Thursday, February 3, 2011

Medication Update: 8 weeks at 10mg

Maisy has now been on the increased dose of paroxetine for 8 weeks, which means that it should be at its full effectiveness. At our recheck appointment with the veterinary behaviorist, Dr. Duxbury commented that the level of improvement Maisy had shown would probably be enough for most people. I, being greedy, wanted more, which is why we increased the medication. I am glad we did, because I’m thrilled with the additional improvement I’ve seen in Maisy.

As you may remember, before beginning the medication, Maisy was averaging 3.58 incidents per day in which she would startle, bark, or growl at mild or undetectable stimuli. About a third of these would happen overnight, waking us both up. These behaviors were pretty intense: approximately 1 in 4 lasted longer than a minute, and she would scan the environment and/or or leave the room to look for the trigger roughly 1 in every 3 times.

After seven weeks on the 8mg dosage, she was averaging 2 incidents per day, and thankfully, the number at night had reduced dramatically, happening roughly 1 time out of 10. Similarly, the duration of her behaviors shortened, and she wasn’t showing any vigilance. You can see the logs for the first two months of medication here.

Now? Well, at 8 weeks on the new dose, she’s averaging 1 incident per day, although it’s honestly hard to label some of them as incidents. For example, on Sunday, she simply looked up and softly “wuffed.” I wrote it down to be consistent, but that sort of thing doesn’t concern me in the least. The average duration of her behaviors is 5.7 seconds, which shows that her vigilance has greatly reduced, and that she recovers quickly. And the absolute best thing? She isn’t waking me up at night anymore.

Here’s the chart for the last two months (click to embiggen):

As you can see, it’s been up and down. She actually did the best at four weeks, with a rough spot at six weeks. I saw a similar trend the first time around, and I’m beginning to wonder if this is just a normal reaction to SSRIs. At any rate, it's clear that the increased dose has had positive behavioral effects.

These effects have carried over to Maisy’s behavior outside our house, as well. Recently, I took Maisy to a pet store on a Saturday afternoon, and it was fairly busy inside. There were rude dogs, men in funny hats and unpredictable children, and yet she handled herself well. In the 45 minutes that we were there, she only had one outburst, a very quick bark at a large golden on a flexi, literally dragging a child wearing clompy boots down the aisle towards us. I can hardly blame her for her reaction! I think the best thing about the visit, though, was that I wasn’t actively managing her. I wasn’t requesting behaviors or shoving treats in her mouth, which is a huge change from how it used to be.

Needless to say, I’m thrilled. After consulting with Dr. Duxbury, we agreed to keep Maisy on this dose. Going forward, I’ll take behavior logs once a month, and then return for a follow-up appointment in June.

Even more exciting… Dr. Duxbury said I could work towards getting Maisy ready for trials again! I've been given orders to take things very slow, so I will be very purposeful about the level of stimulation I expose her to. I am working on a training plan to follow so that I don’t accidentally push Maisy too hard, and I’ll share it with you all soon. If there’s anyone with experience with this, I’d love to hear what you did.

For now, I just want to say that I’m so grateful for the knowledge and experience that Dr. Duxbury has shared with me, the support I’ve gotten from you all, and best of all, my newly relaxed dog. It’s been a crazy journey, but it’s been worth it!


Laura, Lance, and Vito said...

That is awesome news!!! Very thrilling and I am going to be super excited to see you and Maisy at trials!

I also have you to thank for writing about this experience as it has pushed me to just start my own journey with Vito. I hadn't even thought about drugs until you started writing about it.

Anonymous said...

It's great that you're getting the behavior that you want. However, have you read the side effects of Paroxetine? Do you know what this is doing to your dog? Paroxetine comes with a Black Box Warning and some serious side effects; did you have this conversation with your veterinarian? Did he mention that it's not approved for use in pets? If you haven't I'd talk with him about alternatives. One other thing; discontinuation of Paroxetine needs to be carefully monitored. Patients on SSRI's, especially Paroxetine, can experience severe and even debilitating withdrawal symptoms.

Crystal said...

Laura- What are you and Vito doing?

Anonymous- We are seeing a board-certified veterinary behaviorist, someone who has a lot of education and experience using psychotropic medications with dogs. She did inform me that paroxetine is not approved for use in pets, and we have discussed the possible side effects. We are monitoring her closely and perform regular blood work. She even told me that there are also some contra-indications of using paroxetine and certain flea medications at the same time.

I do not think medication is a decision to be made lightly, and we tried both behavior modification and natural supplementation first. At this time, given the benefits and extreme improvement in Maisy's quality of life, I'm comfortable with the risks. Thank you for your concern though.

Kristine said...

So glad it's all been worth it. I don't think anything is an easy fix, not even medication. You've obviously worked so hard with Maisy every step of the way and I think that has helped you both achieve this level of success. I am so thrilled for you both.

Crystal said...

Thank you, Kristine.

Joanna said...

Awesome news! I see great things in your future from here. :D

Kirby @ Dog.Nerd.101 said...

This is awesome. I appreciate your candor in sharing your experience. Do you have an excel file or something that you are using to track her behaviors? Would you be up for sharing it?

Crystal said...

Yes, I am using an excel file. I'd be glad to share it with anyone that would like, but it needs a bit of work- I've hand coded the cells, and can't quite figure out how to make it more user-friendly. It's also very individualized for Maisy, so I'm not sure how useful it would be for others, but I know that sometimes anything is helpful. Shoot me an email cryslea at comcast dot net and I'll share it with you.