Sunday, December 5, 2010

Medication Update: 8 Week Re-Check

Maisy has a re-check appointment with Dr. Duxbury, her veterinary behaviorist, this week. We are going to evaluate her response to Paxil, the current dosage, and consider if an additional medication might be helpful. I’ve kind of been freaking out about this. I have no idea if Maisy’s response to the meds is typical; maybe the average dog is doing better (or worse) at this point. But I guess this is why I hired a professional, right?

There is much less preparation to be done this time around; no form to fill out and no videos to be taken. Because I’m a geek, I have been keeping behavior logs, although the behaviorist didn’t request them. Instead, I was told to be ready to share my general impressions of how Maisy’s doing, and the areas of continuing difficulty.

I find this incredibly overwhelming. I think she’s doing well, and I’m happy that I chose to put her on medication. But she’s not doing as well as I hoped, and I have no idea how much improvement is reasonable to expect. I don’t think Maisy will ever be “normal,” but how close can we get without overmedicating her?

After several days of panic, and many scribbled pages of notes, I realized that it would be easiest to think in terms of goals. How would I like to see Maisy behave? What do I want to see change? In the paperwork I filled out prior to her consult, I identified two goals: for Maisy to be able to relax, and (if possible) to be able to take her to trials again. Although I still have these goals, I’ve expanded on them so that I have a better idea of what I’m looking for. I’ve also prioritized them, because it’s far more important that she can relax at home than at a trial. I’ve listed these goals below, along with my comments on her progress.

1. Ability to relax at home. Specifically, I want Maisy to be able to hang out and/or take naps without startling over undetectable or minor environmental stimuli. Overall, she’s improved. Her vigilance has reduced, as well as frequency of outbursts. The outbursts are lower intensity and lower duration. She is less restless, and is choosing to nap instead of seek constant interactions with others. She is sleeping more often and more soundly, and is demonstrating increased impulse control around the cats.

2. Ability to settle in low-stimulation environments. If I take her to a friend or family member’s house, I’d like for her to feel comfortable enough to lie down and chill instead of pacing or wandering around. Although my parents thought Maisy did well at their house over Thanksgiving, and commented that she seemed calmer, I think that her vigilance and outbursts were on par with baseline data, or possibly even higher. (I wish I’d done behavior logs at their house.) Also, she paced the entire time we were at my grandparents’ house one afternoon, and couldn't settle, even when there were treats involved.

3. Ability to sleep in low-stimulation environments, especially for overnight trips to a family member’s house, but also at hotels. Maisy didn’t sleep the first night at my parents’ house, instead pacing most of the night, punctuated with barking outbursts. After about 12 hours, she seemed to get used to the environment, and was sleeping better than she had prior to medication (even at home), but not as well as she had been when I did the logs for the six-week update.

4. Ability to recover from stressful events within 24 to 48 hours. Maisy had an average of 3.75 outbursts a day for approximately four days after returning home from my parents’ house, at which point they reduced to the six-week levels, or maybe even a bit better. Despite the frequency of outbursts, 40% were silent (compared to 14% at baseline), which seems good. She was able to sleep (and absolutely crashed the night we got home), although not as well as she’d been doing prior to the trip.

5. Ability to go to trials without demonstrating reactivity. Bonus points if she can relax in her crate at a trial, or can do full days and/or multiple days. Obviously, we haven’t tried this yet. We’ll continue to wait and watch to see if it’s appropriate. It may not be, but I would really like to be able to do at least a single run at a small trial once or twice a year. That said, I do recognize that it’s not likely that she’ll ever be in it for the long haul.

Overall, while I’m pleased with Maisy’s progress, I’m hoping for more. I’m looking forward to discussing everything with Dr. Duxbury, and can't wait to tell you guys about the appointment. It's sure to be interesting!


Laura, Lance, and Vito said...

I think you are the one who needs to relax! I think it's wonderful how great Maisy is doing on the meds. Regardless of what you find out at your appointment you must be breathing a sigh of relief to just watch her sleep!

Crystal said...

Oh my gosh, Laura, I have taken about a BILLION pictures of her sleeping. It's ridiculous, but I'm just SO EXCITED.

I kinda freaked out because I'm not very good at thinking on my feet. If I think about stuff ahead of time, I can be quite smart, and I'm great in writing. But trying to relay "this is how my dog is doing" verbally is not easy for me. I just updated again with a chart summarizing the behavior logs, so I think I'm ready for the appointment!