PRESCRIBING FOR BEHAVIOR: Three Levels: HOW DO YOU DECIDE?

1. Is patient/diagnosis likely to respond to medication?

Christopher Pachel, 2. Maintenance/daily vs. Situational/event? DVM, DACVB, CABC Animal Behavior Clinic Portland, Oregon

3. Specific medication options

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1 - Likely to respond to meds? 2 - Treatment focus: (Yes or No) (Maintenance vs. Situational)

 Diagnoses:  Maintenance/daily   Fear/Anxiety Triggers are frequent, unpredictable, unavoidable  Onset of action from 1-3 to 4-6 weeks  Impulsivity/Arousal  “Steady state” effect  Aggression (motivated by anxiety, impulsivity, etc.)  Compulsive disorder  Situational/event  Urine marking  Triggers are predictable, infrequent  Adjunctive support  Onset of action from 15 min to 1-2 hours  In combination with:  Rapid adjustment of doses within trial period  Safety/management  Short duration of action (potential for “scalloped” effect)  Behavior modification

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3 – Specific medication options Considerations

Patient/Diagnosis likely Treatment focus? Specific options:  Medications FDA approved to respond to medication? for use in dogs (NONE in cats) Maintenance Fluoxetine Paroxetine  Clomicalm® (clomipramine) – Sertraline Clomipramine Separation anxiety Yes  Reconcile ® (fluoxetine) – Situational/Event Trazodone Clonidine Separation anxiety Benzodiazepines (5)  Anipryl® (selegiline) – CDS Acepromazine and PDH Other/Adjunctive Gabapentin No Buspirone  Sileo® (dexmedotomidine) – Amitriptyline Noise aversion

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1 Neurotransmitters / Intended Impact 3a – Favorite maintenance medications

Patient/DiagnosisSSRI likely Treatment focus? Specific options: Amino acids: to respond to  medication? Fluoxetine Fluoxetine  Glutamate: excitatory Maintenance  Paroxetine Paroxetine  GABA: inhibitory Sertraline  Sertraline Clomipramine Yes

Situational/Event Trazodone Biogenic amines: Clonidine  TCA Benzodiazepines (5)  Serotonin (5HT) Acepromazine  Clomipramine Other/Adjunctive  Dopamine (DA) Gabapentin Buspirone  Norepinephrine (NE) Amitriptyline

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On to cases! Milo (13yr m/n Maine Coon)

 Primary concern: urination outside of box, spraying, aggression toward other cat (MK)

 Four cats total in home (two residents - Milo and Max, two new - MK and Murphy)

 Daily frequency of urine soiling, combination of horizontal and vertical

 Reliable use of boxes for defecation

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Milo (13yr m/n Maine Coon) Milo (13yr m/n Maine Coon)

 Previous use of Feliway diffusers, minor impact on  Dx:  Urine marking (vertical +/- horizontal locations) frequency of soiling  Toileting / Inappropriate elimination (horizontal locations)  Multi-level home, unstable household routines (owner  Intercat aggression travel schedule)  Tx:  Household mgmt. (separation when unsupervised, journal soiling  Medical workup - no significant findings details, enzymatic cleaner, ongoing Feliway use)  Increased availability of household resources  Use of deterrents (foil, block access, etc.) - no  Clicker training for litter box use impact on frequency  Zylkene trial (reluctance to use medication initially)  Improvement in frequency at 10-12 weeks, but ongoing soiling

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2 Three Levels: “Milo” Fluoxetine

1. Is patient/diagnosis likely to respond to  Generic/inexpensive medication?  Lots of anecdotal experience within the profession  Impulsivity/arousal as focus for treatment, also for fear/anxiety  Available research (“dominance aggression”, urine 2. Maintenance/daily vs. Situational/event? marking, separation anxiety – as Reconcile)  Negative impact on appetite  Pro – resource guarding, competitive aggression, food related arousal 3. Specific medication options  Con – anorexia, client perception

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Paroxetine Sertraline

 Generic/inexpensive  Not quite as inexpensive, but generally affordable

 Generally less of an impact on appetite than  Smallest tablet size is 25mg (may require fluoxetine (similar indications) compounding for cats and small dogs)

 More of an anticholinergic profile than fluoxetine  Social anxiety, less impact on arousal/impulsivity  Helpful for patients with chronic/situational loose unless at higher end of dose range bowels, urinary incontinence  Less likely to cause side effects (sedation, anorexia,  Potential for dry mouth and/or constipation constipation, etc.)

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Clomipramine / Clomicalm “Pebbles” (11 mos Chesapeake B.R.)

 Impact on both serotonin and norepinephrine  Primary concern: aggression toward other dog

 My medication of choice when both (14yr m/n lab mix, Ben) over food impulsivity/arousal and anxiety impact is desired  Onset ~6 months old, progressively worsening

 Significantly more expensive (intensity/frequency, speed of escalation)  Generic/compounded, Clomicalm  Deferential postures by Ben, lack of appropriate

 Anticholinergic side effect profile de-escalation by Pebbles  Sedation not uncommon especially as getting started  Superficial injuries to Ben (significant stress/fear) with treatment

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3 “Pebbles” (11 mos Chesapeake B.R.) “Pebbles” (11 mos Chesapeake B.R.)

 No history of aggression at dog park or daycare

 Lack of response to interventions (walk away, call away, sweet talk, reprimand)

 Generally "inflexible", “Police Officer Pebbles"

 Solid obedience/manners training, moderately structured household

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“Pebbles” (11 mos Chesapeake B.R.) Three Levels: “Pebbles”

 Dx: 1. Is patient/diagnosis likely to respond to  Resource guarding / competitive aggression (relationship specific) medication?  Generalized anxiety (mild, underlying influence on behavior)

 Tx:  Leadership program 2. Maintenance/daily vs. Situational/event?  Basket muzzle training  "Feeling outnumbered" strategies (incl. “belle of the ball”)  Proactive mgmt/avoidance of triggers, intervention strategies  Body language awareness 3. Specific medication options  Physical exercise

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“Silas” (3yr m/n GSD) “Silas” (3yr m/n GSD)

 Primary concerns: fearful of people, objects, trees,  Hypervigilant in public

cars; aggressive toward some dogs  Refuses food when overly aroused/stressed

 18 months in home (10th home / 2 years)  Defecates 4x/day, softer stools with daily stress

 Onset within 6 weeks of adoption (also with prior  Attempts at "desensitization" border on "flooding“ owners)  Walked 1-3 hours/day, 6 mile runs with owner  Variable reaction to other dogs (n/r to "ballistic")

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4 “Silas” (3yr m/n GSD) “Silas” (3yr m/n GSD)

 Dx:  Fear based behaviors (worse on leash, neophobia)  Generalized anxiety (hypervigilance, startle reactions)  Territorial/protective behavior (minor, opportunity based)  Breed specific patterns (GSD), Insufficient socialization (presumed)

 Tx:  Shift in training style (limit of obedience/suppression)  Behavior modification (relaxation, movement cues, DSCC to triggers)  Proactive avoidance / recovery strategies / no rehearsal  Body language awareness (threshold!)  Phase out use of e-collar (as skill set improves)

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Three Levels: “Silas” SSRI/TCA

1. Is patient/diagnosis likely to respond to Dosages (oral administration): medication? Canine Feline Fluoxetine (Prozac®) 1-2 mg/kg q24hr 0.5-1.0 mg/kg q24hr

2. Maintenance/daily vs. Situational/event? Paroxetine (Paxil®) 1-2 mg/kg q24hr 0.5-1.0 mg/kg q24hr (q12hr instead?) Sertraline (Zoloft®) 1-3 mg/kg q24hr 0.5 mg/kg q24hr (q12hr instead?) Clomipramine (Clomicalm®) 1-3 mg/kg q12hr 0.3-0.5 mg/kg q24hr 3. Specific medication options

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“Mabel” (4yr female French bulldog) “Mabel” (4yr female French bulldog)

 Primary concerns: separation anxiety (from Steve),  Able to be kenneled when home alone, no self fear of strangers, aggression toward owner (Ron) injury or environmental destruction

 Recently adopted, breeder from puppy mill  Limited training (attempted classes, unable to make

 More likely to aggress toward Ron when resting on progress in class or at home) couch with Steve, otherwise fearful/avoidant of Ron  Occasional soiling when at home with Ron (unable

 Snapping >>> biting (one bite with contact, no to get her outside vs. anxiety) injury)  “Back injury” – no evidence of pain/discomfort

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5 “Mabel” (4yr female French bulldog) Three Levels: “Mabel”

 Dx: 1. Is patient/diagnosis likely to respond to  Fear based behaviors (impact of undersocialization) medication?  Separation anxiety  Resource guarding  Tx:  BMod (clicker training, sit, eye contact, hand targeting) 2. Maintenance/daily vs. Situational/event?  Relationship building (awareness of body language, mark/reward engagement)  Calm departures/greetings (Steve)  Zylkene trial (reluctant to use medication)  Insufficient response to treatment at 10-12 weeks 3. Specific medication options

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"Riley" (5yr f/s Springer spaniel mix) "Riley" (5yr f/s Springer spaniel mix)

 Primary concerns: target of aggression by other  Owners have limited training experience, slow to dog, unable to confine elsewhere in home, unable to acquire training skills

train due to stress level  Able to manage both dogs during normal daily  Recently acquired by family, one other dog in home, routine, support needed for household gatherings Riley is target of competitive aggression (2-3 per year)

 Infrequent visitors to home, noises from household  Short trial of fluoxetine, "zoned out", discontinued

activity more likely to trigger arousal/barking than  Previous use of alprazolam/acepromazine, is separation/isolation inconsistent response to combination

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"Riley" (5yr f/s Springer spaniel mix) Three Levels: “Riley”

 Dx: 1. Is patient/diagnosis likely to respond to  Separation anxiety (separation affects tolerance for other stressors) medication?  Social/situational anxiety (affects response to training attempts)  Interdog aggression (target of aggression) 2. Maintenance/daily vs. Situational/event?  Tx:  Acoustic strategies (block noises, relaxation)  Relaxation protocol  Confinement training (stimulus gradient for household 3. Specific medication options activity)

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6 3b – Favorite situational medications Trazodone

Patient/Diagnosis likely Treatment focus? Specific options:  5HT2a antagonist/reuptake inhibitor to respond to medication?  PRN usage most common, short term maintenance Maintenance Fluoxetine Paroxetine Sertraline  Most likely to cause sedation without overt ataxia Clomipramine Yes  Essentially no cardiovascular impact

Situational/Event Trazodone  Indications for at home, in hospital, post-surgical… Clonidine Benzodiazepines (5) Acepromazine Canine Feline Other/Adjunctive Gabapentin Buspirone 12.5-50mg/cat PRN to Amitriptyline Trazodone 3-7mg/kg PRN to q8hr q12hr

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“Kelby” (19 month m/n GSD) “Kelby” (19 month m/n GSD)

 Primary concerns: bark/growl at non-family  Home in rural environment, visitors are members, mouthiness/licking, overexuberance, scheduled/planned

inability to listen to commands when excited  Responds to obedience cues when not distracted  Acquired at 5 months, from large/busy family, (responsive at home with family)

limited early socialization  Minor improvements noted already, with minimal  More likely to react at home, when in proximity to understanding of DSCC/"socialization" principles

owners, when approached by men  Non-reactive, non-aggressive when proactively  Muzzled when taken to new places (precaution) crated prior to trigger exposures

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“Kelby” (19 month m/n GSD) Three Levels: “Kelby”

 Dx: 1. Is patient/diagnosis likely to respond to  Territorial/protective aggression  Fear based behavior (minor impact, based on body language) medication?  Reactivity / impaired impulse control (influenced by adolescence)  Breed specific traits (GSD)

 Tx: 2. Maintenance/daily vs. Situational/event?  Proactive confinement / managed scheduled of exposure  Leadership program  BMod (open/closed bar to triggers, relaxation exercises, mvmt cues)  Proactive avoidance / recovery strategies  Body language awareness 3. Specific medication options

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7 Clonidine “Boone” (4yr m/n chocolate Labrador)

 Alpha 2 agonist  Primary concerns: pants/drools, can't settle during

 Inhibits NE release (flight/flight reactions) car rides

 Helpful for patients with pattern of “wind-up”  No history of GI upset, nausea, lip smacking

 Potential for bradycardia/hypotension  Pattern of anticipatory arousal in other situations

 Reversible  Well trained, high functioning hunting dog

Canine Feline

0.01-0.05mg/kg PRN to 0.005 mg/kg to 0.01 Clonidine q8hr mg/kg PO q12hr

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“Boone” (4yr m/n chocolate Labrador) “Boone” (4yr m/n chocolate Labrador)

 Owners split time between multiple homes  Dx:

 Behavior is persistent for 3-4 hour car ride, no  Situational anxiety change over 10-12 trips  Anticipatory arousal

 Excessively sedated on acepromazine, unacceptable side effect profile  Tx:  Paradoxical excitation on alprazolam, worse than  Classical conditioning options (helpful if fear/anxiety, baseline less if anticipatory arousal)  Relaxation work (operant strategies, unsuccessful so far... Impacted by arousal)

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Three Levels: “Boone” Benzodiazepines

1. Is patient/diagnosis likely to respond to  Specific options: medication?  Diazepam – sedation more likely as part of clinical effect  Alprazolam – fast acting, short duration  Lorazepam – may be safer for geriatric/pediatric, feline patients 2. Maintenance/daily vs. Situational/event?  Clonazepam – may achieve something resembling steady state with repeat dosing, longer duration effect  Clorazepate – also has longer duration of action

 Caution re: disinhibition, paradoxical excitation, 3. Specific medication options polyphagia

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8 Benzodiazepines "Waldo" (5yr m/n Rhodesian ridgeback mix)

Dosages (oral administration):  Primary concerns: general anxiety, separation anxiety (controlled) Canine Feline Diazepam  On fluoxetine at time of assessment (helpful), "80% 0.5-2.0 mg/kg q4-6hr 0.2-0.5 mg/kg q8-12h (Valium®) where he needs to be" Alprazolam 0.02-0.1 mg/kg q8-12hr 0.125-0.25mg per cat q12hr (Xanax®)  Avoids physical contact with owner, chooses resting Lorazepam places in other rooms 0.1-0.2 mg/kg q8-12hr 0.125–0.25mg per cat q12hr (Ativan®)  Triggered by approach, touching while lying down, Clonazepam 0.1-1.0 mg/kg q8-12hr 0.1-0.2 mg/kg q12-24hr any sustained interaction (more than 2 treats in a (Klonopin®) row, giving more than 1-2 commands) Clorazepate 0.55-2.2 mg/kg q8-24hr 0.2-0.5 mg/kg q 12-24hr (Tranxene®)

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"Waldo" (5yr m/n Rhodesian ridgeback mix) "Waldo" (5yr m/n Rhodesian ridgeback mix)

 Situational use of Zylkene (3-5 days at a time),  Dx: perceived benefit  Anxiety (situational, separation, generalized, social)  Impact of undersocialization (presumed)  No aggression concerns with people or other dogs

in household  Tx:  History of two "seizure-type episodes", metabolic  Video documentation (SRB - better understanding...) testing WNL  "Play hard to get" - allow him to initiate contact, passive  Work up to "consent test"  Avoidance behavior present prior to start of  Departure routine (minimize disruption of bedding, calm fluoxetine (no perceived change) departure/arrival, long lasting food at time of departure)  Continue fluoxetine, Zylkene

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Three Levels: “Waldo” “Dobby” (7 month f/s Labradoodle)

1. Is patient/diagnosis likely to respond to  Primary concerns: distressed when alone/confined

medication?  Owner is teacher and was home for summer with dog/kids, onset fall when returned to school

 Tolerant of confinement when family is present

2. Maintenance/daily vs. Situational/event?  Lack of interest in food left at time of departure

3. Specific medication options

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9 “Dobby” (7 month f/s Labradoodle) “Dobby” (7 month f/s Labradoodle)

 History of low level resource guarding (food, toys),

 Multiple young kids in home (impact on routine, safety, predictability of departures…)

 Daycare not sustainable option as solution

 Needs to be left home alone for 6-7 hours at a time, 2-3 days/week

 Vocal, hypersalivates, escape attempts when alone and confined to pen (no improvement when loose)

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“Dobby” (7 month f/s Labradoodle) Three Levels: “Dobby”

 Dx: 1. Is patient/diagnosis likely to respond to  Separation anxiety medication?  Resource guarding (minor, competitive posturing only)

 Tx:  Minimize leaving at home alone (meds on board, audio 2. Maintenance/daily vs. Situational/event? strategies, calm departure/greetings)  Independence/relaxation training  Differentiate training location from confinement space  Clicker training, captured relaxation sequence 3. Specific medication options

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“Petey” (7yr f/s cattle dog mix) “Petey” (7yr f/s cattle dog mix)

 Primary concern: distressed during thunderstorms  Clinical signs of trembling, hypersalivation, social and fireworks withdrawal (no destructive behavior or agitation)

 Can be taken to work with either owner  History of low level resource guarding (toward

 Lives in Pacific NW (infrequent exposure to storms) other dog) around high value food items, territorial aggression toward visitors during initial entry  One other dog in home (no impact on anxiety or behavior during trigger situations)  Well managed household, controlled exposure to triggers other than storms/noises

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10 “Petey” (7yr f/s cattle dog mix) Three Levels: “Petey”

 Dx: 1. Is patient/diagnosis likely to respond to  Noise phobia (storm, fireworks) medication?  Resource guarding / competitive aggression (managed)  Territorial aggression (managed)

2. Maintenance/daily vs. Situational/event?  Tx:  DSCC to noises (audio recordings)  Proactive mgmt. of exposure 3. Specific medication options  Relaxation exercises as foundation

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“Peaches” (2yr f/s Bernese Mountain Dog) “Peaches” (2yr f/s Bernese Mountain Dog)

 Primary concerns: leash reactivity to other dogs  Impulsive in her interaction style (specific to

 Has completed multiple "reactive Rover" classes dog/dog exposures)

 Improvement in distance threshold, able to keep  Focused during training, easily overstimulated below threshold during neighborhood walks  Not overtly anxious or stressed, recovers quickly

 No dog/dog interaction concerns when off leash  4/8 pups of her litter have similar issues

 No interaction concerns with housemate (Ochoco, also 2yr f/s Bernese Mountain Dog)

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“Peaches” (2yr f/s Bernese Mountain Dog) Three Levels: “Peaches”

 Dx: 1. Is patient/diagnosis likely to respond to  Reactivity / impaired impulse control medication?  Leash reactivity (dog specific)

 Tx: 2. Maintenance/daily vs. Situational/event?  DSCC to triggers (ongoing)  Emphasis on operant > classical exercises  Impulse control exercises (global impact/benefit) 3. Specific medication options

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11 Acepromazine Sileo® (newest available option)

 Uncommon use as sole agent in my practice  Transmucosal dexmedetomidine

 Sedation without significant anxiolysis most common  Labeled for canine noise aversion

 Significant ataxia, variable effect and duration  Dose 30-60 minute prior to

 Potential for increasing noise sensitivity anticipated noise event, or at first sign of anxiety or fear

 Duration 2-3 hours Canine Feline  Up to 5 doses

 At least 2 hours between doses 0.5-1.1 mg/kg q8-24hr Acepromazine 0.5-1.1 mg/kg PRN (PRN)  Overdose potential (client error)

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3c – Favorite adjunctive mediations Gabapentin

Patient/Diagnosis likely Treatment focus? Specific options:  Effects on neuropathic pain, generalized anxiety, seizure to respond to medication? threshold Maintenance Fluoxetine Paroxetine  Wide dose range, variable dose and dosing frequency Sertraline potential Clomipramine Yes  May be helpful adjunct for “touch sensitive” or noise Situational/Event Trazodone phobia patients Clonidine Benzodiazepines (5)  Helpful when treating anxiety in combination with pain, Acepromazine neuro patterns Other/Adjunctive Gabapentin Buspirone Canine Feline Amitriptyline Gabapentin 10-30mg/kg q8-12hr 3-10mg/kg q8-12hr

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"Sophie" (3yr, f/s DSH) "Sophie" (3yr, f/s DSH)

 Primary concern: hyperalert, attacking of owner  "Resistant to petting" since was a kitten, some

 Lives with elderly couple, female owner has been to improvement in baseline tolerance ER for injuries (3 times)  Minimal exam by referring vet, "crazy cat that

 Most likely to happen when sitting on lap, during attacks its owner", advised euthanasia petting, when startled  Prescribed megestrol acetate, ~10# weight gain

 Biting may be preceded by pupil dilation (not  Incomplete compliance with bmod/interaction rules consistent) recommendations

 Observed skin rippling of lower back, not reliably  Lack of visual tracking (in office), tripped over correlated with aggressive episodes objects in consult room

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12 "Sophie" (3yr, f/s DSH) Three Levels: “Sophie”

 Dx: 1. Is patient/diagnosis likely to respond to  Hyperesthesia syndrome medication?  Redirected aggression  Petting induced aggression  r/o Medical (visual, neuro, pain, other)

2. Maintenance/daily vs. Situational/event?  Tx:  Awareness of body language  Refrain from having her on laps  Neuro consult (declined more than exam)  Discontinue megestrol acetate 3. Specific medication options

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“Moyer” (17 month m/n Eng. Bulldog) “Moyer” (17 month m/n Eng. Bulldog)

 Primary concern: snapping/growling when touched,  Triggers: approached when under the bed, taking aggression when surprised or startled away items, disturbed while resting, when

 Onset of owner directed aggression ~5 months reprimanded by owners prior (isolated incident), scheduled for bilateral  Aggression only directed toward owners, more TPLO (FB removal via endoscopy instead, likely when not feeling well

awareness of pica based on what was removed!)  Ongoing history of allergies (requires cleaning of  Rapid progression (frequency > intensity) after facial folds), stifle arthritis TPLO surgery

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“Moyer” (17 month m/n Eng. Bulldog) “Moyer” (17 month m/n Eng. Bulldog)

 Dx:  Resource guarding (locations, items)  Conflict related aggression (owner directed, impacted by relationship)  Pain/irritable aggression  Tx:  Leadership program (relationship impact)  No shared couch time, "hands off" rules, block under bed space)  Body language awareness  No medication use initially (owner declined)  Inconsistent implementation of bmod  Ongoing aggression (level 2 bites, same contexts)

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13 Three Levels: “Moyer” Buspirone

1. Is patient/diagnosis likely to respond to  Impacts 5HT system differently than SSRI options

medication?  Onset typically within 1-3 weeks

 Potential for “pushy” or “assertive” response

 Non-sedating

2. Maintenance/daily vs. Situational/event?  Can be used in combination with other meds

Canine Feline

3. Buspirone Specific medication options 1.0-2.0 mg/kg q8-24hr 0.5-1.0 mg/kg q8-24hr (Buspar®)

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"TeeVee" (8yr f/s DSH) "TeeVee" (8yr f/s DSH)

 Primary concern: stressed around other cats,  Minimal interest in food during training, impacted targeted by one of the cats in household by stress level

 Blended household (5 cats total), primary conflict  Ongoing use of Feliway diffusers, minor benefit

with one of the partner's cats  No history of aggression for this cat

 Able to separate household into "zones" for  Socially avoidant, but able to give medication reduced exposure, not long term solution orally without significant stress  Previous attempts at classical conditioning (associated other cat's presence with food)

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"TeeVee" (8yr f/s DSH) Three Levels: “TeeVee”

 Dx: 1. Is patient/diagnosis likely to respond to  Social fear/anxiety medication?  Generalized anxiety  Intercat aggression (target)

 Tx: 2. Maintenance/daily vs. Situational/event?  Ongoing segregation  Clicker training of aggressor (enrichment, disengagement)  Increase resource availability  Zylkene trial 3. Specific medication options

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14 Amitriptyline "Barley" (~2yr m/n Border collie / Pyrenees)

 Not generally as stand-alone med in my practice  Primary concern: distressed when alone, fear of

 Potential impact on chronic pain strangers, territorial aggression

 Selective for norepinephrine  In home x 1 year, long term foster by skilled dog trainer, bmod protocols in place  Can be used in combination with SSRIs (some risk)  Follows, agitated during departure prep, crated,  Dose dependent sedation is common perception of settling post departure (not confirmed Canine Feline with video), won't consume food when alone  Needs to be left alone multiple times per week, for Amitriptyline 1-4 mg/kg q12hr 0.5-1.0 mg/kg q12-24h (Elavil®) 4-6 hours per departure

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"Barley" (~2yr m/n Border collie / Pyrenees) "Barley" (~2yr m/n Border collie / Pyrenees)

 Described as "nervous" when routines are disrupted,  Dx: in new environments/situations  Separation anxiety (primary concern)  Generalized anxiety (mild, but ongoing )  Failed food bowl test at shelter (resource guarding,  Resource guarding (managed in current household) managed in current home)

 On fluoxetine at time of initial assessment, SepAnx  Tx: issues worsening  Independence training  Previous alprazolam (no perceived benefit, 0.2  Departure training (relaxation foundation) mg/kg), diazepam (slight response to 1.6mg/kg)  Video confirmation (baseline, response to tx)  DSCC to pre-departure cues

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Three Levels: “Barley” “Trask” (4mos male Aust. shepherd)

1. Is patient/diagnosis likely to respond to  Primary concern: Growling/barking at unfamiliar medication? people and dogs

 Wary with strangers, friendly/affectionate with familiar people

2. Maintenance/daily vs. Situational/event?  Reaction/behavior not location dependent  Foundation training with skilled +R trainer

 "Never relaxed", baseline hypervigilance 24/7

3. Specific medication options

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15 “Trask” (4mos male Aust. shepherd) “Trask” (4mos male Aust. shepherd)

 Dx:  Fear based behavior (social interaction with dogs and people)

 Tx:  Proactive avoidance (threshold)  Awareness of body language (mouth pressure as arousal indicator)  Specific mgmt (hands free leash, low arousal play, pro/con of neuter, setups rather than in-moment training)  BMod (reward recovery, neutral interruption, DSCC, intro strategies, relaxed down)

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Three Levels: “Trask” “Trask” (3yr male Aust. shepherd)

1. Is patient/diagnosis likely to respond to medication?

2. Maintenance/daily vs. Situational/event?

3. Specific medication options

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Algorithm Thank you!

Patient/Diagnosis likely Treatment focus? Specific options: to respond to medication? Maintenance Fluoxetine Paroxetine Sertraline Clomipramine Yes

Situational/Event Trazodone Clonidine Benzodiazepines (5) Acepromazine Other/Adjunctive Gabapentin No Buspirone Amitriptyline

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