Is it a medical problem or a behavior problem?

Manage tricky behavior cases by determining medical factors, championing client education and knowing when to refer issues beyond your clinic’s scope

Determining why some pets engage in alarming or undesirable behaviors is a chicken-or-egg-first conundrum, according to Gary Landsberg, BSc, DVM, Dipl. ACVB, Dipl. ECAWBM. Which comes first—a medical problem or a behavioral issue?

“Behavior changes may be the first and only signs of an underlying medical problem, and that’s exactly why veterinarians must inform us at the earliest signs,” said Dr. Landsberg.

Why should veterinarians consult with a veterinary behaviorist sooner rather than later? Doing so may help a diagnosis, save a pet’s life and avoid damaging the all-important human-animal bond, Landsberg said.

Get to the Root

Ruling out possible underlying medical factors is a top priority during an exam of a pet with behavior issues, said Jill Goldman M.Sc., Ph.D., CAAB. Aggression, for example, may be a result of pain, while other abnormal behaviors can be attributed to metabolic problems, she said.

“Not only are changes in behavior often the first sign of disease, signs of pain and discomfort overlap signs of anxiety and fear,” said Kelly C. Ballantyne, DVM, Dipl. ACVB, a veterinary behaviorist at the University of Illinois at Urbana-Champaign. “Even if medical conditions are not the primary cause of the behavioral concern, they can contribute to or exacerbate behavioral issues.”

Medical problems and behavior issues often go hand-in-hand, according to Kenneth Martin, DVM, Dipl. ACVB, and Debbie Martin, LVT, a veterinary technician specialist in behavior, both with Veterinary Behavior Consultations LLC in Austin, Texas.

“The body and brain are interrelated,” Dr. Martin said. “The brain controls all body functions, and, thus, changes in behavior may be a result of a primary brain condition or secondary to another body system abnormality. Good health and/or the treatment of co-morbid conditions are essential to successful behavioral intervention.”

But determining whether problems are behavior related isn’t always straightforward, because they aren’t always evident—or brought up by pet owners—during routine exams, according to Ballantyne.

Pet behavior should be a topic discussed at every appointment, instead of asking owners about potential issues as an afterthought, or only asking if there appears to be a problem, she said.

“Clients may not realize their veterinarian is a resource, or they may be embarrassed to ask about behavior,” she said.

Use open-ended questions, such as “What concerns do you have about your pet’s behavior today?” to start a dialogue, she suggested.

Once underlying medical problems are ruled out or treated, and the pet still exhibits problems, it’s time to give the owners behavioral advice, including how to effectively manage the problem and prevent reoccurrence, how to modify and improve behavior with rewards-based methods, and, in some cases, using products or medication when the problem is abnormal or excessive, Landsberg said.

“What’s most important is to set realistic expectations for that pet in that home, and to use referral services for veterinary behaviorists for problems that are beyond what the practitioner feels they are capable of treating,” he said, adding that a best practice is to determine what behavior the clinic can’t—or won’t—manage.

Every practice can develop skills to provide preventive counseling for puppy and kitten owners, nuisance behaviors like garbage raiding or jumping up, or problems like feline house soiling or noise fears, according to Landsberg.

However, he added, extremely anxious or fearful animals, or those that have developed aggression, phobias, separation anxiety or compulsive disorders, are best handled through a referral.

Refer and Redirect

Once the problem is identified, it’s time to consider the next step, Dr. Goldman said.

“The best method to offering support and resources to clients is for veterinarians to provide referrals to applied animal behaviorists or veterinary behaviorists,” she said.

Practitioners who consider steering clients with problematic pets to a trainer before seeking out a behaviorist have things backward, she said, adding that while good trainers can teach, certified animal psychologists are needed to work with and improve behavioral issues.

“You really do need the experience of the trained behaviorist to diagnose properly,” she said, adding that once a behaviorist is brought in, it may then be possible to work hand-in-hand with a trainer.

Ballantyne regularly partners with local trainers to produce results.

“Trainers are able to give our clients one-on-one coaching on how to implement our behavior modification plan, objectively report back on the patient’s progress and alert us to issues when they arise,” she said. “We specifically select trainers who have extensive education in the science of learning, utilize only force-free behavior modification techniques and are skilled in client communication. This allows us to create a great team of support for our patients and clients.”

Keep the Bond Strong

Aggression, difficulty with skill learning and other unwanted behaviors strain the human-animal bond severely, according to Goldman.

“Behavior is important because aggression breeds mistrust,” she said. “Punishment and pain undermine bonds. If we’re angry at each other, it undermines the bond. If we’re not communicating, it undermines the bond. If we’re not getting along, it undermines the bond.”

Goldman strongly discourages veterinarians from recommending trainers who use aversive methods that include shock or pinch collars, hard-correction techniques and other “quick fixes,” which she believes actually may be harmful.

Ballantyne explains her human-animal bond philosophy to fellow practitioners and to pet owners by using the American Veterinary Medical Association’s definition, which states that the bond is a mutually beneficial relationship influenced by behaviors essential to the health and well-being of both humans and their animals.

“Behavioral issues are cited as a common cause of relinquishment or euthanasia,” she said. “Veterinarians can help to strengthen the bond by reviewing problem prevention during new pet appointments and discussing behavior at every visit to catch problems early.”

When problems arise, clients need coaching on how to manage a pet’s environment to avoid a continuation of the problem behavior while behavior modification and medical therapies are implemented, she said.

“If the veterinarian is not comfortable developing a treatment plan, referral to a board-certified veterinary behaviorist should be offered,” Ballantyne said.

Martin advises that veterinary professionals use client education to help owners develop empathy and provide them with information and resources regarding positive, humane training to improve the bond.

He suggests a course from Fear Free Foundations for Kittens & Puppies, which provides veterinary professionals with information to help address typical cat and dog behaviors without punishment.

Recommend Other Aids, Solutions

Products can help manage pet behavior only if they are accompanied by therapy, Landsberg said.

“While the drugs can reduce anxiety and might improve trainability, behavioral management and modification are essential steps in improving behaviors and preventing further occurrence,” he said.

Goldman agreed.

“These additions can be used as an adjunct, just like any type of drug therapy,” she said. “But it is an adjunct—an addition to a behavior therapy plan. You need to get the right ones. There’s anecdotal evidence that suggests that they do have some calming qualities.”

Such products include the dog-appeasing pheromone Adaptil, which has some calming properties that help reduce stress-related behaviors, and Feliway, a cat pheromone, that helps reduce marking urination, she said.

Some supplements containing amino acids, such as L-theanine or alpha-casozepine, can be useful, said Landsberg, adding that he also may use selective serotonin reuptake inhibitors like fluoxetine, clomipramine or the recently licensed dexmedetomidine, an oral mucosal gel licensed for as-needed use before a fear- or anxiety-inducing event, or trazodone or benzodiazepine.

While some pheromone and nutraceutical products marketed for their calming effects can be helpful adjuncts to the treatment of mild anxiety and fear, “moderate to severe anxiety and fear-related conditions are more effectively treated with pharmaceutical drugs in combination with management and behavior modification,” Ballantyne said.

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