Hard Work Remains

Maisy is doing great these days. It is wonderful to be able to take her places and do things with her without having to worry that she's going to have a reactive outburst. It's nice to be able to relax and enjoy our daily walk. It's absolutely amazing that she can handle just sitting outside a petstore, watching the other dogs come and go.

Maisy with Fritz and my super awesome friend, Megan.

And yet... I've come to the conclusion that we are possibly at the most critical part of her rehabilitation. Instead of enjoying the fruits of our labor, now is the time to redouble our efforts and work even harder. This realization hit me pretty hard, but I have two main reasons for believing it's true.

First, Maisy is inarguably awesome these days. In fact, she's so awesome that it is easy to forget that she has issues. It is easy to believe they are in the past, and as a result, to take her good behavior for granted. You wouldn't think that after only six or seven months I'd forget where we started, but when you see something day in and day out, it's easy to get used to. Why else would the difference between these videos surprise me so much?

At any rate, it is easy to forget that this new state of being is still tentative. Although Maisy's had several months of excellent behavior, she has several years of lunging, barking and growling to overcome. It's going to take time to turn these new neural pathways from sparsely populated jungle trails into well-traveled interstate highways. I need to make sure I'm reinforcing Maisy's good choices every chance I get instead of relaxing and going easy on the cookies.

Second, it's much harder to tell when Maisy is feeling anxious now. This is because the way she expresses stress has changed- gone are the days of impossible-to-miss, over-the-top reactive displays. This is great, of course, but it also means that I must pay much closer attention to her body language now. When your dog is lunging and barking at the end of her leash, it's obvious that she's not feeling so great. But when you have to rely on such subtle indicators such as a change in muscle tension, breathing patterns, or tailset... well, it requires a lot more effort.

This effort is critical, though. If I can't see these much smaller signs of stress, I won't be able to adjust the environment for her. I won't be able to change my expectations, nor will I be able to increase the rate of reinforcement for the good choices she makes in order to really help cement those new roadways we're building. In short, I will be setting her up for failure instead of success.

So what's the new plan of action? Well, there isn't one, not really. Instead, I'm just holding the course, doing all the same desensitization and counter-conditioning and Control Unleashed techniques that I've done all along. The big thing right now is being mentally present with my dog. I need to remain in tune with how she's feeling, and what she's telling me. I need to continually remind myself that no matter how well she's doing, hard work remains. And I am confident that if I do, good things await us.

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.

Recheck with the Veterinary Behaviorist: Plans for the Future

After all my blathering on, I still haven't gotten to the crux of the appointment: where do we go from here? So today I'm going to share what Dr. Duxbury and I agreed to do next.

Medication
Not ones to mess with a good thing, we are not changing Maisy's paroxetine. She will remain on a daily 10mg dose for the forseeable future. I don't know when/if we'll ever take her off it, but for now, it remains effective and awesome.

However, given how traumatic her recent vet visits were, and considering that Maisy will be staying at a boarding kennel for the first time in her life next month, we decided that we do want have a little something for special occasions.

We did try trazodone at her ultrasound, and I was unimpressed with it then. Still, that day was weird- she was already stressed from her appointment the day before, and the city was doing ripping out the sidewalk in front of our house that day. Plus, Dr. Duxbury really prefers trazodone over the alternatives (it's typically less addicting and seems to have fewer side effects, including paradoxical effects), so we agreed to give it another try, this time on a day when nothing was going on.

Training
Based on the feedback Dr. Duxbury received from our reactive dog class trainer, we discussed the possibility of trying more conventional training classes. (I'm thinking I'll try an advanced rally class, but I might try an advanced obedience class, too- depends on what works best in our schedule, really.)

We're going to take it slow, though.

Maisy and I will remain in our current reactive dog class, but only attend every other week. Dr. Duxbury said we could start taking regular classes immediately, but I think I'm going to take it a bit slower instead. My plan is to go to the club where I plan to take classes every other week and set up Maisy's crate and do the same stuff as we do at reactive dog class: mostly chill in the crate, but have her come out to heel, work on a perch, etc., near the other dogs. I'll probably spend two to three months doing the every-other-week thing before actually signing up and attending a class.

The purpose of doing reactive dog class every other week is to give us a barometer of how Maisy is doing. If Maisy gets reactive in the regular class, but not in reactive dog class, we'll know that she's not ready for the regular class yet. If she gets worked up in the regular class and the reactive dog class, we know there's an issue, but that it's probably not related to the class schedule.

Beyond classes, though, we have two additional assignments: first, I am to condition Maisy to wear a muzzle. This was mostly my idea, but Dr. Duxbury did fit Maisy for a muzzle because I couldn't figure out what size she needed. (As it turns out, she's between sizes.)

 
Second, I am to condition Maisy to love being picked up. She doesn't care for this right now, but if she finds being picked up pleasant, it will make it easier to move her through crowded doorways and spaces without increasing her stress level. It's meant to be a management strategy, to prevent stress, as opposed to something I do in response to stress.

Trialing
Because Maisy did so well just hanging out at the last trial, Dr. Duxbury said we could enter the next one! However, we both agreed that the best course of action is to play it by ear. I'll go, hang out, and if Maisy's doing well, do a day-of-show entry. And then, depending on how she's doing as we enter the ring, I am to seriously consider purposely NQing, and either do just one to two signs, or have a “cookie run” instead of trying to actively compete. Either way, we've been given permission to enter the ring, and I'm happy about that!


Both Dr. Duxbury and I are thrilled with how Maisy's doing. We'll return in three to six months to reassess things again, and I am very excited to see where she's at then.

Recheck with the Veterinary Behaviorist: More Videos

I hope you all don't mind more videos! The difference between the two videos in my last post is so dramatic that I didn't want to detract from them by including extra ones, but I have more that I want to share!

Bike Reactivity
One of Maisy's triggers has always been motion- whether it's a dog running or a bike whizzing past, it's usually unsettling. In the interest of full disclosure, this was one of the areas where we'd made great progress with behavior mod alone. Still, she occasionally had trouble with motion, as this video from last fall indicates:



Since adding medication to the mix, though, she's doing much better with bikes. She's still not entirely comfortable with them (notice how her body stills when she sees them, and how her tail goes up as the pass), but she doesn't feel the need to lunge at them anymore!



Encountering Novel Objects
Maisy has also always struggled with novelty and sudden environmental changes. I was fortunate enough to catch this on tape last fall when we went on our usual walk through the neighborhood only to discover a couch on the side of the road! As you'll see, she's quite cautious to approach the couch, and normal road noises (which she didn't usually find upsetting) caused her to jump.



Compare that to this video I took just a few weeks ago. In it, we encounter a large waste bin in our alley that hadn't been there before. Although she's still cautious, it's much less pronounced than it was with the couch. She approaches, checks it out, and that's that.



Strange/Trigger Dogs
I don't have any good before video, but I have two great videos of Maisy around “trigger dogs.” Maisy was pretty reliably unnerved by large, dark dogs with prick ears- Dobermans, German Shepherds, and Bouviers, for example. In fact, the first dog she ever demonstrated reactivity toward was a Great Dane, so I consider them the ultimate challenge. As it happened, I was going for a walk with a friend, and she had invited another friend with a Great Dane.

It did not end in disaster like I thought it might, although Maisy did lunge at the dog once. It felt horrible at the time, but when I reviewed the video, it didn't seem that bad at all. No barking or growling, and she recovered pretty quickly. In fact, she even laid down about 90 seconds later! She wasn't entirely comfortable (her body is tense, her tail is low, and she's panting mildly), but I still think this is a pretty big deal.



And here's a second video, about 45 minutes later. She's still alert, but more relaxed than in the previous video. She also deserved WAY MORE COOKIES for her behavior here- total mom fail. It was kind of funny, actually, because as we were watching this video at Maisy's appointment, I sighed and said, “I needed to give more cookies,” and Dr. Duxbury kind of laughed and said, “I was just thinking that!”



I am so, so proud of how my little dog is doing. She's improved so much since beginning meds that I can't believe it sometimes. We are now able to do things that I never dreamed possible- hanging out in a group? Unreal. And yet very real. Medication has changed our lives.

Recheck with the Veterinary Behaviorist: Before and After Videos

It probably wasn't fair to leave the last post hanging like that, mostly because Dr. Duxbury and I didn't really discuss the logs. She thanked me for bringing them in, but the bulk of our appointment was spent watching videos.

Because she had three students in the room with her, I showed the “before” videos that complemented the "after" videos so they had a frame of reference. I'm really glad it happened like this, because I don't think we would have watched the before videos otherwise. Why would we have? We both were there, we both remember what Maisy was like... right?

The truth is, when I watched the before videos, my jaw dropped. I didn't remember Maisy being that anxious, that vigilant, that slow to bounce back from stress. What I remember is Maisy being herself, and that she'd improved a lot through the training we'd already done.

Here's the before video. For context, this was taken at my reactive dog class last fall. We were pushing Maisy a little bit harder than usual because we wanted to make sure we got good video for the initial appointment. (I was later told that wasn't necessary, so I do not recommend you do the same thing.)



And here is the after video. There are some differences between the two videos- different location, different dog, different orientation- but not enough to cause the drastic change you will see in Maisy's behavior.



Amazing, right? Let me tell you, if I had had any doubts about whether or not medication was the right choice for my dog, well... they're gone now. Instead, I turned to Dr. Duxbury and said, “Why didn't I do this sooner?”

Recheck with the Veterinary Behaviorist: Behavior Logs

It seems hard to believe that Maisy has been on medication for eight months now. Sometimes it feels like just yesterday that we started this journey, and at others, it feels like it was a lifetime ago. On Monday, we had Maisy's six-month recheck with her veterinary behaviorist, and once again, I must take this opportunity to highly recommend Dr. Duxbury at the University of Minnesota Behavior Department. As always, I absolutely adored working with her. She's full of great insight and is absolutely masterful at reading body language. She has tons of experience, which leaves me feeling very comfortable with her recommendations. And it doesn't hurt that I really like her.

Anyway, I have so much that I want to share about Maisy's progress, about Dr. Duxbury's reactions, and about what the future holds that this will probably take multiple posts. Today's entry will take a look at the behavior logs I kept in the past couple of weeks. (Click here to see past behavior logs.)

Usually, I keep a week or two of logs to get an idea of how Maisy is doing. Her pre-medication baseline was 3-4 anxiety episodes per day, so I was pretty excited to see how she was doing. This set of behavior logs were different, though. You see, right before I planned to start keeping the logs, Maisy ended up in the doggie ER. She then had two back-to-back appointments with a specialist, which she found incredibly stressful. I kept logs anyway knowing that they wouldn't be an accurate representation of how she's doing in general, but feeling like it was my duty. Then I remembered that I have logs from the last time she had a stressful event (five days at my parents' house at Thanksgiving), so I laid them out side by side (click the image to enlarge it):

As you can see, I have data from the day of the stressful event (in both cases, I started keeping logs in the late afternoon), as well as for the subsequent week. The initial response is the same: 3 instances of anxiety vocalizations or startles on the day of the stressful event. And, I'd say that her recovery time is about the same for both sets of data- three full days after the stressful event, although I'd definitely say there was residual stress for a couple days beyond that both times. 

I have to admit, I was a bit disappointed by this. One of my goals was really for Maisy to bounce back quicker after a stressful event, and that has not happened. In fact, now I'm not sure it can happen; I don't know that it's possible to hurry stress hormones out of the body.

However, I am thrilled by how much better she's doing in handling the stress. I mean, check out that graph! The red lines are so much lower than the blue lines! Before, over the full seven-day period, she had an average of 2.86 instances of anxiety per day. Now, that's just 1.14. Before, over the three-day primary recovery period, she had an average of 4 instances per day, and now it's only 2 per day. More than that, the quality of those anxious outbursts has changed. The intensity and duration have gone way down.

So, even though these aren't exactly conventional behavior logs, they are incredibly interesting, and I'm quite happy with Maisy's progress. I absolutely love what Paxil has done for Maisy's quality of life. Of course, now the question is... did Dr. Duxbury agree that the Paxil has been helpful? Was she as impressed by the results of our logs? I'll let you know in my next post...

Sarah Kalnajs Seminar: The Canine Risk Assessment

Initially, I didn't think I'd write about today's topic, not because it isn't interesting, but because I wasn't sure how useful it would be to you, my dear readers. That's because Sunday's topic was about aggression: in puppies, how to assess them, and how to begin working with them. It was also specifically tailored for canine professionals, which I am not. I assume the majority of my readers are not, either. Still, so many people in the blogging world do rescue that I really thought this information should be out there, so today I'm going to write about Sarah's canine risk assessment.

The canine risk assessment is not the same as a temperament test. It comes after the temperament test, after you've already decided that this is a Dog With Issues, and it is meant to be used when you're trying to decide if you can rehabilitate this dog. It is meant to be an objective tool that allows a behavior consultant to make recommendations and gauge the likelihood of success. It does this by giving you a ten-point method of systematically eliciting information that will help you make your decision.

The Canine Risk Assessment
1. What was the age of onset? How long as the behavior gone on?
Generally speaking, an earlier onset and longer duration means a worse prognosis. Sarah said that early onset suggests that the behavior has a genetic component, as opposed to something the dog learned. Learned behaviors are easier to modify than ones that are coming out due to faulty wiring. A longer duration means the dog has had plenty of time to practice the bad behavior, and that those neural pathways become stronger, and the behavior more likely as a result. (See this excellent post for more on this concept.)

2. How specific is the behavior?
Here, we're trying to discover if the behavior happens only in certain settings, or only with certain stimuli, or if it has generalized and happens in respose to very fuzzy triggers. Sarah acknowledged that while it can be harder to work with a very specific behavior (because you have to set up the situation perfectly in order to do behavior modification), it is also lower risk because you can easily predict when it will happen.

3. How predictable is the dog's behavior?
This question is often directly related to the prior one. A dog whose behavior is very specific is probably quite predictable, and thus is far safer than one whose behavior has no known cause- or at least it's difficult to determine the cause. The unpredictable dog is also going to be harder to work with, and will probably have a poorer outcome.

4. Does the dog give visible or discernable warnings?
We will need to rely on our ability to read dog body language here: does the dog “warn” you that he's about to act aggressively, or does it come “out of nowhere?” In addition to considering the dog's warnings, we need to consider how obvious those warnings are- can his owners or the general public see them, or will they blithely mistake them for something else? Obviously, a dog who doesn't give good warnings, or one who doesn't give obvious ones are going to be riskier.

5. How quick is his trigger?
In that same vein, regardless of how well the dog warns, we need to consider how long he warns, too. A dog who gives a long, drawn-out series of warnings is far safer than the dog who attacks abruptly. Even the best warning is worthless if you don't have time to react to it.

6. Has the dog harmed anyone else (human or otherwise)? How severe was that harm?
This is a rather self-explanatory question. The dog who has a long rap sheet, or who has inflicted serious harm, is far riskier than one who hasn't hurt anyone.

7. What is the dog's arousal level like? Can he inhibit his behavior?
A dog who is often out-of-control or easily aroused is going to pose a greater risk than one who is able to self-modulate his responses. Of course, how seriously you take this behavior will depend on his age, size, and situation- if you have two dogs with similar arousal levels, the smaller one is probably going to be safer.

8. How likely would unintentional provocation be?
The fact is, people gravitate to small dogs, fuzzy dogs, and young dogs, and Sarah thinks this can make the situation worse. She has a point- as anyone with a scruffy little puppy can attest, it is nearly impossible to keep people away when the dog is perceived as “cute.” Unfortunately, this also means that it is far more likely that well-meaning but clueless people will unintentionally provoke the dog into bad behavior.

9. Is management possible, reasonable, and likely?
Make no mistake: these are actually three different questions. Management is an important component of any behavior modification program- you need to have a way of preventing the behavior while you're working on it. However, even if management is possible, it might not be very reasonable. Can you really expect someone to never have guests? And even if it is reasonable, not everyone is willing or able to implement the management plan.

10. Are the owners fearful of the dog?
Finally, regardless of whether or not the owners (or fosters or whoever is caring for the dog) are justified in their feelings or not, it is very difficult to make good progress when the dog's caretakers are afraid of him. If they are, rehoming the dog- if it's safe to do so- is the best option. If it's not safe to do so, there will be some tough decisions to make, including the consideration of euthanasia.


Once you've answered each of these questions, it's time to classify each as either “positive” or “negative.” Then it's time to make a decision about the dog's prognosis. A dog who clearly has more positives than negatives may be safer... or he may not be, depending on what is in his negative column. Sarah said some things may be weighted more heavily than others. For example, if a dog has only one fault, but it's that he bit a person so badly that they needed 100 stitches, it's clear that he's a high-risk dog. On the flip side, a dog with many negatives, but who has never caused harm is probably a much better candidate for rehab.

Finally, I really must stress that these are questions that are best answered with the help of a competent and qualified behavior professional. The canine risk assessment was meant for use by professionals, and I think it is vital that laypeople- from seminar junkies like me to rescue volunteers who have fostered for decades- consult with a professional. Still, it is my hope that learning about Sarah's canine risk assessment will help us laypeople see the issues more clearly, and help us identify when we might be over our heads with a dog, especially since a little knowledge can be a dangerous thing.