Thursday, June 30, 2011

Now I Understand

 At my old job, I worked with adults with disabilities, but many of my clients were also diagnosed with some sort of mental health condition. Today, I want to tell you about Jerry. (Both his name and the details have been changed for privacy reasons. The essence remains true.)

Jerry was diagnosed with an anxiety disorder, but when I first met him, he was on medication, so I found it hard to believe that the mild-mannered man in front of me was the same man as described in his file. According to his paperwork, when his anxiety was really bad, he would become destructive and violent.

But his brothers didn't care that his medication was making him calm. He wasn't acting like the Jerry they knew, so at their insistence, the medicine was stopped. At first, everything went well. He became more talkative, and was really quite funny. As time went on, though, his cute sayings turned into perseveration. He began to pace the hallways and pick at his skin until it bled. It was heart-breaking to watch, and I'll admit I was quite judgmental. I just couldn't understood why his brothers, who claimed to love him, would do this.

You're probably wondering what all this has to do with dogs. Well, it's this: I tried the trazodone with Maisy the other day, and I hated what it did to her. For a good portion of the morning, she sat staring at me, but not really seeing me, if that makes sense. Every time I tried to interact with her, she'd blink slowly and lick her lips. She barely moved, and then only with significant coaxing. Even so, it was painfully slow and she appeared uncoordinated and clumsy. She just seemed drugged.

No matter how well the trazodone worked, I would have hated it because of that alone. Unfortunately, it gets worse. Within half an hour of taking it, she abruptly stopped eating breakfast and began whining incessantly instead. If I was sitting, she was in my lap, and if I was standing, she was curled up around my foot. For a dog who doesn't really like to touch or be touched, she was acting as though she needed to crawl inside my skin.

She refused to enter the bathroom- you know, the room where we keep the post-tooth-brushing-rawhides that she begs for every chance she gets? She seemed terrified of the tile floor, even though she's never before shown any hesitancy of walking on it (or any other tile floor) before.

Outside, she avoided locations and objects she normally loves, and she would stare and stare when she heard a noise. It wasn't hypervigilance so much as it seemed like she just couldn't process what she was hearing.

Thankfully, I knew that medication can and should work better, so I emailed Dr. Duxbury before it had even worn off completely, expressing my concern. She emailed back and called Maisy's reaction an “agitation response.” She advised me not to use trazodone anymore, and said she would phone in a prescription for clonidine instead.We'll try that this weekend.

But this experience gave me a new sense of empathy. I suddenly understood how Jerry's family must have felt. His anxiety may have been gone, but at what cost? For several hours, I felt like I'd lost my dog. Everything I love about my dog- her enthusiasm, her happiness, her energy, her intelligence- it was all gone. She wasn't acting like the Maisy I know. How must Jerry's family have felt, slowly watching their brother go from a funny guy to one who barely spoke? Sure, he wasn't injuring himself anymore, but he also wasn't doing much of anything.

I'm so glad that it's not an all-or-nothing proposition. I am thankful to have the support of a veterinary behaviorist who will help us find the drugs that work, who wants "only the best" for my dog. I am so glad that we found a long-term medication that allows Maisy to feel comfortable in her own skin, but that doesn't rob her of her personality. And I hope that Jerry's family can find that for him, too.


A. said...

Before I finished reading your post, I, too, was thinking, "It sounds like Jerry is great! Why would his brothers want to remove him from the medication?" But I get it now. You're right: he seemed well enough, but the people who had known him the best and longest knew what was sacrificed to get there.

I'm glad that your vet listens and is considerate. Here's hoping the new medication takes better!

Crystal Thompson said...

Unfortunately, folks who are in "the system" have a lot of staff turnover, so we often have little context for what "normal" is like for them. I had no idea that Jerry could talk and be so funny until they took him off meds. Professionals need to collaborate better with families to ensure that the meds chosen don't have undesirable side effects. It seems to me that there can be a balance between symptom control and preserving the personality. I still think Jerry would benefit from medication- they just didn't find the right one.

I am thankful to have a vet behaviorist who understands that using medication isn't simply about medical improvement. It's about LIFE improvement.

Ashley Hiebing said...

I had an experience similar to what you described in high school. I was on a lot of different meds, and for the most part they just completely numbed me out, to the point where sometimes I would have dissociative episodes (forget who I was, what I was doing, like I was watching myself in a movie, etc). As I mentioned in my blog, I struggle with overwhelming emotions and a lack of coping skills, so it was a fine line between being a zombie and freaking out at every little thing.

My illness (not fond of using that word, but that's what it is) is pretty famous for not responding to medication. Therapy works better, but for some people they can find the right drug cocktail to keep things under control.

I would imagine it's the same with dogs. Some meds just don't work at all, or make things worse, and some work great. I hope you find one that works!

Cheryl and Kirby said...

Wow that had to be awful to watch Mayzie go through that, I can imagine how people feel with their family members when they are on those meds too. You are right, they need to find the right balance. Sounds like you have an awesome vet, good luck with the meds.

Kirby's mom