Small Animal Proceedings. Saturday, January 28, 2017

Small Animal Proceedings Saturday, January 8, 07

How to Approach Basic Behavior Problems Speaker Christine D. Calder, DVM A 998 graduate of Mississippi State University College of Veterinary Medicine, Christine spent over 5 years as a general practitioner in both New Jersey and Maine before returning to Mississippi State in 04 to complete a non-conforming residency in veterinary behavior. Since her arrival at MSU-CVM, Christine has started a behavior referral service in the teaching hospital and a clinical behavior teaching program. In addition to her interest in behavior, she also enjoys shelter medicine and finding ways to enhance the human-animal bond.

3 Christine D. Calder, DVM Behavior Services MSU-CVM How to Approach Basic Behavior Problems Why is Behavior Important? 6-8 million dogs and cats surrendered to shelters every year and 3-4 million euthanized in shelters. HSUS Behavior cited as # reason that dogs are surrendered and # reason for cats A recent study of U.S. veterinarians estimated that about 4,000 pets each year are euthanized at veterinary clinics for behavioral reasons Many pets are relinquished before the client even seek help.3 40% of all dogs are relinquished within one year of entering into a new home.4 Treating Behavioral Disorders Goal: relief of mental suffering associated with disorder and the improvement of mental wellbeing Remember: Behavior disorders are emotional problems Dog training classes does not treat behavior disorders Many well trained dogs have aggressive and anxiety disorders Conflict aggression Separation Anxiety 4 5 Prevention is often easier than treatment Behavior Counseling Always have option to refer Charge for your time Don t be afraid to schedule a second appointment Take a good history Background information Aggression screen Interactions Last 3 incidents House diagram-house-soiling Step : Rule out medical causes Behavior is a diagnosis of exclusion Many behavioral clinical signs can result from medical disorders CBC/Chemistry/UA minimum T4 in older dogs/cats Other diagnostics as needed 6 Step : Treatment Plan Options:. Do nothing

. Rehome 3. Treat 4. Euthanasia Treatment Plan: 5 steps and multiple phases 7 8 9 0 Phase I Safety and Avoidance Communication Tools Safety and Avoidance Identify and avoid triggers Prevent practice of the behavior Remember learning is always occurring (operant and classical conditioning) Monitor body language for stress behaviors and avoid or redirect Communication Repair human-animal bond Cue-Response-Reward system Avoid punishment Foundation behavior Focus behaviors Body language understand cues Management Tools Head collars Muzzles Front clip harness Leashes Gates/Crates Through a Dog s Ear Mutt Muffs Calming Caps Aromatherapy Food Dispensing and puzzle toys Anxiety Wrap/Thundershirt Phase II and Beyond Behavior Modification Medications Good time to refer Behavior Modification: How to change behavior long term. Rule out the medical causes. Control the environment and avoid triggers 3. Positive Reinforcement

Reward for behaviors want to see- do this not don t do that Systematic Desensitization/Counter-conditioning Classical Conditioning Operant Conditioning 4. Response substitution 5. Extinction 6. Positive Punishment (rare if ever) 3 4 5 6 Medications Nutraceuticals vs. Pharmaceuticals Valid client patient relationship Know your clients goals and expectations Medication will not cure a problem but may be part of a management plan Know what you are treating and the side effects It s your license Polypharmacy is common Follow-up is important Careful of client abuse Option : Non-pharmaceutical Pheromones Diets Nutritional supplements Good place to start Some scientific literature Mild behavioral problems No known side effects Often layers Pheromones: Cats Feliway F3 fraction of feline facial pheromone Alters emotional state via limbic system and hypothalamus Spray or diffuser Spray on lab coat, scrubs, towels Multicat Ceva Lactating queens Nuturecalm Mimics the pheromone cats are exposed to while nursing Adaptil: Dogs Ceva Pheromone for dogs Spray, Diffuser, Collar Reduce Anxiety and facilitate adaption to new surroundings Spray on clothes, bandanas, towels 3

7 8 Diets Nutritional Supplements Anxitane L-Theanine Similar to an SSRI raises serotonin levels Tastes good Zylkene Milk protein Similar action to benzodiazepam Sprinkle on food Solliquin Sam-e 9 0 Option : Pharmaceuticals Type of dosing Maintenance Mild to moderate anxiolytic effects 6-8 weeks until effect Same daily dose regardless of trigger intensity Choose if trigger constantly or unpredictably present Safer for long term use PRN/situational Mild to strong effects (dose effect) Effects within minutes Dose just before trigger Choose if intermittent and predictable trigger Not great for long term use Common PRN Medications Trazodone (-5 mg/kg q ) SARI- Serotonin Antagonist Reuptake Inhibitor 90 minutes before with food Benzodiazepines Increase frequency of GABA receptor opening(inhibition) True anxiolytic 30 minutes before Clonidine(0.05 mg/kg q) A agonist Decrease NE release 30-60 minutes before 4

3 4 5 Maintenance Medications SSRI- increase serotonin Fluoxetine(Prozac) Paroxetine(Paxil) Urinary retention Sedating Sertraline(Zoloft) Least side effects Higher doses TCA Clomipramine (Clomicalm)- most specific for serotonin-expensive! Amitriptyline-questionable if helpful Other common daily medication options Gabapentin (3-0mg/kg BID) Reduces overall reactivity and anxiety with few side effects Sedation Chronic pain Buspirone (Buspar)-shy cats, fearful dogs, noise phobias Serotonin Partial Agonist Increase confidence Few side effects Usually not monotherapy Serotonin Syndrome Overdose of single agent or polypharmacy More commonly seen with accidental ingestion of client s medications Treatment symptomatic and supportive therapy Watch higher doses Before increasing meds Check behavior modification plan compliance Add in a PRN Keep track of other meds i.e. tramadol Summary Behavior is a part of every day practice One of the leading causes of euthanasia in patients Behavior is emotional and not a training problem First step is a good physical exam and diagnostics to rule out medical Always have the option to refer and charge for your time Remember to take a good history 5 step treatment plan Before you medicate know what you are treating and why Medications alone will not cure- need behavior modification Follow-up is important 5

6 Questions??? 7 8 Case Example: Aggression on leash-dogs or people Safety and Avoidance: Walk at off times Head collar 4-6 foot leash 80 turn Cross street-distance Avoid punishment Avoid aversives (prong, e-collar) Communication: Focus behaviors(touch, look, find it) Foundation behaviors Tools: Head collar Clicker Calming cap/ doggie goggles Behavior Modification: Identify triggers Start with CC Open Bar: Closed Bar Click treat for look +no reaction Click and treat for look at human DS Operant conditioning Decrease distance Medications: None often needed If reactivity is high may need trazodone or clonidine before walks Aggression to Family Members Safety and Avoidance: Identify and avoid triggers Safe haven Avoid Punishment Muzzle-basket Leash and head collar Stay away when eating Let have stolen object Do not hug/kiss Communication: Cue-response-reward Structured interactions Predictable 6

Reward non anxious behaviors Focus and Foundation behaviors Go to mat Recall Body language Watch for conflict behaviors Respect and do not punish the growl Tools: Crates, gates, mat Basket Muzzle Leash and Head Collar Food dispensing and puzzle toys Behavior Modification: DS/CC to triggers Response substitution Give and take game DS/CC to touch DS/CC to muzzle/headcollar Medication: SSRI if triggers are not easily avoided PRN for confinement Avoid benzo will take away bite inhibition 9 Aggression to visitors Safety and Avoidance: Crate before visitors arrive behind closed door Ask visitors to text or call first Place note asking visitors/delivery personnel to not ring bell Avoid punishment Communication: Cue-response-reward Focus behaviors (look, touch, find it Foundation behaviors (sit, down, stay, go to mat) Tools: Food dispensing toys Head collar and leash Crate and gates Mat Manner s Minder (Treat and Train) Behavior Modification: DS/CC: Frequent visitors vs. in frequent visitors Doorbell-teach go to mat Touch-hands reaching Medications: 7

Depends on co-morbidities and predictability of triggers Trazodone for confinement 30 3 Separation Anxiety Safety and Avoidance: Crate vs. gate Leave house once a day Communication: Cue-response-reward Focus Behaviors(for toolbox) Foundation behaviors(sit, stay, down, go to mat) Ignore 0 minutes before leaving Exercise Tools: Gates, crates Food dispensing and puzzle toys Mat Video-progress Essential oils-lavender DS/CC: Independence exercises Departure cues No planned departures-may sensitize Good crate: bad crate Once can be ok alone for 0 minutes then can start to decrease PRN meds Medications: PRN: benzo, trazodone, clonidine-may need to try several Maint: SSRI or TCA-clomipramine Gabapentin can be helpful in reducing overall anxiety and reactivity-sedation may be helpful Buspar in combination with SSRI is an option. Thunderstorm Phobia Safety and Avoidance: Provide safe haven Encourage to use before storm arrives Manage environment Communication: Cue-response-reward-reward only calm non-anxious behaviors Focus and foundation behaviors Massage therapy Tools: Food dispensing toys Mat TDE music Fan/white noise machine Mutt Muffs/Calming cap/ Thundershirt 8

Behavior Modification: Recorded storms Classical conditioning Medications: PRN given before storm May need to try several Give if storm is predicted 3 33 Barking Safety and Avoidance: Identify underlying cause Avoid punishment Avoid access to windows/doors, fence line Do not leave outside unsupervised Communication: Cue-response-reward Foundation and focus behaviors Look, touch, go to mat, recall Tools: Leash Head collar Mat Manner s minder (treat and train) Window film Behavior Modification: DS/CC to triggers (people, door bell, other dogs, etc ) Redirect and response substitution Medications: Depends on underlying motivation Aggression between household dogs Safety and Avoidance: Keep separated Avoid punishment Use muzzles, head collars and leashes Identify and avoid triggers Communication: Cue-response-reward Focus and foundation behaviors Look, target, mat Recognize conflict behaviors Tools: Muzzles Head collars and leashes Mat Gates and crates 9

Behavior Modification: DS/CC to each other Look at that game Medications: Depends on if triggers can be identified and avoided Most likely needed for abnormal dog Abnormal doesn t provide bite inhibition or respond to appropriate social cues 34 Aggression between cats(also used for marking cats) Safety and Avoidance: Separate for at least weeks Identify and avoid triggers Communication: Positive reinforcement training-touch, come, go to mat Structured play time-0 minutes Tools: Resources Toys Clicker Behavior Modification Bring together slowly- food/play DS/CC to triggers Medications SSRI may be helpful Buspirone-victim cat Anxitane/Zylkene Food 0

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Puppy and Kitten Basics: Raising Behaviorally Healthy Pets Speaker Christine D. Calder, DVM A 998 graduate of Mississippi State University College of Veterinary Medicine, Christine spent over 5 years as a general practitioner in both New Jersey and Maine before returning to Mississippi State in 04 to complete a non-conforming residency in veterinary behavior. Since her arrival at MSU-CVM, Christine has started a behavior referral service in the teaching hospital and a clinical behavior teaching program. In addition to her interest in behavior, she also enjoys shelter medicine and finding ways to enhance the human-animal bond.

Puppy and Kitten Basics: Raising Behaviorally Healthy Pets Christine Calder, DVM Behavior Services College of Veterinary Medicine Mississippi State University Why Prevention? Behavior Problems are one of the number one reason pets are surrendered to shelters. Dogs that did not attend obedience school are 68.% more likely to be surrendered. House soiling 9.3% Boisterousness 0% Aggression towards people (7.7%) and dogs (9%) House soiling is the number one behavior reason cats are surrendered. Most dogs and cats are surrendered at - years of age (social maturity) Patronek, Gary J., et al. "Risk factors for relinquishment of dogs to an animal shelter." Journal of the American Veterinary Medical Association 09.3 (996): 57-58. Salman, Mo D., et al. "Behavioral reasons for relinquishment of dogs and cats to shelters." Journal of Applied Animal Welfare Science 3. (000): 93-06. 3 4 5 6 Basic Building Blocks and Needs Crate Training Housetraining basics Socialization Chewing and Nipping Working with Nuisance Behaviors Cue-Response-Reward Exercise Obedience Training Litter box use Environmental Enrichment Socialization Teaches dogs and cats to cope and respond in a healthy acceptable manner-learning Dogs: 3-4 weeks is critical time pleasant exposures will help dog be friendlier and less fearful Cats: -7 weeks critical time Important to continue socialization throughout life Lack of socialization results in fear. Fear can results in aggression or other behavioral problems. Socialization and training go together Socialization Checklist Why puppy socialization class Sets dog up to succeed Bonds client to practice Helps dog form positive associations with practice

Provide veterinarian and veterinary staff to be source of information Puppy Start Right 7 8 What about cats? Kitten Kindergarten Provides socialization Provides exposure to veterinary procedures and handling Helps clients bond Helps cats enjoy going to vet Established veterinarian and staff as valuable resource Crate Training Prevents destructive behavior Limits access to house until house rules are learned Aids in housetraining Reduces separation anxiety Potential Problems Too much time in crate Whining Ignore Never let out when whining Ask to sit before opening door 9 0 Housetraining Use a crate and/or ex-pen Helps develop bowel and bladder control Follow a schedule Critical to success Puppy leans to expect to eat and eliminate at certain times Don t free feed Clean up Accidents-Anti-icky Poo Catch them in the act Redirect It is your fault-no punishment Figure out why it happened don t let it happen again Important to set up for success and reward Litter box Use Scoop the box once a day Empty and clean the box once a week(not strong smelling cleaners) Use an uncovered box in a quiet location Use clay clumping litter One more box than cat and one box on each floor of the house Chewing Normal behavior for puppies that are teething and exploring their environment

Puppy Proof Don t confuse by giving puppy shoes or socks to chew Confine/crate when can t be watched Give people time and play to teach what is acceptable behavior Make sure getting enough exercise If consistent usually diminishes after years 3 4 5 Safe Chewing Choices Food dispensing and puzzle toys Those that can be filled with soft cheese, dog treats or peanut butter. Can freeze Kongs Large dog biscuits Chewing toys that can be soaked in water and frozen Careful with Rawhides some dogs can gulp down large chunks becoming ill Real Bones can cause slab fractures and dental bills Nipping Normal part of play in puppies Practice fighting and hunting skills Some dogs have a greater tendency to nip and mouth than others Retrievers bred to carry things in their mouths Bite Inhibition Redirect Withdraw and ignore for 0 seconds Teach touch Stop nipping by giving toy to carry, ball to chase, or a chewy to gnaw No rough housing Nuisance behaviors Ignore bad behavior No eye contact No touching No talking Redirect to more appropriate behavior Reward good behavior Extinction Burst: Flurry of unwanted behavior before the dog stops the unwanted behavior DO NOT GIVE IN Time out Consistence and Patience Cue-Response-Reward Teaches consistency Gives dogs choices Establishes predictability Teaches rewards only come with calm, relaxed behaviors Following this protocol, aggression and other behavioral issues can be reduced Start with puppies 3

Reduces jumping behaviors Teaches self and impulse control 6 7 8 Exercise One of the number one reduction and prevention of behavioral problems Under stimulated dogs and cats get bored and find other means to entertain themselves (chewing, scratching, digging, escaping, etc ) More likely to jump, nip, and be generally disobedient Tired puppy is a good puppy Play Obedience Training-Operant Conditioning Cats can be trained too Puppy classes and basic obedience Human animal bond is strengthened as owner and pet learn to communicate better Promotes socialization Look for trainers in the community that offer: Positive Reinforcement Certified Pet Dog Trainers (CPDT-KA) Clicker training Foundation and Focus Behaviors Focus Behaviors Look Touch Find it Foundation Behaviors Sit Recall Place Leash walking Down 9 0 Targeting Easy to teach Building block to other behaviors Helps calm nervous or shy dogs Teaches hands predict good things Handling exercises Most dogs like it Can use as redirection Use a clicker Give Dogs a Fun Job or Sport 4

Herding sheep or other livestock Search and rescue Sport Agility Flyball Lure coursing Field Trials Freestyle Dock Diving Barn Hunts 3 4 Cats Can Be Trained Too Clicker Training Target Sit Come Off/On Walk on leash Gentle with teeth and claws Permit grooming and handling Environmental Enrichment for cats Different surfaces to perch/sleep on Horizontal and Vertical Different feeding, sleeping, and Elimination area Play with daily Consistent Routine Exercise Interactive toys/games Mental Stimulation Hunting games/toys Need to scratch Scratching in Cats Two purposes Sharpen their nails Mark territory Choose visible area Call attention to the spot Carries the cats scent Indicates height and strength of cat that made the marks Attracted to new things in the environment Provide an acceptable place to scratch Good Scratching Place Vertical Very Solid 5

Cat needs to use all its muscles without the object wobbling and falling over Right kind of surface Rope better than carpet Deep enough for claws to sink in but soft enough that it shreds Layers of burlap nailed to a panel and mounted on a wall or side of a cupboard Real log with bark on it Some will settle for horizontal surface May need to add cat nip 5 6 7 Tools Food dispensing and puzzle toys Front clip harnesses Head collars Food tubes Toys Wand toys Laser lights (cats only) Resources for Pet Owners The Other End of the Leash, Patricia McConnell Decoding Your Dog, American College of Veterinary Behaviorists The Trainable Cat, Sarah Ellis and John Bradshaw How to Behave So Your Dog Will Behave, Sophia A. Yin Positive Dog Training, Pamela Dennison Don t Shoot the Dog, Karen Pryor Culture Clash, Jean Donaldson Puppy Start Right, Kenneth and Debbie Martin Questions? 6

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Behavioral Pharmacology Speaker Christine D. Calder, DVM A 998 graduate of Mississippi State University College of Veterinary Medicine, Christine spent over 5 years as a general practitioner in both New Jersey and Maine before returning to Mississippi State in 04 to complete a non-conforming residency in veterinary behavior. Since her arrival at MSU-CVM, Christine has started a behavior referral service in the teaching hospital and a clinical behavior teaching program. In addition to her interest in behavior, she also enjoys shelter medicine and finding ways to enhance the human-animal bond.

Behavior Pharmacology Christine D. Calder, DVM Behavior Services College of Veterinary Medicine Mississippi State University Justification Neurotransmitters involved in the regulation of neuroactivity in CNS including parts of brain involved in emotion and learning Fear and anxiety major component of most animal behavior problems Adjunctive therapy Never in absence of safety or behavior modification Some behavior problems due to pathology and medication first line treatment 3 4 5 Before you prescribe AMDUCA Animal Medical Drug Use Clarification Act Valid veterinary-client-patient relationship Inform clients of extra-label (signed?) Know state laws regarding DEA medications Rechecks required for refills (3 month year) "Extralabel use" is defined as: "Actual use or intended use of a drug in an animal in a manner that is not in accordance with the approved labeling. This includes, but is not limited to, use in species not listed in the labeling, use for indications (disease and other conditions) not listed in the labeling, use at dosage levels, frequencies, or routes of administration other than those stated in the labeling, and deviation from labeled withdrawal time based on these different uses." ( CFR 530.3(a)) Under the provisions of CFR 530, the FDA recognizes the professional judgment of veterinarians, and permits the extralabel use of drugs by veterinarians under certain conditions. Extralabel use of drugs may only take place within the scope of a valid VCPR. In the absence of a valid VCPR, if an approved new animal drug is used for a use for which it is not labeled, such use has caused the drug to be deemed unsafe under the Federal Food, Drug and Cosmetic Act ( the Act ) ( U.S.C. 360b), and therefore adulterated under the Act ( U.S.C. 35(a)(5)). http://www.fda.gov/animalveterinary/guidancecomplianceenforcement/actsrulesregulations/ucm 085377.htm#Extra-Label_Use Before you prescribe Have good knowledge about efficacy and side effects of drugs Do not take advice from non-vets Vets are liable, not the trainer Before you prescribe Basic health status of animal Physical CBC/Chem/UA baseline values Thyroid? Middle aged + cats yes!

Dogs -? Empirical evidence weak, anecdotal strong for hypothyroidism underlying cause 6 7 8 Before you prescribe In competition animals? Probably banned Most dog conformation and competition also banned Passing along genetic predisposition? Police and working dogs?? Before you prescribe Know your clients goals and expectations Medication will not cure a problem but may be part of a management plan Are they being safe? Have you given appropriate behavior modification advice or referred to appropriate professional? Type of dosing Maintenance Mild to moderate anxiolytic effects Weeks to effect Same daily dose regardless of trigger intensity Choose if trigger constantly or unpredictably present Safer for long term use 9 0 PRN/situational Mild to strong effects (dose effect) Effects within minutes Dose just before trigger Choose if intermittent and predictable trigger Not great for long term use Benzodiazepines Increase frequency of GABA A receptor opening (enhance inhibition) Anxiolytic, muscle relaxant, anticonvulsants Good for predictable stimuli Quick onset and short-acting Give BEFORE fear or panic onset Benzo side effects Over-sedation Ataxia Increased appetite Hallucinations Insomnia Feline idiopathic hepatic necrosis with oral diazepam Insufficient glucuronic metabolism Paradoxical excitement

Give test dose prior to exposure to stimuli Benzo side effects Class IV controlled drug After prolonged use Tolerance (need more to obtain same effect) Chemical dependency/withdrawal syndrome Decrease 5%/week or withdrawal signs of rebound anxiety or seizure possible Be aware of human abuse potential How to chose? Alprazolam good first choice Health of patient Oxazepam & lorazepam no metabolites and considered safest Duration HUGE Individual variation trial and error No effect or adverse reaction to one, try another 3 4 5 6 7 Trazodone Serotonin A Antagonist/Reuptake Inhibitor(SARI) antidepressant 5HT A block, α-*, H*(low-mod dose) *Blocks arousal system and causes sedation Higher dose SRI PRN or maintenance drug Not controlled, no dependency Can (should?) use in combo with antidepressants/benzo If you would consider using ace, consider trazodone instead Low side effect risk GI, agitation Clonidine α agonist (autoreceptor in locus ceruleus) Decrease NE release PRN predictable stimuli Can use in combo with antidepressants or trazodone Side Effects seem to be low risk, dry mouth, hypotension, agitation Sileo Brand new Dexmedetomidine oral gel Only FDA approved medication to treat noise phobia Transmucosal Calming without sedating Over 6 weeks Dental or gingival disease may effect absorption Selective Serotonin Reuptake Inhibitor(SSRI) 3

SSRI Blocks reuptake of Serotonin by the presynaptic neuron Highly specific for serotonin and little effects on other neurotransmitters 8 9 0 3 SSRIs Anxiolytic, anti-aggression, anti-compulsive Maintenance, not PRN Fairly long half-life (approx 5 days) Takes 6-8 weeks for max effect 50% dose for st weeks Choice dependents on symptoms of anxiety and other problems E.g. keeping owners up at night choose sedating paroxetine Reconcile FDA approved for Separation Anxiety in dogs Fluoxetine Elanco OFF THE MARKET Side effects of SSRI Vomiting, diarrhea Constipation, urinary retention (M) Initial, temporary anorexia (5HT 3,4) Increased agitation (5HT A, C) Seizure or other neuro signs Abnormal bleeding Serotonin Syndrome Usually from combo (especially MAO-I); amitraz, tramadol (or any opioid) Usually acute onset Neuro mentation change, ataxia, hyperesthesia, tremors, seizures GI diarrhea, abdominal pain, hypersalivation, anorexia Respiratory distress Tachycardia fever TX supportive Tricyclic Antidepressants(TCAs) Blocks reuptake of neurotransmitters Anxiolytic, anticompulsive, antiaggressive Clomipramine very selective for 5HT, used almost interchangeably with SSRIs, often first choice for OCD and ritualistic behaviors Amitriptyline may use for derm cases, not first line behaviors Wide variation in receptors affected resulting in variation in clinical effect 4

4 Tricyclic Antidepressants (TCAs) 5 6 7 8 Clomicalm FDA approved for canine Separation Anxiety Clomipramine Novartis TCA side effects Serotonin syndrome never give with MAOI and with caution with other meds facilitating serotonin activity Weight gain, sedation (H) Constipation, urinary retention (M) Sedation, dizziness, hypotension (alpha ) Cardiac arrhythmia and blocks Na channel blocker Also binds T3, T4, TSH 50% dose first 7-4 days to reduce side effects Buspirone (Buspar) 5HT A partial agonist Monotherapy for generalized anxiety Not first choice (monotherapy) for aggressive animals Augment of SSRI response SSRIs may deplete 5HT stores Buspirone may slow impulse and allow vesicles to replenish Very few side effects Makes more social Victim cat in ICA Fearful dogs Monoamine Oxidase Inhibitor Monoamine Oxidase destroys NE, DA, 5HT Inhibitor- blocks oxidative deamination of brain amines and therefore increases levels of NE, DA, 5HT, and elevates mood. 9 Selegiline (Anipryl) FDA approved Canine Cognitive Dysfunction Increases DA Decreases destruction Inhibits Dopamine Active Transporter Increases DA release by inhibiting autoreceptor Enhances endogenous free radical scavengers Reduce free radical output from MAO Sympathetic properties of amphetamine metabolites-animals without CDS may become more agitated but benefits aged patients. Serotonin syndrome Off the market 5

30 3 3 33 Gabapentin(Neurontin) and Pregabalin(Lyrica) GABA analogue- looks like GABA but not active or physiologically regulated Block neuronal firing by binding to subunit of calcium channel Originally developed as anti-seizure, not effective Anxiolytic Muscle and Nerve pain Safe because no active metabolites and does not bind to plasma Main side effect is sedation although in humans psychosis. Other antidepressants Serotonin Norepinephrine Reuptake Inhibitor(SNRI) duloxetine (Cymbalta) great treatment for depression and pain (NE effects) venlafaxine (Effexor) FIC cats Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) buproprion (Wellbutrin/Zyban) Nonandrergic and specific Serotonergic Antidepressant (NaSSA) alpha antagonist mirtazapine (appetite stimulant in small animals) Not used much in vet med (for behavior problems) Nutraceuticals NT agonists or precursors (GABA, 5HT) Neuroprotectants (from oxidative stress) improve neuron health and keep neuronal signaling efficient antioxidants Free-radical scavengers Nutraceuticals National Animal Supplement Council (www.nasc.cc) DHA/EPA (Omega 3 FA) Harmonease Magnolia and Phellodendron extract Rescue Remedy Valerian, Bach (and alcohol) St Johns Wort serotonin Senilife Novifit- SAMe Melatonin Synthesized from serotonin in pineal gland Antioxident Vit. A, D, E 34 Nutritional Supplements Anxitane L-Theanine Similar to gabapentin 6

Tastes good Zylkene Milk protein Similar action to benzodiazepines Sprinkle on food 35 Solliquin L-theanine: an amino acid found naturally in black, green, and white teas. Magnolia officinalis: an extract from the bark of the Magnolia tree. Phellodendron amurense: fruit and bark extracts from the Amur cork tree. Whey protein concentrate: a milk protein extract. 36 37 38 39 40 4 Pheromones Feliway F3 fraction of feline facial pheromone Alters emotional state via limbic system and hypothalamus Spray or diffuser Nuturecalm Mimics the pheromone cats are exposed to while nursing Multicat How to use the Feliway MultiCat Diffuser: Plug in the diffuser in the room where the cats spend the most time. For best results, use continuously for at least 30 days. The diffuser covers up to 700 sq. feet. Adaptil Ceva Pheromone for dogs Spray, Diffuser, Collar Reduce Anxiety and facilitate adaption to new surroundings Diets Diets Hills b/d Purina Pro Plan Bright Minds Medium chain triglyceride oils(from vegetable oil) Alternative source of energy(ketones) for aging brain cells Some anecdotal reports of improvement on cognition Questions??? 7

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Elimination Disorders in Cats Speaker Christine D. Calder, DVM A 998 graduate of Mississippi State University College of Veterinary Medicine, Christine spent over 5 years as a general practitioner in both New Jersey and Maine before returning to Mississippi State in 04 to complete a non-conforming residency in veterinary behavior. Since her arrival at MSU-CVM, Christine has started a behavior referral service in the teaching hospital and a clinical behavior teaching program. In addition to her interest in behavior, she also enjoys shelter medicine and finding ways to enhance the human-animal bond.

3 4 5 6 7 Elimination Disorders in Cats Elimination Problems 40-70% of cats referred to a veterinary behaviorist have some type of elimination problem Most commonly reported behavioral problem Urinating outside the box most frequent Defecation less frequent Initial cause may be medical but maintenance of problem becomes behavioral Basic approach to diagnosing house-soiling Get a good history Physical exam Lab work+/- Radiographs Diagnosis Treatment plan Follow-up Differential diagnosis for elimination disorders Medical Disease Behavioral Aversions Preference Territorial Anxiety Cognitive Dysfunction Sexual/social status Lack of Training Step : Rule out Medical Causes Physical Examination CBC/Serum Chemistry Urinalysis +/-Urine Culture T4 Radiographs Fecal Physical Examination Over grooming of the inguinal/lower abdomen Look for penile barbs Palpable calculi-bladder Abnormal kidney size and shape Joint crepitus Medical Causes Cats experience pain while urinating or defecating

Diseases that cause PU/PD GI Disease Nutritional Disorders Anatomical Disorders that interfere with normal elimination Neurological Disease Debilitating Disease 8 9 0 Most Common Medical Causes Young-FIC and uroliths Older cats-neoplasia and bacterial infections 60% have a history of FIC/feline lower urinary tract disease Horwitz, Debra F. "Behavioral and environmental factors associated with elimination behavior problems in cats: a retrospective study." Applied Animal Behaviour Science 5. (997): 9-37. Step : Take a Good History Location Substrate Posture Amount of urine Litter box behavior Triggers Other cats Humans Environmental change Step 3: Marking vs. Inappropriate Elimination Two different diagnosis Different treatment plans Behavioral history important to differentiate Some cats will have both Inappropriate Elimination Clinical Signs Horizontal surfaces Squatting position Large amount of urine Eliminates near the box but not in it Poor litter box etiquette Often will not use the box at all Inappropriate Elimination causes Aversion Location Litter box

Preference Location Substrate 3 4 5 6 7 8 Litter box aversion Often avoids the litter box completely Cats often fail to dig and cover wastes Straddle the box and avoid touching the litter Dig outside the box Shake feet excessively after leaving the box Eliminate close by but not in the box Litter Box Aversion Causes Dirty litterbox # Painful elimination Trauma Unacceptable litter Unacceptable box Harsh cleaners Use by other cats Liners Location Aversion Causes Traumatic or frightening event occurred around the box Lack of privacy Near loud appliances Too close to food and/or water Substrate and Location Preference Preference for certain areas or surface for elimination Most commonly seen in cats that stop using box for medical reason then choose another surface or spot in the house for elimination Quiet area and somewhat secluded Carpet or certain piece of furniture Marking Clinical Signs Usually vertical surfaces (walls, drapes, side of furniture) Most stand some will squat (horizontal surface) Small amounts of urine Will still use litter box for most elimination Marking 3

Normal communicative behavior Urine more important than feces for scent marking All cats are capable of exhibiting behavior but intact males more likely 0% of neutered males and 5% of spayed females will mark Hart, Benjamin L. "Behavioral and pharmacologic approaches to problem urination in cats." Veterinary Clinics of North America: Small Animal Practice6.3 (996): 65-658. Multi-cat households more likely to spray 9 0 3 Marking Causes Territorial Hormonal Anxiety-induced Sometimes used to make feel more self assured-coping mechanism Displacement behavior Punishment Arousing events Sights, sounds, odors Not likely medical Clues to Cause Conflict outside (other cats or triggers) Outside walls and windows Conflict inside (other cats, animals, people) Interior doors, walls, and furniture Who's items are targeted Separation Anxiety in Cats House-soiling most common clinical sign (O bed) Psychogenic grooming-female Destructive behaviors-males Vocalizations Step 4: Treatment Plan. Identify culprit. Litterbox number 3. Litterbox hygiene 4. Litter type 5. Clean the environment 6. Avoid punishment 7. Reward litterbox use Inappropriate Elimination Treatment Plan Address litter box factors Clean soiled areas Anti-icky Poo/Febreeze Pet Odor Eliminator 4

Make soiled areas aversive Detergent Soaps Citrus, pine, lemon scented products Carpet Runners Pheromones Plenty of resources Increase vertical spaces Environmental enrichment Avoid Punishment 4 5 6 7 8 Marking Treatment Plan Identify triggers and avoid Treat intercat aggression Medications Pheromones Limit access to soiled areas and clean well Outdoor time/space Block visual access if outside cats are trigger Increase people time Play Reward based training Separation Anxiety Tx Similar to IE and Marking Multimodal enrichment Anti-anxiety medications Management Tools Remote Devices Scat Spray Scat Mat Scarecrow Window film Stand up litter box/ Plexiglass Stud pants (http://www.grannynannyhearts.org/studpants.html) Vinyl Carpet Runners Medications No drugs have been shown to decrease inappropriate urination. It is a toileting issue. May be helpful in reducing marking behavior in combination with environmental management and behavior modification Nutritional Supplements: option # 5

Anxitane L-Theanine Cats tend to like it Zylkene Milk protein Sprinkle on food Solliquin Both L-theanine and milk protein 9 30 3 Pheromones: option # Feliway F3 fraction of feline facial pheromone Alters emotional state via limbic system and hypothalamus Spray or diffuser Feliway Multicat Mimics the pheromone cats are exposed to while nursing Nuturecalm collar Diets: option #3 Pharmacological Treatment: Option # Selective Serotonin Reuptake Inhibitor (SSRI) Blocks reuptake of Serotonin by the presynaptic neuron Fluoxetine(Prozac) 0.5-.0 mg/kg/day Paroxetine(Paxil) 0.5-.0 mg/kg/day Side effects: Decrease appetite Vomiting/Diarrhea Increase agitation Urinary retention 3 Pharmacological Treatments: Option # Tricyclic Anti-depressant (TCA) Blocks reuptake of neurotransmitters Clomipramine (Clomicalm) 0.5-0.5 mg/kg q 4hrs More specific for Serotonin than other TCA s Side effects similar to SSRI includes sedation 33 Other Treatment Options-Amitriptyline Tricyclic anti-depressant Bitter tasting-more difficult to give No studies on effectiveness to date 6

34 35 36 37 38 Other Treatments-Buspirone Buspirone reduce 55% stop 33% Less side effects-hepatic Might be useful older cats Twice Daily dosing - weeks for effect Lower relapse rate than benzodiazepams- 50% Other Treatment-Benzodiazepines Diazepam Reduces spraying in 55-74% Relapse 90% of the time Greatest effect on neutered males Side effects Twice daily administration Lorazepam, oxazepam, clonazepam No active intermediate metabolites Other Treatments-Cyproheptadine Antihistamine Appetite stimulant Comparative study clomipramine more effective Kroll, T., and K. A. Houpt. "A comparison of cyproheptadine and clomipramine for the treatment of spraying cats." Proceedings of the 3rd International Congress of Veterinary Behavioural Medicine. Potters Bar: Universities Federation for Animal Welfare. 00. Other Treatments-Selegiline MAOI (Monoamine Oxidase Inhibitor) May be useful for elimination disorders related to cognitive decline Not much research on effectiveness Other Treatments-Progestins Less effective than most other meds except in neutered males 50% compared to 0% effective in females High potential for side effects Immunosuppression Mammary cancer Diabetes mellitus 39 Summary of Medical Treatment-Marking Greatest reduction of marking resulted from fluoxetine in combination with environmental management and cleaning Clomipramine was also effective but dose and effects were more variable. 7

Pheromones resulted in significant reduction in marking but did not stop it. Transdermal not effective 40 4 Step 5: Follow-up Need to treat for at least 8 weeks Once stopped spraying for months, then can try to decrease medication slowly over several months Reoccurrence likely unless environmental changes are made. Second course of treatment can be as effective as the first. 6- month rechecks and bloodwork if on meds Summary House-soiling is a common life threatening behavior problem in cats A good history, physical examination, and diagnostics is critical for an accurate diagnosis and treatment. Identifying the culprit is necessary Treatment is multifactorial Marking is a normal form of feline communication Medications will not reduce inappropriate elimination but can help reduce marking behavior 4 8

NOTES

Aggression in the Veterinary Hospital Speaker Christine D. Calder, DVM A 998 graduate of Mississippi State University College of Veterinary Medicine, Christine spent over 5 years as a general practitioner in both New Jersey and Maine before returning to Mississippi State in 04 to complete a non-conforming residency in veterinary behavior. Since her arrival at MSU-CVM, Christine has started a behavior referral service in the teaching hospital and a clinical behavior teaching program. In addition to her interest in behavior, she also enjoys shelter medicine and finding ways to enhance the human-animal bond.

3 4 5 6 7 8 AGGRESSION IN THE VETERINARY HOSPITAL CHRISTINE D. CALDER, DVM INTERESTING FACTS An estimated 78.5% of dogs coming into veterinary hospitals show signs of fear, anxiety, and stress 8% of those dogs bite due to fear 5% show active defensive tendencies It s not just the pets: 6% of dog owners and 38% of cat owners are stressed just thinking about going to the vet Bayer Veterinary Care Usage Study FEAR VS. ANXIETY VS. STRESS Fear: Emotional response to a situation Anxiety: Anticipation Stress: Specific response of the body to a stimulus FEAR Emotional response Not born with fear response As eyes and ears open start to bond with the animals around and determine if the surrounding environment is safe. Startle easily but recover quickly because everything around is safe. As they get older and begin to wander, default becomes to be afraid of new things Wild animals the default setting is to be afraid of new things. WHAT IS AGGRESSION? Aggression is a behavioral strategy that a pet uses in a social interaction to avoid or end an unwanted encounter and to relieve underlying fear or anxiety. Common Sense Behavior Modification: A Guide for Practitioners Debra Horwitz, DVM and Amy L. Pike DVM Vet Clinic Small Animal 44 (04) MOST COMMON REASONS WHY OUR PATIENTS ACT AGGRESSIVELY? Fear Anxiety Stress Pain Learned behavior: past experiences WHY IS IT IMPORTANT TO REDUCE FEAR, ANXIETY, AND STRESS IN OUR PATIENTS? We want to provide the animal with a good experience We want to make the animal better, not worse Remember ever interaction we have teaches the animal something. It is safer for all involved Helps provide trust from client and increased compliance. Provides good welfare for patient and client WHAT ABOUT FINE?

3 4 WHAT SHOULD IT MEAN: D = Deliberately I = Initiates V = Voluntary I = Interactive N = Novel E = Encounters F = Freely I = Interacts N = Nicely E = Enthusiastically Relaxed state of mind, willing and voluntarily participant in the procedure, and can take treats. WHAT IT OFTEN MEANS: F = Frozen A = Avoiding S = Stoic T = Tolerant F = Freaking out I = Insane N = Neurotic E = Emotional Fine can also be Feelings Inside are Not Expressed Patient perspective: Want it over Fast, Fast, Fast!! 9 0 FINE IS NOT ALWAYS FINE Their compliance is not an indicator for obedience but rather coping instead of escalating into an aggressive state. Colleen Koch, DVM DVM 360 Low Stress Handling Algorithm: Key to Happier Visits and Healthier Vets WHY ELSE IS FINE NOT GOOD ENOUGH? Fear is the most damaging thing a social species can experience. It can cause permanent changes in the brain Karen Overall CATS AND THE VETERINARY HOSPITAL Cats stress begins at least 30 minutes before appointment and can last at least 30-45 minutes after visit. Fear number one reason aggressive at the vet. Pain is number. Clients tend to bring in old and young cats-loss of opportunity for client education and early disease detection Cats are not small dogs! NEEDS VS. WANTS Identify if procedure needs to be done Ear infection Eye injury

Sutures Nail trim (want vs. need) Identify if procedure can be rescheduled Vaccinations Nail Trim Anal gland expression 3 WHAT METHODS ARE WE GOING TO USE IN THE HOSPITAL? If need, chemical restraint may be needed If want, send home with PRN medication Short term: Mostly low stress handling and classical conditioning Fear is an emotion not a behavior can t be reinforced with food. Long Term: We can talk to clients about desensitization and counterconditioning-operant conditioning. 4 5 FEAR-AGGRESSIVE CATS Nutraceuticals Zylkene Solliquin Medications: Gabapentin 00-00 mg/cat hr before arrival Trazodone 5-50 mg/cat Phenobarbital Melatonin 0.5 mg Oral buprenorphine Telazol powder in food-feral cats Oral ace with above Sedation Dexmedetomidine -5 microg/kg IV or 5-5 microg/kg IM With opoid- butorphanol 0.mg/kg Ketamine 5 mg/kg + midazolam 0.5 mg/kg Boxing down/tank-not ideal FEAR AGGRESSIVE DOGS Nutraceuticals Zylkene Solliquin Medications: Trazodone 3-8 mg/kg 90 minutes before appointment Gabapentin 0-40 mg/kg/dose Clonidine up to 0.0-0.05 mg/kg 90 minutes before Oral Dexmedetomidine gel (off label) Sedation Dexmedetomidine -3 microg/kg IV or 3-0 microg/kg IM *decrease dose if use with opiods* Butorphanol commonly used in combo with above at 0. mg/kg IV or IM 3

Consider morphine/hydromorphorne/methadone if high level of pain 6 7 8 9 0 FOOD IN THE VETERINARY HOSPITAL-WHAT DOES THE RESEARCH TELL US? TOOLS: Teach O how to put on at home Basket Muzzle better than sleeve Can feed through Can pant and drink water Gentle Leader Snoot Loop Calming Caps Towels Mats WHAT ELSE CAN WE DO TO REDUCE AND MANAGE STRESS, FEAR, ANXIETY, AND AGGRESSION IN OUR PATIENTS?. Prepare for the visit. In the waiting room 3. In the exam room 4. At the hospital PREPARATION STARTS WITH RECEPTION Ask questions when client makes appointment. Do you have a carrier? Does the pet need medication? Preferred Dr.? Prefer male vs. female Dr.? Schedule first of the day or last of the evening Ask client to wait in car-text/call when arrive Manage waiting room (separate dogs and cats) Place anxious animals right into exam room Check out in exam room THE EXAM ROOM Give time to acclimate Classical music Mat on floor Mat on table Litter box on floor Toys in the room Cats-have all equipment in the room Pheromones in the room THE EXAM On the floor with dogs Some cats prefer to stay in carrier Some dogs and cats prefer in the lap 4

3 4 Towels Examine back to front Monitor body language (lip licks, yawns, panting, ears back, suddenly closed mouth) Continuous touch and talk Greater than 0 treats per minute HOW TO GREET A DOG DO: Let the dog come to you Face sideways and avoid direct gaze- make yourself small Move slowly, smoothly and avoid sudden movements Give the animal time to get used to your presence Relax Watch dog s body posture and responses Approach with a happy but not excessively high pitched voice DON T Lean over the dog Try to kiss the dog Reach for the dog Grab the dog s collar Turn your back on a fearful dog 3 4 5 6 RESTRAINT Follow the 3 second rule- dogs and < in cats Reposition Second person Chemical restraint Always support the animal and avoid flipping Adjust your technique based on the animals response Guide into position changes-use your body Cats-Do not automatically scruff or stretch Hold the collar and prevent movement in 6 directions but not death grip-support LOW STRESS HANDLING: SMALL DOGS-C HOLD LOW STRESS HANDLING: LARGE DOGS TOWELS AND BLANKETS Small Dogs Cats 7 WHAT ABOUT SCUFFING? Mother has specific pressure points Can make more aggressive-defensive aggression Often learned helplessness 5

Use C-hold(thumb and pointer finger) and towels Emergency only 8 9 30 3 3 33 34 35 36 37 OTHER PROCEDURES OTHER PROCEDURES BLOOD DRAW- HILLVIEW VETERINARY CLINIC THE SCALE SLEEVE MUZZLE: HTTP://DRSOPHIAYIN.COM/RESOURCES/NEWSLETTERS/NEWSLETTER- VOL--SPRING-0 THE HOSPITAL Low light Soft voices Separate dogs and cats Place cats in higher cages Hiding places for cats Lets dogs come to you-do not reach in cages Pheromones Classical music Lavender diffusers PREVENTION An Ounce of Prevention is Worth a Pound of Cure -Benjamin Franklin EXAMPLE OF PREVENTION-FREEPORT VETERINARY HOSPITAL FREEPORT, ME SUMMARY Aggression is a strategy that an animal chooses to stay safe Aggression is often a result of fear, anxiety, or pain and can be learned. To reduce aggression we have to recognize and change the emotional state of the animal. Fine is not obedience Fine still equals fear Force will increase struggling and result in negative emotions. Classical conditioning helps change the emotional state Desensitization and counter conditioning teach the animal a better coping strategy. Less restraint doesn t necessarily take more time and can be safer for all involved. QUESTIONS? 6

NOTES

Separation Anxiety Disorder Speaker Christine D. Calder, DVM A 998 graduate of Mississippi State University College of Veterinary Medicine, Christine spent over 5 years as a general practitioner in both New Jersey and Maine before returning to Mississippi State in 04 to complete a non-conforming residency in veterinary behavior. Since her arrival at MSU-CVM, Christine has started a behavior referral service in the teaching hospital and a clinical behavior teaching program. In addition to her interest in behavior, she also enjoys shelter medicine and finding ways to enhance the human-animal bond.

SEPARATION ANXIETY DISORDER CHRISTINE D. CALDER, DVM WHAT IS IT? One of the most common diagnosed behavioral condition 4%-7% of dogs receiving veterinary care 0-40% of dogs referred to animal behavior practices Severe emotional distress and physiological changes that occur Left alone in any environment Separation from human companion Separation from other dogs Sherman, Barbara L. "Separation anxiety in dogs." Compendium (008): 8-3. Sherman, Barbara L., and Daniel S. Mills. "Canine anxieties and phobias: an update on separation anxiety and noise aversions." Veterinary Clinics of North America: Small Animal Practice 38.5 (008): 08-06. 3 4 RISK FACTORS FOR SEPARATION ANXIETY DISORDER Any breed or mix Adopted from shelter Single person household Left alone or away form owner for long period of time Crated for long period of time Change in environment or routine Separated from mother too young Genetics? Co-morbidities (i.e noise phobias) CLINICAL SIGNS Clinical signs only occur when home alone or away from their person Vocalizations barking/whining/howling Elimination urination +/- defecation Destructive behavior chewing, scratching, digging Departure anxiety clingy, depressed, aggression in some Excessive greeting behavior Hypersalivation-puddles Self-injury Teeth, toenails, lacerations, nose Anorexia

5 6 7 8 9 DIFFERENTIAL DIAGNOSIS Incomplete housetraining Noise or storm phobia Boredom/inadequate enrichment/inadequate exercise Territorial aggression Confinement anxiety Medical condition STEP : TAKE A GOOD HISTORY Does elimination occur when owners are home? incomplete housetraining or marking Do you notice fearful/anxious behavior during storms? Storm phobia Do you notice fearful/anxious behaviors when hear noises? Noise phobia Does the behavior occur sporadically? Noise or storm phobia Did the behavior start on a storm day? Storm phobia Destruction occur in the presence of owner? boredom, inadequate enrichment Is the behavior focused on front windows and occur when home? Territorial aggression Is the dog crated? Confinement anxiety Are there other clinical signs that may point towards medical? Age of onset? Geriatric PU/PD Seizures Incontience STEP : GOOD PHYSICAL EXAMINATION AND DIAGNOSTICS Behavior diagnosis is one of exclusion Minimum Database CBC Serum Chemistry Urinalysis +/- urine culture Fecal Thyroid Radiographs Ultrasound STEP 3: VIDEO RECORDING Only way to get a true diagnosis of separation anxiety!!! Look at the clinical signs Video in and out of crate (if confined) Essential for diagnosis and success of treatment TREATMENT PLAN: PHASE I Treat other underlying co-morbidities Try out of crate, behind a gate, or ex-pen if suspect confinement anxiety Doggie Daycare (if ok with other dogs) Boarding facility Family member housesit/or take to family member s house