How stress affects health and behaviour; strategies for prevention and treatment

Transcription

1 QUESTIONS AND ET RÉPONSES ANSWERS Web Conference Conférence web December 9 février 13 th, 2011 How stress affects health and behaviour; strategies for prevention and treatment Speaker: Dr. Gary Landsberg, BSc, DVM, MRCVS, DACVB, DipECVBM-CA Q: If a cat is chewing and scratching the furniture, what s normal and what s compulsive? A: Few cases are considered abnormal initially. Cats need a place to scratch for marking and likely claw conditioning. Cats with a desire to chew, may be satisfied if you offer them cat grass, or even a dog chew to distract them. A videotape from the owners always helps to see the behaviour with your own eyes. Is it normal and does the pet only need other outlet? Therefore, the first approach would be to provide the cat with other options. Q: When a pet is exhibiting compulsive coping behaviours, is it best to comfort the pet, ignore the behaviour, or attempt to distract? A: When you have undesirable behaviours that are fearful and anxious, your goal is to calm the pet. The sequence should be calm down, settle down, then reward as much as possible. Give a calm mood and state. The outcome in behaviour is to calm the pet down. Q: In the case of separation anxiety, what should the owner s response be to the animal when the owner comes home to a destroyed environment? A: The situation must be improved for future departures with a behaviour program and likely with drugs, but when coming home to a problen, ignore the dog until it calms down and then greet it normally. It is normal to be upset, but do not punish the dog, because punishment makes the problem worse. The best thing to do is to start a behaviour modification program that is reward based. Q: Is pica considered an abnormal behaviour and should it be treated with behaviour meds? A: Pica is GI/ingestive sign that can be associated with stress and can be compulsive or can just be a desire to eat items that are undesirable to owners (e.g. stool eating). As mentioned medical causes must first be ruled out. In the example of the cat that was sucking on the sweatshirt when falling asleep, this helped the cat to cope, settle; therefore I did not feel like it needed to go on medication. However, if it is compulsive such as when items are chewed or swallowed, or wool sucking in cats and the behaviour is dysfunctional and does not lead to a relaxed state, medical treatment as well as behaviour modification program and a drug is likely to be required.

2 Q: What if the dog continues to growl, snarl, struggle and won t take treats? (question associated with the webinar video of a dog with a gentle leader during physical exam) A: The goals are safety, to calm the pet and to avoid an unpleasant assocation with the visit. With low level fear an anxiolytic, such as diazepam, will sometimes be useful prior to the visit; diazepam may increase appetite but could also disinhibit (increase aggression). Zylkène before the visit or pheromones (diffuser in the exam room or sprayed onto a blanket on the exam table) may calm the pet enough to accept treats. Alternately for short procedures, a muzzle or head halter (for safety) until the procedure is done and keep stress to a minimum. For longer procedures, give an intramuscular sedative to do the exam. Q: Have you ever seen a case of house soiling (urination only) in a kitten due to stress solely? A: Marking behaviours (urination stream on vertical surface) can occur in young kittens and these can be due to stress or anxiety, or associated with sexual maturity. Of course, if a cat is predisposed to FIC, stress could be a contributor at any age. In a kitten, soiling on horizontal surfaces is likely an avoidance of the box/litter or a preference for other areas or surfaces. Q: Could you give examples of handling that could help achieve stress-free nail trims? A: Any desensitization or counterconditioning program should begin with something the animal will tolerate (e.g. touching feet, holding paw or even the presence of a nail clipper) and associating this with favoured treats (therefore works best when the pet is hungry). Then gradually move on at each session to where the animal continues to tolerate (e.g. holding paw, clipping one nail) and ending with a reward. As a preventive, any type of handling (of the face, feet, paws, body, etc.) that does not cause fear and is associated with a high value reward improves compliance. Q: Can you name some behaviour issues where natural products can be appropriate? (when owners are hesitant to use psychotropic drugs) A: There are lots of situations, especially early fears and situational stresses (noise sensitivities, vet visits, adoptions into new homes, moving or change in the environment, overeactive when meeting new people, separation anxiety, travel anxiety). Use safe and natural products with evidence of efficacy. Q: What causes should be considered/investigated if a natural product or a prescription drug works on a stressed animal for a few months, and then just stops working. Any ideas why? A: It is unusual for an animal to improve and suddenly have a relapse. Here are a few possibilities to investigate. Confirm with the owner that the dose wasn t reduced and is still administered every day. For example, the minimal daily dose for Zylkène is 15mg/kg; some animals could benefit from higher doses. Has anything changed in the animal s environment (new stress in its life)? Could this animal also have a medical issue contributing to the behaviour signs? Has a behaviour modification program been put in place when the medication or natural product was started? Is it still in place? If the explanation can t be identified, a consultation with a veterinary behaviour specialist could be suggested to the owner.

3 Q: What do you think is the best drug for canine separation anxiety? A: First of all, it is always best to use a licensed product. This way you know there is data for efficacy, dose, pharmacokinetics as well company support. Then, each case is different. Sometimes a natural product alone will be enough. On the other hand, for severe anxiety, medication such as clomipramine or fluoxetine would usually be dispensed and can be used in combination with natural products such as Zylkène. Behaviour modification must be used concurrently to help the pet be gradualy more calm while away from the owners. And finally, it is even possible to use three different products together such as a benzodiazepine, a natural product like Zylkène (or pheromones) and an ongoing drug such as clomipramine. Q: Can you give Zylkène with other behaviour modifying drugs? Could Zylkène be used with selegiline to help manage stress in a dog suffering from cognitive dysfuntion syndrome? A: Yes, Zylkène can be given in combination with other behaviour modifying drugs and should be safe with selegiline. It is important to always check the potential for drug interactions, and this is why you will benefit from choosing a licensed product. Some over-the-counter products could have potential interactions, especially on serotonine so that combination with other drugs that affect serotonin are a concern. Even other medical drugs, non-behaviour related, can have some effect on serotonin. Q: Would you suggest Zylkène for routine use in shelter pets prior to and after adoption? A: It s a good idea to have behaviour tests in shelters to give advice to adoptive parents. Each case is an individual, so yes, for some Zylkène could be an option and for others another drug could be beneficial for the animal. Q: How does the Zylkène work once in the brain? A: Zylkène is proposed to have an affinity for GABA receptors in the synapses and thus have an inhibitory and anxiolytic effect. Q: How long does it take to see results with Zylkène? Is Zylkène meant for long-term usage? A: Zylkène can be used for both short term and long term situations. Results can be observed within a few days, although for chronic behaviour issues it is suggested to administer a minimum of 8 weeks and behaviour modification must be used concurrently. Q: Is Zylkène suitable to use in animals with food allergies? A: Zylkène contains hydrolysed casein derived from cow milk. Although unlikely, animals allergic to bovine proteins may not tolerate Zylkène. Q: Is there any lactose, glucose or galactose in Zylkène? A: There is no lactose in Zylkène. The sweetener is maltodextrine. Q: Have you noticed any gastrointestinal effects from Zylkène? A: Mild gastro-intestinal signs, such as soft stools, have been reported on occasion. They tend to be self-limiting. You may consider reducing the initial start-up dose in these cases.

4 Q: With Zylkène would you recommend adjusting the dose as needed if the initial dose is not effective enough? Can we overdose an animal with Zylkène? A: 15mg/kg is the minimal dose. If this dose provides some improvement, but the desired results are not reached, one could try increasing the dose and evaluate if it provides more benefits. The ingredients found in Zylkène do not have a considerable potential for toxicity, it is very unlikely to overdose. Q: What about amytriptyline for the long term treatment for thunder fear in dogs? And for cats with FIC? A: Since clomipramine and fluoxetine are licensed for dogs and we have both data and pharmacokinetics, and there is no data for amitriptyline, I have not used it for many years in dogs or cats. As for cats, it is bitter and also has not been studied for efficacy, while clomipramine and fluoxetine have been used for urine marking in cats and are likely to reduce stress. In addition the 5 mg fluoxetine and 8 mg fluoxetine make dosing quite simple (e.g. 1/2 tablet for small cat 5kg or less and 1/2 to 1 tablet for cats over 5kg). Q: Why did you show a prong collar to illustrate punishment in dogs? When used with intelligence, it is a very good and gentle tool for training a dog, much better than a choker chain collar. A lot of trainers use the prong collar in positive training techniques. A: In my opinion you cannot use a prong collar in a humane training environment. It is not gentle - each time the dog pulls the prongs tighten on the neck to cause discomfort (which stops the dog) and at the extreme I have many documented cases of prong injuries. Used correctly and with a dog who can tolerate the prongs without excess fear, it can be used for negative reinforcement, provided you correct with prong until the pet behaves appropriately and immediately release. Whether prong or choke, they cause unecessary discomfort even when used correctly (in other words there are other options) and when used incorrectly (i.e. they do not inhibit the behaviour except with greater force) they can cause injury. Most behaviourists try to avoid any form of punishment if there is an entirely positive approach that is effective. Q: Can you comment on the use of the thundershirt for dogs with noise phobias? A: These types of products are used for environmental modification in order to avoid stimuli. The goal during thunderstorms is to avoid exposure to the stimuli with a state of prevention. This can be done with doggles, thunder huts, mutt muffs, static capes, external shutters, calming caps, thunderbands etc. Each animal is different and it is up to you to find what works and what doesn t. Then you can start to work on the behaviour problem to teach the pet to have a safe haven and a comfortable area. And then gradually desensitize while giving plenty of positives to overcome the fears and anxieties. Anecdotally thundershirts do seem to calm or suppress the reactive fearful behaviours such (although perhaps not the fear itself) so that the pet might be calmed and rewarded. Q: Is there a point at which euthanasia is the answer to agression behaviour? A: Yes. Every case should have a risk factor analysis to determine the intensity of aggression, and whether it can and will be successfully prevented in the specific home with the specific owners. If this is practical the next determination is whether the pet can be significantly improved (i.e. prognosis, expected outcome) and whether the owners are willing to accept any limitations on what can be achieved. If the risk factors are such that the pet cannot be safely kept in the home, then the question becomes Would there be a home in which the pet would be safe, and can we find one...?. If not euthanasia should be recommend.

5 Q: If an animal is very fearful of coming to the vet, is there a medication that can be given prior to the vet visit? A: No. The best suggestion is not to give any medication, but rather an anti-anxiety product and then sedate the animal when they are in the clinic. The goal is to avoid the animal being exposed to the event if they haven t been desensitized. Then put the animal on a behaviour program in order to desensitize the animal and turn the event into a positive experience. Q: What was the website Dr. Landsberg mentioned in regards to FIC and stress? A: - also consider catvets.org and fabcats.com Q: What is the internet site for multimodal environmental? A: - also consider catvets.org and fabcats.com This continuing education web conference was made possible by