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An Urban Experience
would cause medication choices to be limited?
While it is impossible to predict how diligently a
particular client will implement the behavior modification and management changes, certain factors can be considered when assessing the adequacy of a particular environment. Veterinarians should consider the presence of young children, the number of caretakers in the house, the number of hours that the dog has to be left alone during the day and the owner’s willingness to participate. If the household is clearly deficit in the qualities needed for a positive outcome, medication should be strongly considered as a part of the treatment plan.
The latency to arousal is the amount of time that it takes for the animal to mount a stress response once the owner has started her morning routine. For example,
if the dog begins to show signs of stress when the owner picks up her keys, the dog has a long latency
to arousal. If the dog shows signs of stress when the owner’s alarm goes off or when she takes a shower (early in the departure sequence) she has a short latency to arousal. Dogs with a short latency to arousal should be considered candidates for treatment with at least one pharmaceutical.
Behavior problems can significantly affect an animal’s quality of life. Daily panic attacks contribute to chronic stress which can cause various sequelae including suppression of the immune system and muscle wasting. If the animal’s stress reaction is intense on a daily basis, a pharmaceutical should be considered as a part of the treatment plan.
The assessment of risk to the patient is dependent on owner attitude toward the patient and the problem as well as the strength of the human animal bond. Because the signs of separation anxiety frequently include damage to the owner’s property and the injury to the pet, it is not uncommon for owners to approach their veterinarian about euthanasia. If the owner is considering euthanasia or if the pet is causing injury to herself, a pharmaceutical should be considered for the patient.
Predictable behaviors can often be treated with PRN pharmaceutical whereas unpredictable behaviors or behaviors where the stimulus cannot be controlled are more likely to need a daily administered maintenance medication and/or an as needed medication.
The veterinarian should attempt to characterize behaviors as mild moderate or severe. There is no validated scale which can be used to classify the severity of behaviors however generally the veterinarian should consider whether or not the patient has injured itself, the strength of the physiologic reaction which accompanies the behavior and the owner’s stress level.
Patient’s whose owners can’t premedicate for departures or who have concurrent behavioral diagnoses will most
likely need long term and PRN pharmaceutical treatment. Patients who are mildly affected or who have concurrent medical diseases may be better served through the use of supplements instead of medications. The choice of
an individual supplement or medication should be made based on the clinical signs of the patient. For example, if the patient is withdrawn and will not eat while the owner is gone, a benzodiazepine which will increase appetite, decrease anxiety and elevate mood while offering mild sedation or Zylkene® may be the best choice. On the other hand if the patient is frantic, panting and pacing, raiding the garbage, trazodone or Solliquin® may be the most successful pharmaceutical treatment.
Once the decision of whether or not to institute medical treatment has been made, the veterinarian should prescribe behavior modification and management changes. The standard of care for veterinary behavioral medicine is to prescribe behavior modification for behavioral diseases.
First appointment management changes include: leaving the dog with food toys, hiding departure cues from
the dog, discontinuing all punishment and making the owner’s departure and return non events. Many dogs
with separation related disorders are best treated without confinement due to the likelihood of confinement anxiety. Finally, offer day boarding or daycare until the dog is stable.
An appointment should be made within 7 days for behavioral treatments. These treatments are generally conducted by the technician and include: adding structure to the owner/dog relationship, rewarding
the dog when he is relaxed and stopping all physical punishment. Make sure to address any safety issues and ask the owner if the dog is showing any aggression toward the family
The second appointment should be scheduled
about one month after the initial appointment. At this appointment, additional history should be gathered, progress and the affect of medications can be assessed and second level behavior modification should be recommended. At this time, medication changes can be made as well. During this appointment, the technician will become indispensible, as she will be teaching the client how to complete the behavior modification. Second
line behavior modification includes techniques that are best completed when the dog’s anxiety has started to subside. These include uncoupling departure cues and relaxation techniques.
A third appointment should be scheduled 8-12 weeks from the first appointment. At this appointment, gradual departures can be added if needed and the effect of the daily-administered medication (if prescribed) can
be assessed completely. At this time, any changes to medication doses can be made and a more accurate prognosis can be given to the owner.

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