How not to let a behavior case ruin your day -- partner up

The schedule is slammed on a Friday afternoon, and you are running behind. Your next appointment is there “just” for booster vaccines. “Wonderful,” you think. “This will only take five minutes, allowing me to catch up.” And then it happens… You wish Mrs. Smith a wonderful weekend, and she says, “Well I hope you have a good weekend doctor, but I will have a terrible one because the forecast calls for storms on Sunday. Charlie hates storms!” What would you say to Mrs. Smith? Would your reply be something like, “I’m sorry to hear that. Make sure to give Charlie lots of love this weekend,” while thinking to yourself you just don’t have time to discuss behavior in the course of a busy day? Do you feel unprepared to address these concerns because you didn’t receive enough training in veterinary behavior in the first place? Does the idea of discussing behavior modification, environmental management, and behavior medications give you anxiety of your own? Well, you’re not alone. A 2012 study investigating veterinarian-client communication during wellness visits found during a sample of 17 wellness exams, every client brought up at least one behavior concern (58 behavioral concerns in total). Of these, only 10 were discussed by the veterinarian. And of those 10, none were followed up with any management beyond what was spoken about during the initial examination.1 This article aims to give you the tools to change that. We are going to discuss how to get clients and patients the help they need, all in less than two minutes of your time. Our plan can be broken down into two easy steps: Step 1: Identify the problem: Once you’ve done that, ascertain the client’s willingness to proceed with management. Step 2: Address the problem: Provide the client with a trusted resource (i.e. behavior veterinarian, behavior consultant, or trainer) who can help, and begin your own medical management. Let’s use our storm-related anxiety case as an example and apply the steps as described in the previous paragraph: Step 1: Assure the pet owner you acknowledge their concern. Avoid brushing it off. Let the client know this is not a problem unique to their pet, and you are glad they brought up it with you. You could say something like this: “Storm-related anxiety is a very common and potentially very serious problem. I am glad you brought this to my attention, Mrs. Smith. There are a number of things we can do to help. Would you be interested in discussing some solutions?” Step 2: If you are fortunate enough to have a veterinarian or other staff member on hand who has special training in behavior, you can recommend the client set up a behavior consultation with that individual. If you do not have a qualified individual on staff, it’s time to look elsewhere for help. Veterinarians frequently ask me where to find trainers, behavior consultants, and behavior veterinarians to whom they can refer their clients. While there are many organizations purporting to train their members in animal behavior, my experience is many veterinarians don’t know whom to trust and find themselves easily overwhelmed with options. (See “Behavior and training resources” sidebar below for an overview of some reputable organizations and how to find members near you.) In our storm-anxiety example, let’s assume you have a preexisting relationship with a local canine behavior consultant, Mrs. Franklin, who you found previously on the International Association of Animal Behavior Consultants’ (IAABC’s) website. Assuming Mrs. Smith is interested in proceeding, you might tell her, “I think Charlie would greatly benefit from a consultation with Mrs. Franklin. She is a canine behavior consultant and is highly skilled in addressing behavioral concerns such as thunderstorm phobia in dogs. I think a consultation with her would be a great place to start, so I will have our staff provide you with her contact information.” Remembering to rule out underlying medical causes, you add, “Since storm anxiety is a complex problem, I would like to delve into it with you in a bit more detail. Let’s run some blood work to make sure Charlie’s organs are functioning normally, since underlying medical problems can sometimes influence fearful behaviors such as storm anxiety. When I call you with the lab results, we can also discuss the option of using certain medications or supplements during storms.” This script requires approximately 60 seconds of speaking time, yet it provides an excellent starting plan for this dog’s behavioral pathology. Behavior and training resources If your plan is not to see behavior consultations in your practice, you will need a network of reliable individuals to whom you can refer cases. Your network may include boarded specialists, veterinarians with a special interest in behavior (nonspecialists), PhD behaviorists, animal behavior consultants, and positive-reinforcement trainers. It is a good idea to identify a few nearby individuals from one or more of the organizations listed here. Ideally, you should call or email these professionals first to assess their methods. The American Veterinary Society of Animal Behavior (AVSAB) “How to choose a trainer,” guidelines may be helpful,” which you can find here. If you are at a loss as to where to look for qualified individuals, consider this list—and links—a starting point: American College of Veterinary Behaviorists (ACVB)—Board-certified veterinary behaviorists American Veterinary Society of Animal Behavior (AVSAB)—Nonspecialist veterinarians, as well as PhD behavior consultants Certified Applied Animal Behaviorists (CAAB)—animal behaviorists with postgraduate degrees (master’s or PhD in behavioral science, or DVM) International Association of Animal Behavior Consultants (IAABC)—certifies animal behavior consultants Certification Council for Professional Dog Trainers (CCPDT)—certifies both dog trainers and behavior consultants Pet Professional Guild (PPG)—offers membership to pet professionals, including canine trainers and canine behavior consultants; some members are experienced with cats and other species, as well The bite wound scenario Mr. Lee presents with his beloved Doberman pinscher, Cujo, who has been attacked by his other dog, Rufus. This is the second time you have seen Cujo for being injured in an altercation with Rufus. You present Mr. Lee with a treatment plan for surgical repair of Rufus’s bite wounds. Later that day when Mr. Lee picks up Cujo, you discuss postoperative care and medications. You know you should also address the elephant in the room, meaning the behavioral problem that has led to these fights, as more injuries are likely in the future. In my behavior practice, 68.8 percent of dogs that have presented for inter-dog aggression have caused penetrating bite wounds two or more times. Step 1: You might consider saying, “Mr. Lee, I am glad we were able to get Cujo treated today. I think it would be great to focus on prevention of this issue in the future. It is not uncommon for us to see cases where dogs in the same household sometimes injure each other, and there are a number of things we can do to help. Would you be interested in discussing some solutions to prevent further episodes like this?” Step 2: This is a case where both the animal’s mental and physical health (and potentially the physical health of people in the home) are at risk. Referral to a qualified individual is crucial. You may consider referring Mr. Lee to a veterinarian you have identified on the American College of Veterinary Behaviorists (ACVB) or American Veterinary Society of Animal Behavior (AVSAB) websites. You might also say the following: “Mr. Lee, I think it would be very important to have Cujo and Rufus assessed by a veterinarian who has a special focus in behavior. I would strongly recommend contacting Dr. Daniels so we can ensure Cujo and Rufus can live in harmony, and reduce the risk of serious injury as well. Until your appointment with Dr. Daniels, I recommend keeping Cujo and Rufus apart from each other as much as possible.” In inter-dog aggression cases (or any other case where multiple pets are part of the behavioral concern), we should evaluate the possibility medical changes in any of the involved pets could play a role. In Cujo’s case, he may be exhibiting behaviors that result in him being victimized by Rufus. Alternatively, Rufus may have medical or behavioral pathologies that could be making him more aggressive, hence the following advice: “Mr. Lee, I think we should have Rufus come in for an examination as well. If Rufus is feeling unwell, it may alter his behavior, leading to aggressive events between him and Cujo.” The jumping puppy scenario Mrs. Lopez comes in for a wellness exam with Hopper, her one-year-old Labrador. Hopper seems friendly and readily takes treats from you while you complete your physical examination, but constantly jumps up on Mrs. Lopez, your staff, and you. Mrs. Lopez rolls up her sleeve to show you the scratches she has sustained over the past few months, and comments: “Hopper is such a good dog, but he really likes to jump up on me. Maybe if it would help if you cut his nails.” With the aid of some treats, your staff has no trouble trimming Hopper’s nails. However, you know even after the nail trim, Hopper can still injure Mrs. Lopez by scratching her or knocking her over if he jumps. This case is not an example of a behavioral pathology, but rather an undesirable behavior, i.e. inappropriate attention-seeking. Step 1: You could approach the subject with Mrs. Lopez this way: “Hopper does seem like a great dog, but I’m sure it’s no fun to have your arms scratched. It may be he is trying to get your attention by jumping. I know the perfect person who can help you teach Hopper other ways to ask for your attention so you don’t get scratched or knocked over. Doesn’t that sound like a great idea?” Step 2: Assuming Mrs. Lopez has responded affirmatively in Step 1, you might refer her to a positive reinforcement trainer you have identified through Certification Council for Professional Dog Trainers (CCPDT) or Pet Professional Guild (PPG): “I can recommend a certified professional dog trainer who only uses positive reinforcement methods and can help you teach Hopper alternative behaviors. This way, Hopper can still have fun and be happy, but won’t be jumping up on you!” While it is always a good idea to rule out medical causes of behavioral changes, it is relatively unlikely a young dog like this would be jumping due to a medical problem. It is more likely he is demonstrating inappropriate attention-seeking behaviors because he never learned appropriate ones. On the other hand, if this dog was not a puppy and had just recently started demonstrating this behavior, it would be more prudent to recommend a medical workup to address such an acute behavioral change. The house-soiling cat scenario Mr. Brown brings in Petunia, his female spayed cat, for urinating outside the litter box. A complete physical examination and diagnostic workup (CBC/chem/UA/T4, urine culture, and radiographs) demonstrate no apparent medical abnormalities, so you suspect the house-soiling is behavioral. Cats urinating outside the litter box could be plagued by health or behavior issues; sometimes clients need a push to consider nonphysical experts. Photo: Bigstock Step 1: Validate the client’s concern: “Mr. Brown, I am sure it is very frustrating to have Petunia urinating outside the litter box. There are many potential causes for this, and I think we need to consider this may be a behavioral problem. Would you like to discuss some behavioral solutions?” Step 2: While it is important the veterinarian continue to monitor for any medical abnormalities in this case (e.g. feline idiopathic cystitis [FIC]), bringing in a behaviorist, such as a certified applied animal behaviorist (CAAB), can provide crucial behavioral management for this patient. “Since stress and anxiety can play a significant role in house-soiling, I think it’s time for us to add somebody to the team who can treat the behavioral components of Petunia’s case. I will have our staff provide you with contact information for an animal behaviorist who has done an excellent job with some of our other feline house-soiling patients.” Even if we are unprepared to address behavioral pathologies ourselves, there are multiple networks of qualified individuals we can rely on. A team approach to behavior is critically important. Just as we consider referrals to cardiologists, ophthalmologists, and imaging services an important part of daily practice, we should not overlook the many options available for help with behavioral issues. Let’s engage the networks of veterinarians, behavior consultants, and qualified trainers to assist us in getting these patients the help they need, without requiring a dramatic change in practice style. Steven Edwards, DVM, is a 2013 graduate of Ross University School of Veterinary Medicine (RUSVM), and currently serves as president-elect of the American Veterinary Society of Animal Behavior (AVSAB). He is founder of Veterinary Relief and Behavior, which offers relief services to practices and veterinary behavior consultations to patients in Florida’s Tampa Bay area. Dr. Edwards can be reached at PetDoctorEdwards@gmail.com. REFERENCES Roshier, A. L., and E. A. Mcbride. “Canine Behaviour Problems: Discussions between Veterinarians and Dog Owners during Annual Booster Consultations.” Veterinary Record: 2012; 172, no. 9: 235–35.

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