Be Careful What You Wish For

As the owner of a high-energy dog, I have often longed wistfully for something a bit quieter. I have specifically envied my friend Elizabeth, who has a greyhound. For those of you who foolishly believe that as ex-racing dogs, greyhounds must be impossible to live with, let me reassure you: they take retirement very seriously. If a surface is horizontal, a greyound will lie on it. Which, of course, makes Elizabeth's greyhound Beckett seem perfect to me and my fellow crazy-dog-owning friends.

That said, this weekend, when we tried out clonidine as our new short-acting "event" drug, I realized that I sort of prefer a crazy dog over a more mild-mannered one.

Ahhh, that's much better.

Maisy has had some mixed responses to medication. Paroxetine has been a wonder-drug for her, but her experience with trazodone was awful. So, I was nervous when I gave her half of a 0.1 mg tab of clonidine last Saturday. I shouldn't have been- I didn't really see much of a difference in her demeanor.

Still, it was a pretty low-key day to go with a pretty low dose, so the next day we tried a full one. We also happened to be going to a BBQ with dog-friends, and they all commented that Maisy seemed more subdued than usual. She wasn't lethargic, they said, just a bit slower.

I should have been thrilled. I've been saying for years that I want a quieter dog, but to be honest, it wasn't quite as awesome as I'd hoped. I missed Maisy's flitting about, her obnoxious begging, and her quirky antics. While the paroxetine seems to filter out the "static," the clonidine just turns the volume down entirely.

When I shared that with Dr. Duxbury, she replied that she understood completely. While she felt the response was favorable, she recommended only using it for high-anxiety situations. I can use it up to twice a day, but if I need to use it for several days in a row, it's best to taper it off. For example, at the end of the month, Maisy will be staying at a boarding kennel for four days. Once I return, I will give her half doses twice a day for two to three days, and then once a day for a few more days after that. I foresee a very boring week...

While the medication will be helpful for situations like boarding or emergency vet visits, I know I won't be using it regularly, nor for things like trials. I just don't like the quiet Maisy. I'd much rather have my enthusiastic, outgoing, crazy dog. So, be careful what you wish for, guys- you might find that you've been wrong!

Medication Update: 4 weeks at 10mg

I love Paxil.

That’s what I told Maisy’s veterinary behaviorist when I updated her on Maisy’s progress. Needless to say, the report was absolutely glowing. You guys, I love Paxil.

As a reminder, at baseline, Maisy was having an average of 3.58 incidents a day in which she barked, growled or startled at undetectable or minimal stimuli. It wasn’t uncommon for those incidents to last longer than a minute. She would trot around the house vigilantly, scanning the environment, looking for… something. After two weeks on paroxetine, that had reduced to 2.5 per day. At four weeks, it was 2.67. At six weeks, 1.33. At seven weeks, it was up again to 2. Then we increased Maisy’s dosage from 8mg to 10mg, and after two weeks, she was having an average of 2.5 incidents per day.

I took three days worth of behavior logs this week. Guess how many incidents she had. No, go on, guess. I’ll wait…Okay, are you ready?

She had one.

Not per day. One. Total. For three whole days. And the incident was pretty minor at that. I’m not entirely sure what happened, as I wasn’t in the same room with her, but I heard her bark twice. The barks were somewhere between an alert bark and a play bark, and when I went to check on her, she was sitting in the living room, wagging her tail, and looking through French door at her cat, Malcolm. Malcolm was next to the front door, and if I had to guess, he probably made some small noise that startled her. There was no vigilance. She didn’t leave the room, and the incident wasn’t long and drawn out. She just barked. And that was it. That’s all that happened in the last three days.

At Maisy’s re-check appointment a month ago, I told Dr. Duxbury that I was hoping to reduce the number of incidents from 2 to 3 per day down to 2 to 3 per week. I guess we made it.

I love Paxil.

But that’s not all the good news. For instance, Maisy continues to sleep. In fact, this weekend, I emailed my friends to ask how much their dogs sleep, because Maisy is now averaging 17 to 18 hours of sleep per day. (For the record, this was pretty much right on with what their dogs do.) Whereas she used to pace, harass the cats, or incessantly drop a tennis ball in my lab, now she tends to simply curl up next to me and snooze.

Along those same lines, the other day Maisy was doing just that, and when I got up and left the room, she didn’t follow me. This has never happened before. She has always followed me, even if I was just moving a few feet away. Not that I minded, of course, but I always felt bad that she would jump up as if startled just because I moved. I actually love that this time, she just sleepily watched me walk away.

Another first happened when my husband came home late (think 2 am) one night. Usually, this causes an explosion of barking and growling, but she didn’t make a peep that night. She woke up, and she was excited to see him, but she was quiet. (While I count this as a success, I have to admit, I never really minded that she was so loud when someone entered the house late at night.)

She’s doing great in class, too. In our shaping class on Sunday, there were two new dogs present, and Maisy was initially a bit stressed as a result. Then I realized that I had fallen back into my old habits of trying to shovel treats in her mouth as quickly as possible. When I realized what I was doing, I remembered Dr. Duxbury’s advice to take slow down when I’m working with her. Immediately, Maisy relaxed. Wow!

Tuesday night in reactive dog class, Stella, the bouvier that Maisy always reacts to, was back in class after an eight week hiatus. I wasn’t sure how it would go, but Maisy silently watched Stella from her crate, jumping up only once. Later on, she barked at Stella as she left, but she settled down pretty quickly. So, while she wasn’t perfect, she was pretty darn good!

In fact, she’s been so good that Dr. Duxbury wanted me to confirm that Maisy is still energetic and playful at appropriate times. And she is. She loves her walks, chases her ball enthusiastically, is eager to train with me, and still gets the nightly zoomies. Her personality hasn’t changed at all. She’s just more comfortable.

Have I mentioned that I love Paxil? Because I totally do.

Medication Update: 2 Weeks

Maisy has been on paroxetine for two weeks now. She took a half dose for the first week, and has been on the full dose (8mg) for a week now. Since the prescribing information I received from the compounding pharmacy said that we may see results as early as 2 weeks, I thought it would be interesting to do a quick evaluation of how it’s going so far.

The most important thing is that Maisy has tolerated the paroxetine well. She hasn’t had any significant side effects, and at this point, it is unlikely that she will. She has had slightly harder, dryer stools, but nothing that’s worth worrying about. It may or may not even be related to the paroxetine, but either way, I’ve been supplementing her breakfast with canned pumpkin to help her out.

I do think the paroxetine is helping. The veterinary behaviorist told us not to expect improvement until Maisy’s been on the medication for 4 to 6 weeks, with full effectiveness at 8 weeks, but even so, I’ve noticed some small changes that give me glimmers of hope.

The first thing I noticed happened after Maisy’s fourth (half) dose, when she actually took a nap in the middle of the afternoon. Not only that, but she actually slept for the entire time, and didn’t startle awake a single time! It used to be that if I touched her while she was lying next to me, she would jump. Now when I pet her (or even just accidentally bump her), she might simply lift her head, but often she just opens her eyes to look at me instead.

The restlessness seems to have reduced as well. For example, about a month ago, Maisy and I were hanging out together while I watched television. Maisy was lying down, and over the course of 45 minutes, I counted 11 times that she lifted her head for two to three minutes to scan the environment. Yesterday, we did the same thing, and although the count came out the same, it seemed like she was actually resting. Each time she lifted her head, it only lasted five to ten seconds, and several times, it seemed that she was actually shifting to get more comfortable. She went from curled up in a ball next to me, to lying flat on her side, to lying sprawled on her back!

I think this is part of an overall trend of lower intensity reactions, especially when something startles her. For example, the other day Maisy was lying next to me quietly when I heard a noise outside. Maisy heard it too, and I thought she was going to jump up like she used to. Instead, she jerked her head slightly, but only lifted it about an inch off the couch! I’m not sure if she interrupted her response on purpose or not, but it was amazing to see.

The vocalizations around the house are happening less often, too. When I did the behavior logs prior to her appointment, I learned that Maisy would jump up and growl, bark or “wuff” at subtle or undetectable stimuli an average of 3.375 times a day. In an effort to get some objective data, I’ve been keeping a behavior log for the last 48 hours. During this time, she’s only displayed the behavior four times, for an average of twice a day.

As for her leash reactivity, well, it’s too soon to say for sure. She did growl a little bit at a chocolate lab that we saw in our local pet store the other day. She even lunged at him, but by the time she reached the end of the leash, the growl had dissolved into this pathetic whine. Later, as we were standing in the check-out line, the same dog rushed up to Maisy, and although she briefly stiffened up, she quickly relaxed.

Yesterday, as we were walking past an elementary school, a group of half a dozen older kids suddenly burst out of the school, chattering loudly. I could see Maisy tensing up as if she was going to lunge and bark. However, instead of having a hair-trigger reaction, it almost seemed like she was thinking about whether or not she should react. This slight hesitation (it was really only an extra half a second) was just enough time for me to interrupt her response, and we played a quick round of Look at That instead!

For all of these changes, Maisy is still the same dog. She’s still energetic, playful, and eager to train and work. Her personality hasn’t changed at all. She doesn’t seem drugged up or different in any way, she just seems more comfortable. We should see this increase as the medication becomes fully effective, and while it’s possible that she might need a second med to help her completely, I’m thrilled with what I’ve seen so far.

Why, yes, she does.

Recently, I wondered if Maisy might have Generalized Anxiety Disorder. As a result, I scheduled an appointment with a board-certified veterinary behaviorist to find out. The short answer is yes. But the long answer is probably more interesting…

So, Maisy had her appointment with Dr. Duxbury yesterday. Before I go any further, let me just say that I really enjoyed working with Dr. Duxbury. Since she has so much education and experience, I was nervous that she might be one of those ego-driven specialists you run into from time to time, but nothing could be further from the truth! I really felt that Dr. Duxbury took the time to listen to what I was saying, and she was very respectful of me and the work I’ve done with Maisy. If anyone in the Twin Cities metro area needs a veterinary behaviorist, I would highly recommend her. It was an expensive appointment, but it was worth it.

The actual appointment was about 90 minutes long. Dr. Duxbury complimented me on the pre-appointment questionnaire I had sent in advance; I gave enough details that she had a really good picture of who Maisy is. This ended up saving a lot of time because she didn’t need to take much history from me. In fact, apparently I described things so well that she didn’t even review our behavior logs! Instead, we jumped right into watching videos.

I had about an hour’s worth of video that I had taken at home, in class, while on walks, and even at trials. I really enjoyed watching the videos with her, mostly because she found them so interesting. In fact, she ended up copying all of the videos I brought in so she can use them with her advanced students. She said Maisy is an excellent example of a “complicated case,” and that it will be very helpful for her students to see the video.

I think the video she liked best was the one below. It’s long- 10 minutes- but this is a very typical snapshot of Maisy “relaxing” at home. (The action starts around two minutes in.) Dr. Duxbury was especially interested in the interactions with the cats you see towards the end of the video, especially the stereotypic tail chasing.



Dr. Duxbury’s assessment of Maisy, after viewing the videos, and interacting with her in person, is that she is “functionally anxious.” Dr. Duxbury complimented me on the work I’ve done with her, and said that Maisy might not have been functional at all had circumstances been different for her. Here’s what she wrote in her report:
You have done a wonderful job trying to help Maisy learn to relax and to not react to other dogs and other environmental stimuli. Her continued reactivity and vigilance even in her 'safest' environments (e.g. at your home) suggests that she is generally anxious. This is likely related to her very limited early environment.

I also appreciated that Dr. Duxbury saw Maisy’s good qualities. Most people are quite charmed by Maisy when they meet her- she’s cute, of course, but she has a personality that just doesn’t stop. In fact, it is sometimes hard for people to see that she has issues because she is so functional. Dr. Duxbury described her as “outgoing and social and very eager to play and to work on training, but at the same time she seems overly attentive to subtle stimuli in her environment and reacts… to other dogs.”

Ultimately, Dr. Duxbury diagnosed Maisy as follows:

• Fear related aggression (lunging, barking, growling only -- no bites) to unfamiliar dogs and certain unfamiliar people.
• Resource guarding - directed towards the cats.
• Generalized anxiety - increased sensitivity to environmental stimuli, exaggerated startle response, hypervigilance, long recovery after arousing events.

The main component of the treatment plan was, as I’d hoped, medication. Dr. Duxbury prescribed paroxetine (also known as Paxil). She said she’s had really good results with paroxetine for dogs like Maisy, and felt that it would be the best choice for her given her particular set of issues. The only downside to paroxetine is the dosage- Maisy will be taking 8mg a day, and it generally comes in 10mg tabs. Since that would be very difficult to split accurately, it will need be ordered from a compounding pharmacy, which increases the cost. (Of course, the upside to that is that it will be salmon flavored, which will make it much easier for us to give!)

Dr. Duxbury didn’t have any further suggestions for types of behavior modification. She said that about the only thing I haven’t tried is BAT, which she didn’t feel would be helpful for Maisy (although she didn’t rule it out for the future). She said that I should continue to do what I’m doing, including my classes with my current trainer, Robin Sallie.

She did have some suggestions on how I carry out the behavior modification. These suggestions are relatively small changes to how I do things, and probably things Robin has told me to do a million times before (in fact, I actually asked her if she’d talked to Robin in advance, it sounded so much like her!). Despite being fairly minor revisions to our training, I suspect that they will, in conjunction with the medication, make a huge impact on Maisy. Because of that, I’ll dedicate a separate post to the topic.

Anyway, Maisy will start her medication as soon as it arrives from the pharmacy. We probably won’t see any changes in her behavior until she’s been on it for 4-6 weeks, so she’ll have a recheck with Dr. Duxbury in about 8 weeks. At that appointment, we’ll discuss the medication, the dosage, and whether or not we want to add a second med to the mix (something which Dr. Duxbury said may be needed for Maisy). While I don't believe Maisy will ever be "normal," I am pretty excited to see how this will help.

What is Generalized Anxiety Disorder? (And Does Maisy Have It?)

This is what puppy-hood was like. Endlessly.

Maisy has never been a “normal” dog. Most of my pictures of her as a puppy have motion blur, and not just because I have a cheap point-and-shoot. She just never slept. At three months, she became overly upset at the appearance of a soda can in the bathroom. And when she took her CGC test at eight months, the evaluator wrote on the form, “seems a little nervous.”

“Little” was an understatement. Although Maisy is generally a very outgoing and curious dog, she is also very cautious and worried about new experiences. I know this sounds contradictory, but to a certain degree, I think this is normal for many reactive dogs- they feel conflicted about what’s going on around them, and react accordingly. But Maisy sometimes seems even more conflicted about things. For a long time, I simply thought she was “quirky,” but when a friend shared a handout on Generalized Anxiety Disorder with me, I began to think differently.

So, what is Generalized Anxiety Disorder (GAD)? It is when a dog consistently overreacts to things, is more active than would be seen in a normal dog, and is excessively vigilant to its surroundings. The key here is the extreme nature of the dog’s reactions; these reactions will be seen even when there isn’t a “truly provocative stimulus.” Further, there is rarely a pattern to the things that cause this overreaction. For example, if a dog overreacts only to thunderstorms, it may still be anxious, but it would not be diagnosed with GAD.

Dogs with GAD are typically wary of things or startle at things in a way that seems out of proportion with the actual stimulus. Even when a reaction seems to be justified, the reaction is still more intense than what would be expected. They are often very light sleepers who awaken easily. They may be destructive, but there’s no true pattern to their destructiveness. They might have some general reactivity to unfamiliar people or places. Physically, they may demonstrate regular vomiting, diarrhea, itchiness or rashes.

Does Maisy have GAD? Well… it sure sounds like her. Incredibly active? Check. Overreacts to things? Check. Vigilant about her environment? Check. She is definitely a light sleeper, and she certainly startles often. She had some of the physical symptoms as a puppy. But other things don’t fit the diagnosis. For example, she’s never been destructive. While Maisy has always demonstrated a lot of caution with new objects, she’s actually pretty friendly and interested in meeting most new dogs and people.

I don’t know if she actually meets the diagnostic criteria for GAD. GAD is considered a diagnosis of “last resort”- most anxiety can be categorized in some other way, such as separation anxiety or thunderstorm phobia. Still, she is anxious in general, so in order to resolve this mystery, Maisy has an appointment next week with Dr. Duxbury, one of only 51 board-certified veterinary behaviorists in the US and Canada.

I am both excited and nervous about this appointment. Dogs with GAD do not easily learn to ignore the things that upset them, and as a result, medication is often needed. I don’t know if Maisy needs medication, but I’ll be honest: I think I am approaching the limits of my abilities. Maisy has improved incredibly in the year-and-a-half that I’ve been doing behavior modification with her, but she still seems so uncomfortable in her own skin sometimes. So, even though I’m not crazy about the idea of medications- I trend more holistic most of the time, after all- I can’t help but wonder if it isn’t the kindest thing I can do for her.

(Note: the handout, and this post, is based on Dr. Karen Overall’s Clinical Behavioral Medicine for Small Animals, 2nd Ed..)