Animal Behavior Case of the Month

Christine D. Calder 1Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762.

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Statement of the Problem

A service dog was evaluated because of a sudden refusal to enter certain public venues while working; a history of attempts to escape followed by barking, panting, trembling, and pacing when left at home; and a history of attempts to escape, panting, and hiding during thunderstorms or at the sound of distant gunshots.

Signalment

The patient was a healthy 44.5-kg (97.9-lb) neutered male Golden Retriever service dog approximately 5 years of age.

History

The dog had been obtained from a breeder at 9 weeks of age with the intent that it would be trained as a service dog for the female owner. According to the owners, noise phobias were not reported in dogs of the same bloodline. Since approximately 1 year of age, the dog had reacted to the sound of distant gunshots and to thunderstorms by pacing, panting, and hiding or seeking out the male owner. Nine months before the behavioral consultation, the dog had been resting at the female owner's feet in the audience during a police ceremony when a 21-gun salute was performed. The dog immediately jumped up and ran onto the stage to seek out the male owner, who was participating in the ceremony. The owners reported that the dog's fearful behavior in response to a variety of noises had intensified since that incident when it was performing service dog duties and when it was off duty.

Four months before the initial consultation, the owners and dog had been in a church sanctuary when the pastor clapped his hands loudly during a sermon. The dog had been asleep under the pew, and it immediately stood up and started panting heavily, with its pupils dilated and ears back. The owners were sitting in the middle of a pew and could not leave until the service ended. They indicated that since that time, the dog would not enter the church willingly and would not enter the sanctuary if brought through the church entryway. Over the past 2 months, the dog had begun to halt and show reluctance to move (described as freezing) at various store entrances, at some locations within those stores, and at various restaurants; all these sites had previously been frequented by the dog and owner for approximately 3 years without incident.

Other concerns were related to the dog's behavior when it was left at home. Two years before the initial behavioral consultation, the female owner found that on the rare occasions when she tried to leave the dog alone in the house, it would attempt to push through the door behind her and then bark, pant, and pace until she returned. This behavior also occurred if the male owner was at home, although he could redirect the dog by calling its name and cueing it to come to him on most occasions after the female owner had left the house. A few weeks before this visit, the dog had refused to enter a restaurant with the owners, and the male owner had taken it home. After entering the house, the dog had barked, paced, and panted until the female owner returned. A canine pheromone diffuser, a commercial pressure vest, a dilute flower extract solution, noise-reducing earmuffs designed for dogs, melatonin, and l-theanine chews were purchased and had been used without a noticeable change in the dog's behavior.

Physical Examination Findings and Laboratory Results

The dog entered the hospital through large automatic doors and walked into the consultation room without showing signs of reluctance. Both owners were present at each visit. Physical examination revealed a broken right maxillary third incisor tooth with no other abnormalities. Initially, the dog's pupils were dilated, its ears were back, and it was panting, but it readily responded to and performed behaviors cued by the owner. The cues were positively reinforced with treats brought from home. Approximately 30 minutes after the appointment began, the dog lay down on the floor with its head down and appeared relaxed. A CBC, measurement of serum antibody titers to assess vaccination status, and serum biochemical analysis including total and free thyroxine concentrations had been performed by the referring veterinarian the previous week. There were no clinically relevant abnormalities in the results.

Diagnosis

Refusal to enter familiar public venues was attributed to noise-related anxiety, and signs of fear in response to thunderstorms and gunshots were indicative of noise phobia. Phobia, anxiety, and fear can have different characteristics, although they have clinical signs in common.1–7 A phobia is a profound fearful response associated with the sympathetic branch of the autonomic nervous system and leading to escape or avoidance.1–8 Anxiety is anticipation of a danger or threat.1–7 Fear comprises physiologic, emotional, and behavioral responses to a perceived or actual threat.1–7 Because the dog's efforts to escape in response to thunderstorms and gunshots were more pronounced than its avoidance of entering public venues, this noise sensitivity was described as a phobia, and avoidance of or freezing in position at particular locations was deemed a sign of anxiety.1 Auditory stimuli in those locations were thought to be the trigger for anxiety, rather than fear of specific places, because the venues where the behavioral signs occurred were familiar and varied.4

Noise sensitivities can be the result of genetic influences, inadequate positive social and environmental experiences early in life, and owner responses to the dog's behavior.1–6,8 In this case, 2 traumatic experiences that took place several months before the consultation (a 21-gun salute and loud clapping in the church) may have resulted in a nonspecific fear response and subsequent noise-related anxiety.1–6,8 Separation anxiety is a common comorbidity associated with noise phobia1–5,7,8; however, the escape attempts and anxious behavior when the female owner left the house did not correspond to the typical clinical signs of separation anxiety owing to the lack of destructive behavior, hypersalivation, inappropriate elimination, and rearrangement of household items. The signs that were observed could have been caused by several other factors, such as the sudden change in the dog's work routine, strong attachment to the female owner, and inadvertent reinforcement of the behavior from the owner, rather than separation from the owner.2,4,5,7 Canine cognitive dysfunction syndrome and sensory deficits were ruled out as causes of the dog's refusal to enter public venues because avoidance behavior occurred only when paired with specific environmental stimuli.1–5,7,9 Primary medical causes such as orthopedic pain and metabolic, endocrine, neurologic, and neoplastic diseases were considered unlikely on the basis of physical examination findings, observations during the consultation, and laboratory analysis results.1–5,7,9

Treatment

Because of concerns for the owner's safety and to prevent the rehearsal of anxious behaviors, the owners were instructed to retire the dog from service duty until the next examination. When the female owner needed to leave the house, the use of a sitter who could redirect and distract the dog was recommended. Communication through a cue-response-reward system was prescribed to establish consistent and predictable interactions between the dog and its owners and to ensure that only desired, nonanxious behaviors were rewarded.1–5,7,10,11 The dog showed a strong desire to pick up objects on cue, so the owners were instructed to practice tossing an object, such as a set of keys, across thresholds in the house and to cue the dog to cross the thresholds and pick up the object.3,4,10 The owners were given instructions on teaching the dog hand targeting on cue as an alternative behavior.10 During the treatment phase, both of these methods could be used to encourage the dog to move through doorways and down aisles when needed instead of using pressure on the leash or physically moving the dog. In preparation for systematic noise desensitization and counterconditioning as well as independence exercises, the owners were instructed on how to teach the dog to go to a mat on cue.1–5,7,10 Later, they would teach the patient to relax on this mat as the owner gradually moved away (creating distance) and relaxation was conditioned (building independence).1–5,7,10 A remotely activated treat dispenser was recommended to facilitate this process. Because the anxious behavior was increasing in frequency and intensity, psychotropic medications were prescribed. Buspirone, a partial serotonin receptor agonist, regulates the neurotransmission of serotonin and is considered a mild anxiolytic; treatment was started at 30 mg (0.7 mg/kg [0.3 mg/lb]), PO, every 12 hours.1–5,11–13 This azaperone medication was chosen because of its antianxiety effects and ability to increase signs of confidence with minimal adverse effects as well as the potential to be safely combined with other serotonin-enhancing medications.1–5,11–13 The owners initially declined treatment of the dog with fluoxetine (a selective serotonin reuptake inhibitor) or clomipramine (a tricyclic antidepressant) because of their perceptions of potential adverse effects, but agreed to reconsider this decision if the patient's response to the initial treatment protocol was insufficient.1–5,10,12 Although adverse effects of buspirone are not common, the owners were informed of potential responses such as disinhibition and increased aggression and gastrointestinal signs as well as its extralabel use in dogs.1–5,10–13 Because buspirone could take several weeks to reach maximum efficacy, trazodone was prescribed at 200 mg (4.5 mg/kg [2 mg/lb]), PO, every 8 to 12 hours, to reduce anxiety if the dog was left home alone, for public event outings, and during thunderstorms.1,2,4,14–18 Trazodone, a serotonin 2A receptor antagonist and serotonin reuptake inhibitor, can have calming and anxiolytic properties, and it is usually effective within 90 minutes after administration.2,4,14–18 The reported adverse effects of this drug are similar to those of buspirone.2,4,13–18 Trazodone was chosen instead of a benzodiazepine because of concerns for adverse effects of the latter treatment, such as a potential paradoxical reaction, sedation, decreased locomotor activity, and ataxia, which could create a dangerous situation for the female owner.1–5,10,12,19

Follow-up

At a recheck examination 3 weeks after the initial consultation, the patient was reportedly responding well to buspirone treatment. According to the owners, the dog appeared more relaxed overall and had been kept at home since the previous visit. The female owner had attempted to teach the recommended relaxation exercises to the dog but was not always successful. The dog would initially stay lying on the mat and appeared to relax when the female owner moved around the house, but it would get up if she moved toward the front door. Two thunderstorms had occurred since the previous visit, and the owner had chosen to give less than the prescribed dose, administering 100 mg (2.2 mg/kg [1 mg/lb]) of trazodone for each event. No adverse effects associated with the medication had been observed, and the owner reported that the dog appeared less anxious than it had without the medication. Approximately 2 hours before this recheck examination, trazodone had been administered at the described low dose because a thunderstorm had been predicted to develop during travel time to the hospital. In the examination room, the dog appeared to relax quickly and assumed lateral recumbency with its head down and eyes closed. Its respiratory rate was considered normal. The owners were instructed to start taking the dog to quiet, uncrowded places where it had shown no avoidance behaviors in the past.

On reevaluation 8 weeks after the initial consultation, the patient was tolerating the medications well. The owners had started to bring the dog to their physician appointments and other uncrowded venues as instructed. Both owners would go with the dog, and if they observed signs of stress (ears held back, pupils dilated, panting, or freezing in position), they would leave or use hand targeting or a pick-up cue (tossing a set of keys) to keep the dog focused and moving. In addition to these outings, the female owner was giving the dog high-value treats when gunshots were heard while outside and during thunderstorms. She indicated that since she had started this practice, the dog would sit next to her rather than run back to the house when gunshots were heard.

Four months later, the owners were still administering buspirone at the previously described dosage and also providing trazodone at the previously described dosage as needed during thunderstorms and other stressful events. No adverse effects had been noted; the signs of noise phobia during storms had lessened, and the dog could be redirected by various means (eg, with a command to sit and make eye contact, or by offering food). The owners had started bringing the dog to revisit many of the businesses where the avoidance behaviors had previously occurred, and it would willingly enter most of these places, although sometimes hand targeting was needed to encourage crossing the entry threshold. On outings to restaurants and physicians' offices, they would bring along the noise-reducing earmuffs and a digital media player (placed in a pocket of the dog's service vest) to play classical music.1 The ear buds for the audio device fit well under the ear muffs, and the dog appeared relaxed under these circumstances. They still avoided 2 restaurants where the dog had previously appeared the most fearful, and they had not attempted to reintroduce the dog to the church, mainly because the sanctuary was being renovated. Extensive renovations were also scheduled to take place at their home in a few months, and this concerned the owners. They were instructed to continue their dog's outings and environmental management, and a commercially available recording of construction noises was recommended along with systematic desensitization and counterconditioning to these noises by pairing the playing of the recording with food or puzzle toys, beginning with the sound at a very low volume while the dog remained in a relaxed state.1,3–5,19,20 Subsequent sessions would include a gradual increase in volume, as long as signs of fear (lip licking, holding the ears back, yawning, panting, or pupil dilation) or escape behaviors were not present.1,3–5,19,20 Instead of using this approach with a recording, the owners used large plastic air-filled cushions from shipping boxes for desensitization and counterconditioning; the female owner would sit indoors and pop the packing material while the male owner kept the dog positioned outside a nearby screen door and provided high-value food rewards.

Eight months after the initial behavioral appointment, the dog was still responding well to the treatment protocol, with buspirone administered as prescribed and trazodone rarely needed (reserved for thunderstorms only). The owners reported that the dog would willingly enter stores, restaurants, and physicians' offices without hesitation and that they had started to take it back into the church, not attempting to enter the sanctuary but sitting in an office nearby with the dog's noise-reducing earmuffs and earbuds providing classical music in place. At home, no escape behaviors were seen when gunshots were heard or during thunderstorms, and the female owner was able to redirect and distract the dog by giving cues to take a toy or object or perform hand targeting while providing positive reinforcement.

One year after the initial consultation, the dog continued to do well and was serving full time as the female owner's service dog without environmental accommodations (eg, noise-reducing earmuffs and music). At the time of last follow-up, treatments consisted of buspirone (0.7 mg/kg, PO, q 12 h) and trazodone (2.2 to 4.4 mg/kg [1 to 2 mg/lb], PO, q 8 to 12 h, as needed). Weaning the patient off both medications was discussed but declined by the owners. Having a complete hematologic analysis, including a CBC and serum biochemical evaluation, and a urinalysis performed yearly was recommended.

References

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