and you believe in yourself and the technique. If anxiety or aggressive threats ensue, STOP, and move in to chemical restraint. You can either spend the time doing the desensitization or dealing an uncooperative patient or the aftermath of a bite. Physical restraint is time consuming and ties up staff that could be carrying out more important tasks. It also puts people at risk. If a client gets injured you risk a lawsuit. If a staff member is injured your losses will include decreased manpower and time spent handling accident reports, insurance claims and the psychological blow it delivers to the remaining staff and the bite victim. Even a mentally stable dog or cat can learn fear from repeated exposure to situations that are painful or feel threatening. Once fear escalates, the release of cortisol and epinephrine has profound effects on learning and memory. Sensitization, were repeated exposure to an aversive stimulus leads to an increase in the fear response, rather than habituation (decreased response over time,) is not an uncommon result of forcing procedures on scared and frightened patients. By putting them in a position were defense seems to be their only option, we are doing them a disservice. If hospitals manhandled human patients the way we manhandle our animal patients, criminal charges would be brought against the staff and administrators. While some breeds are now anecdotally associated with fearful behavior, fear-biting and excessively anxious responses, fear is an adaptive normal behavior that can be present in any individual. Remember also that pain and fear thresholds will vary and are under neurophysiological control. To label anyone, human or animal, with terms such as "weenie," "chicken" or "wuss" for their inability to meet some standard of tolerance to aversive situations or feelings undermine our capacity for compassion and for objectively evaluating their welfare needs. The Argument FOR Chemical Restraint Short acting anesthesia provides amnesia (and no learning of fear,) minimize the risk of injury and save time and money. Having to repeat radiographs because films are not of diagnostic quality because of an "uncooperative" patient takes more time, increases exposure to X-rays, stresses the support staff and the veterinarian as well: you need the results as quickly as possible and your technicians have other things to do. If you wait until your patient is sympathetically aroused you it will take longer to bring the anxiety response under control. Catecholamine release also increases the chances of anesthetic complications. It is remarkable how complacent and comfortable we become in our behavior patterns due to habit. In the human psychiatric field, where people can become violent and dangerous to staff due to their disease, and patients have little control over what happens to them while in an altered state, an effort has begun over the last 10 to 15 years to change the attitudes and practices of staff. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment of Punishment has made changes in international recommendations restricting the use of seclusion and restraint to exceptional cases where there are no other means of remedying the situation. Yet staff at psychiatric wards and hospitals regard these methods as acceptable patient-management strategy (Steele RL. Staff attitudes toward seclusion and restraint: anything new? Perspect Psychiatr Care 1993; 29:23-28.) When patients were surveyed, they preferred medication over seclusion and restraint. (Sheline Y, Nelson T. Patient choice: deciding between psychotropic medication and physical restraints in an emergency. Bull Am Acad Psychiatry Law 1993; 21:321-329.) Seclusion and restraint have been shown to negatively affect both patients and staff, and was deemed an unsafe procedure (Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraints Can J Psychiatry 2003; 48:330-337.) It may precipitate aggression, model aggressive ways of interacting with others or reinforce aggression (Dafern M, Howells K. Psychiatric inpatient aggression. A review of structural and functional assessment approaches. Aggression Violent Behav 2002; 7:477-497.) Little rigorous evidence in favor of the widespread use of control and restraint techniques in the management of violence (Wright S. Control and restraint techniques in the management of violence in inpatient psychiatry: a critical review. Med Sci Law 2003; 43:31-38 Chemical restraint in cats can be achieved via gas anesthesia. Sevofluorane and even isofluorane administered in a gas tank then facial mask provide fast induction and recovery. Their use allows for a thorough exam and sample collection that take less time because the body is relaxed, facilitating all aspects of the examination. Recovery is fast as well. Cats should be monitored as is routine for anesthesia; pulse oximeters make this task easy along with auscultation, mucus membrane evaluation and palpebral reflex assessment. Endotracheal tubes, intravenous fluid set-up and crash carts can be kept near at hand should an emergency arise. If injectable agents are used for sedation, care should be taken in their choice. Dissociative anesthetics do not provide anxiety relief and only selective analgesia of superficial vs. visceral pain. Telazol,® a patented mixture in a 1:1 ratio of ketamine and zolazepam, or a combination ketamine and midazolam, would achieve amnesia and both muscle relaxation and anxiolysis. Zolazepam and midazolam are both water soluble benzodiazepines that are not as painful as diazepam upon IM injection. If a particularly painful procedure must be performed, analgesia must be provided as well. Dosages are 0.2-0.4 mg/kg IV for midazolam and 2-8 mg/kg IV for Telazol.® In dogs, where the use of gas anesthesia for short term restraint may not be cost effective except for the smallest of dogs, Domitor® alone or with Torbugesic-SA,® at a dose of 0.01 mg/kg and 0.1-0.2 mg/kg respectively, given intravenously or 0.02 mg/kg and 0.2-0.4 mg/kg respectively, given intramuscularly, are good combinations where bradycardia is not a concern. The Domitor® portion can be reversed with Antisedan® allowing the dog to walk out of the clinic alert. In Muir, et al, Handbook of Veterinary Anesthesia, 4th ed. (2007) Telazol® use is recommended for restraint at a dose of 2-10 mg/kg IM or IV. For difficult dogs, the recommendation is to add 1 mg/ml medetomidine to a 5 ml Telazol® bottle. The dose of this combination is 0.1 ml per 5-10 kg IM. It is a particularly appealing mixture because tiletamine is an amnesic agent, zolazepam is a muscle relaxant and has anxiolytic properties and medetomidine provides analgesia. For the next visit, fearful patients can be premedicated with a benzodiazepine. Acepromazine has no anxiolytic properties and it is common for animals to "fight" its effect during the hospital visit due to sympathetic activation only to "pass out" at home, much to the owners' distress. Dogs or cats on acepromazine can still startle in response to environmental stimuli, particularly in response to noises, and aggression can be exacerbated under its influence. Oxazepam is dosed at 0.04-0.5 mg/kg Q6H PO in the dog and 0.2-1.0 mg/kg q12-24H PO in the cat. Alprazolam is dosed at 0.02-0.1 mg/kg Q6-8H PO in the dog and 0.0125-0.25 mg/kg Q8H PO in the cat. They must be given before any anticipatory anxiety develops. They are not indicated in cases of impulsive aggression. Chemical Restraint Summary
Desensitization, discussed later, is preferably performed while the pet is not medicated with benzodiazepines, who can lead to state dependent learning, although both oxazepam and alprazolam are taken by people with profound anxiety without impairment in everyday life. In Hospital Care Hospitalized patients have the additional stress of staying in a strange environment along with any physical discomfort that they may be feeling. Recent changes in our awareness of pain and pain management have improved our attitude toward this important aspect of patient care. Some of the physiological effects of mental distress are not unlike those generated by pain. Epinephrine and cortisol exert their effects regardless of the trigger that stimulates their release into the bloodstream. Gluconeogenesis via glycogen, fatty acid and protein catabolism and humoral immune system depression are consequences of cortisol and epinephrine increases. Consider assigning a staff member to evaluate mental status on all hospitalized patients. This assessment takes but a few minutes per patient and can be used to check on the condition of catheters, infusion rates, transdermal medication patches, bandages, pain, and cage cleanliness. With respect to anxiety, signs can include avoidance of eye contact or hiding, non-responsiveness to surrounding stimuli, stereotypical lip-licking that is mechanical and invariant in its features, and partial or complete anorexia. Vocalizations of any kind are a communication effort on the animal's part, but very often veterinary staff sees it as a nuisance or annoying behavior and becomes callous in their response to it. This is a disturbing observation that I make in most hospitals I visit. It a human patient vocalized in a similar fashion, and if that patient was you, how would you feel if your efforts were ignored, or worse yet, if you were punished for the? Frequency, pitch, pattern, duration all give clues to the reason for the vocal display. Most people can identify distress when they hear it: these vocalizations are high pitched, show little variability in their pattern and will go on until the need is addressed. Sometimes, just decreasing visual stimuli by covering the cage door or moving the patient to a quieter area is sufficient; if not, you need to explore the root cause - pain or distress - and you need to do something about it besides yelling, striking the cage door or squirting the patient with water. Remember to slow down during animal interactions, unexpected fast movements raise an alarm even in humans. Because we typically approach animals in cages to deliver an unpleasant, albeit necessary, procedure, occasionally visiting for the sake of a visit helps prevent animals from associating veterinary staff with strictly negative experiences. Although many hospitals discourage the owners from provide familiar items, if you warn the owners in advance that items may get misplaced, many will agree to take the small risk if means the pet will receive form comfort from the familiar object. Provide a hiding box with bedding for cats will encourage them to use it to hide instead of using the litter box to lie in. Clear or opaque plastic containers are easy to disinfect. Alternatively, you could mark a cardboard box with the patient's name that can still be recycled at the end of the patient's stay provided it is not soiled. Finally, stop your staff form pushing patients or dragging them with a leash. They are scared, not stubborn or trying to make your work day a miserable one by making you fall behind schedule. The popular slip leashes used in hospitals do not have a built in stop that prevents choking and occlusion of the jugular veins. Using fear or pain to comply with your wishes is anathema. A recent study published in JAAHA looking at the effects on intraocular pressure (IOP) in dogs of brachycephalic breeds pulling against regular buckle collars showed a statistically significant increase in IOP and recommended the use of harnesses in breeds susceptible to glaucoma or with thin or weak cornea. (Pauli, AM et al, Effects of the Application of Neck Pressure by a Collar or Harness on Intraocular Pressure in Dogs J Am Anim Hosp Assoc 2006; 42:207-211)) Long Term Strategy The owners need to understand why extreme fear or aggression are problems that should be addressed: you might be unable to treat a pet in need of attention and once the dog or cat is in fight or flight mode, some test results may be affected and there are increased risks for anesthesia. Desensitization to visits to the hospital, where the pet is brought to the hospital, exposed to the lowest level of stress inducing stimulus it can tolerate, then rewarded for staying calm, can be practiced before the next visit is due. Over time, the degree of difficulty is increased. So the dog may first sit in the parking lot before he is taken home. When he can master that low level trigger, he can be brought through the door into the waiting room, eventually on the scale, the exam room, the table, and so on. In cats, desensitization may be more difficult if an appropriate reward can't be identified. Most trained cats that you see were rewarded with food. If the cat will not accept food, habituation is more likely occur than desensitization. Head halters, such as the Gentle Leader,® can have a calming influence on mildly anxious dogs and they also give a stop signal that mimics the one given by mother dogs to their puppies. Enhancing Behavioral Services in Your Practice Puppy and kitten classes create a win-win situation. If held at your facility, you accustom juvenile pets to your practice and balance out the injection and thermometer experiences with play sessions and rewards. Along with behavior and training, you cover general care and wellness recommendations. They also are a great way to showcase your practice's offerings. Offering pre-purchase counseling helps avoid poor owner-pet fits by making sure the potential owners have realistic expectations about their chosen pet. One area where both human and veterinary medicine could improve the most in is in behavioral health screening. Quick and simple questions can be asked by questionnaire while the owners wait in the reception area or the examination room, or directly when the history is taken. For each developmental stage, the following topics can be addressed: Juvenile period - house breaking, toys and play behavior, crate and obedience training, mouthing Social maturity - changes in social interactions (with people, dogs or other animals,) development of any aggression (growling, snapping, biting) or fear, any other unusual behaviors. Middle age - any behavior that the pet did not first develop during its social maturity stage Senior patients - age-related changes (varied) The best way to ensure healthy behavior services become a part of your practice is to have a dedicated staff member, one who has previous experience or enthusiastic interest for the project. Tackling Behavior Problems Unlearning can take longer than learning in some cases, particularly where fear is involved, so preventing unwanted or unpleasant behaviors is best. After problem develops, early detection and treatment, as with many disease processes, improves prognosis and the likelihood of a successful outcome. Learning is a chemical process at the cellular and molecular level; with repeated stimulation of the same neural pathway there is an increased number of presynaptic butons, Increased synaptic efficiency, Increased release of neurotransmitter and Increased receptor sensitivity. At the molecular level, learning requires gene expression and protein synthesis and therefore requires time. Medication does NOT cause learning, it facilitates acquisition of by attempting to restore normal synaptic interaction when there is a deficit. Normal patients will derive no benefit (no "smart pill.") Behavior modification is necessary for the patient to learn what the desired behaviors are. Finally, as with all medical disorders, you must have a diagnosis before choosing medication for treatment. Diagnosing Behavior Problems First, determine if the behavior is Normal or Abnormal. This means that you need to know what normal behaviors are and must learn them for each species, for each life stage and what selection pressures we placed when we created breeds. Signs such as growling, snapping, biting, hissing, shaking/trembling, "destructive" behavior, urinating or defecating in the house are non-specific signs, as much of a diagnosis as fever or limping would be. Obtaining a Diagnosis means you must get a thorough history. Besides observing the pet, it is helpful to get a video recording of the behavior. After history taking, determine differential diagnoses, then formulate a treatment plan. One problem that veterinary behavior medicine suffers form is a lack of uniformity in diagnostic terminology. Various authors use different criteria, particularly for the diagnosis of aggression. When managing behavior problems in your practice, don't cave in to owner-pressure to give a pill "to calm him down" or "take the edge off." Schedule the time to properly evaluate and diagnose the problem. Get a thorough history with a description, not an interpretation, of the episodes. This means the triggers and victims of the behavior, the emotional state of all those involved and any inciting or contributing factors. Consider the pet's medical history, including any medications the pet is on. Some common medical rule-outs for inappropriate urination include cystitis, crystalluria, cystic calculi, Idiopathic cystitis-like syndrome, DM and Cushing's disease. For inappropriate defecation, constipation and obstipation are common inciting factors. Feline hyperaesthesia is a syndrome with signs going from mild (excessive skin rippling) to wild (self-mutilation.) The cat may vocalize and run as if escaping from threat. Some owners may think their cat has been poisoned, is having a seizure or is "possessed. In cases of aggression, pain, thyroid disease or other disorders of the central nervous system must be ruled out. A number of veterinary behaviorists, myself included, believe that abnormal aggression is anxiety-based, due to poor impulse control and in a few cases, due to a unknown medical etiology. Canine Hypothyroidism (there is difficulty & controversy in its diagnosis):
Cognitive Dysfunction Canine and feline syndromes recognized
Feline House Soiling: Identify any location or substrate preferences or aversions
Thunderstorm/Noise Phobia
In noise phobia, noises trigger panic behaviors Separation Anxiety and Thunderstorm phobia treatments General Treatment Guidelines
Acral Lick Dermatitis
No hard and fast "rules"
If You Use Drugs
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