Thursday, December 9, 2010
Re-check with the Veterinary Behaviorist
Maisy had her eight week re-check with Dr. Duxbury, her board-certified veterinary behaviorist, on Monday. This appointment lasted longer than I expected- almost two hours- and we reviewed the behavior logs and the charting that I had done. We also discussed my general observations, as well as my goals and hopes for Maisy. I guess I still don’t know if Maisy’s response has been “typical,” but Dr. Duxbury did say that for most people, the level of improvement we’ve seen in Maisy is “enough.”
I don’t want to undermine Maisy’s progress- it’s been phenomenal, and I’m thrilled. In fact, Maisy was incredible in the exam room yesterday. At our first appointment, Maisy alternately paced and sought out interaction. She settled only when I asked her to, and it was very clearly an operant behavior, not a truly relaxed one.
This time around, Maisy was much calmer. She spent most of the time on her mat, and she had a very soft, heavy-lidded look to her eyes. Incidentally, I’ve heard people talk about this look on email lists before, but never really understood what they meant. Now I do, and I must have pointed it out to Dr. Duxbury half a dozen times because I was so amazed. Although she did get up from time to time, her body movements were soft and fluid instead of quick and frantic. She wasn’t pacing so much as she was bored. She was truly a different dog. Dr. Duxbury even said that she wished she’d taken video at Maisy’s initial consult!
With that said, I want more progress. Maybe that makes me greedy, I don’t know, but like Dr. Duxbury said, we won’t know how much more is possible without trying. She certainly didn’t seem to think I was being unreasonable, and I completely trust that she would say something if I was.
We discussed my goals for Maisy. Dr. Duxbury wasn’t surprised that Maisy had a hard time when we were at my parent’s house, but she was a bit concerned by how long it took Maisy to recover. (I actually feel like a three to four day recovery period is a big improvement for her, but I don’t have any data to back that up.) We agreed that a short-acting, as needed medication is probably in Maisy’s best interest. We discussed both trazodone, which is a serotonin modulator, and alprazolam (Xanax), which is a benzodiazepine. Since we don’t have any big events planned for several months, we decided to wait until we’ve decided what to do with her routine meds.
Because I want to see the number of anxiety-provoked reactions around the house reduced from the current average of two per day to something like three or four per week, we agreed to increase Maisy’s paroxetine. Currently, she’s on 8mg (1mg/kilo of body weight), and we decided to increase it to 10mg (1.25mg/kilo). I will continue to keep intermittent behavior logs, and we’ll consult again in four to six weeks. At that time, we’ll discuss increasing to a max of 12mg (1.5mg/kilo) and/or adding a second medication (probably clonidine, a centrally acting alpha-agonist).
Speaking of behavior logs, I totally got a gold star. I’m glad they were useful, because they are an awful lot of work. Honestly, I’m not looking forward to doing more of them, but I can’t deny their importance. Dr. Duxbury’s student analyzed them for patterns (she thought maybe Maisy was having a series of lower-intensity behaviors that culminated in a high-intensity one, but that theory didn’t pan out). We also discussed the fact that some of the stimuli that Maisy is reacting to is reasonable- for example, someone at the door- while some of it isn’t. My new task is to start coding my logs in an effort to pinpoint which type of stimulus is causing most of her reactions.
I will also start doing some desensitization and counter-conditioning around the house. I decided to focus primarily on interactions with the cats, mostly in an effort to help reduce the stress in their lives, too. Dr. Duxbury also recommended giving a treat when Maisy startles but doesn’t go over the top. Obviously, being consistent with this will yield the best results, so I’m going to have to pay close attention to what’s going on. I will also need to have treats close by, which may result in my being mugged for a few days. This could be interesting!
Like I said, it was a great appointment, and I was absolutely thrilled with the professionalism, respect and attention we received. Seriously, if anyone in the area needs a vet behaviorist, I can’t recommend Dr. Duxbury enough.