Separation anxiety: Treating dogs in the wake of COVID-19Not every pet develops separation anxiety due to abrupt changes in the owner’s schedule, but the ones that do deserve our help August 19, 2020 By Valarie Tynes, DVM, DACVB, DACAWWe have experienced many dramatic changes in our lives recently and so have our pets. Many have adapted to families being around all the time, becoming comfortable with this new routine, and, then bam! Everything changes again. Across the country, some communities and families are under stay-at-home orders, while others are moving about freely. Even if your community has lifted restrictions, some people will remain in lockdown due to underlying health issues. That said, pets may have their worlds rocked as they find themselves home alone for the first time in months when the kids go back to school this fall. Animals that never experienced separation anxiety in the past could suddenly be coping with the perception of abandonment. We know behavior is the leading cause of pet relinquishments. On top of this, many pets are being given up due to uncertain living or financial conditions. This is happening when pet owners may need their companionship and emotional support more than ever. It behooves all of us in the veterinary profession to help prevent and overcome pet behavior problems before they result in irreparable damage to the human-companion animal bond. What pets are at risk? No one knows exactly what causes separation anxiety and we cannot predict which animals will develop it. We do know, however, some factors predispose certain individuals to developing the problem. Senior pets: Generally speaking, senior pets have higher rates of anxiety-related problems. As we age, our ability to tolerate changes decreases—our pets are no different. Sudden or frequent variations in their routines are more likely to be distressing to them. Newly adopted pets: Some studies have suggested dogs from shelters have a higher rate of separation anxiety. Does this necessarily mean they are more likely to develop this problem? Or does it mean dogs with separation anxiety have been relinquished at a higher rate or even escape more often and are then picked up by animal control? No one really knows. Keep in mind these pets have experienced upheavals in their lives about which we know very little. Pet owners are usually desperate for these new pets to settle into their home and be happy. So efforts should be made to help ease the stress of transition into a new household with new routines. Most dogs, especially those with separation-related problems, recognize the sound of their owner’s car. They may not reveal the intensity of their distress until they hear the car drive away. Photo by Jacquie De Almeida Pets with existing behavior issues (e.g. separation anxiety, noise aversion, etc.): These pets may have been better behaved and possibly even perceived as being less anxious while the owners are home. Owners may serve as social support for some anxious animals, helping them to feel better about being exposed to things that usually worry them. Due to their existing anxiety-related problem, they may be more sensitive to, or less able to cope with, another anxiety-inducing event than dogs without these problems. A sudden change in their routine, such as the owner going back to work, might be the “straw that breaks the camel’s back.” Puppies: Puppies may not necessarily be more prone to separation anxiety than other pets, but they do provide an opportunity we should all leap at: prevention. There are things we can do to decrease the chance a puppy learns to fear its crate or to make it feel better about being left alone. If this is done while the puppy is young, when they are most easily affected by new experiences (good or bad), we have the ability to positively influence his or her welfare for their entire life. Spending a few minutes educating new puppy owners about this critical time in a puppy’s life and how best to manage it is priceless. Helping families before they leave the house entirely If the pet owner knows they will be returning to work within the next few weeks, they should be encouraged to begin preparing the pet by doing the following: Leaving the pet alone for short periods and then gradually increasing the length of time they are on their own Every time the pet will be left alone, regardless of how long, owners should offer a special treat. Ideally, it will be something owners only give the pet when they are going to be alone. The longer your planned absence, the longer lasting the treat should be. Stuffed and frozen Kongs or other food puzzle toys can help Dog-appeasing pheromones create a more calming environment. These are available in diffusers that can be plugged into outlets in the area where the dog spends the most time. Collars that are impregnated with the pheromone and release it continually while it’s worn by the dog are another option. They are excellent choices for those individuals that have multiple anxiety-related problems, and also because the collar goes everywhere with the dog. Diffusers may be the better choice if owners, for whatever reason, don’t want to put another collar on their dog. Diffusers and collars are equally effective; however, some owners may find one easier to use than the other, while other clients may use both to increase their chance of success Recommend the client slowly adjust their schedule to one they can realistically be able to stick to when back to work. Here is an example: Many owners are enjoying hour-long walks with their dog every morning right now, but eventually they will be limited to shorter walks in the evening. As such, they should begin decreasing the length of morning walks and increasing evening exercise In the case of the geriatric animal, ask the client to bring their pet in for an exam and necessary diagnostics, so that all medical problems are managed as well as possible. Anxiety and pain can be difficult for owners to differentiate. Because pain leads to anxiety, it is critical that appropriate pain management be in place before the pet becomes stressed again. Pets that have demonstrated signs of anxiety in the past—but are better while the owners have been at home—may need to be video-recorded while alone in the house. By doing this a few times, you can confirm whether the pet is doing well or it is stressed or anxious when left alone. If they are exhibiting signs of anxiety, such as panting, pacing, salivating, or vocalizing, even in the presence of a dog-appeasing pheromone, consider adding a calming nutraceutical (alpha casozepine or L-theanine) or anxiolytic medication (see sidebar below). Use the time while the owner is still working from home to determine what medication and dose may be necessary to sufficiently calm the pet. Clients are more likely to be able to take the time to “test-dose” a medication by setting up a smartphone to record the pet’s behavior when they leave the house. The most important thing the veterinarian can do is remind the owner that most animals are extremely resilient and cope well with changes in their lives. For those who do not, we simply want to educate the client that quick action before problems worsen is critical. CHOOSING MEDICATIONS TO TREAT ANXIETY, FEAR, OR PHOBIA IN PETS Click chart to enlarge I am frequently asked by veterinarians, “What is the best drug to treat ‘X’?” or “What is the best dose of ‘Y’ for noise phobias?” I really wish the answer to treating behavior problems was that easy. The fact is, the drug that works to treat one dog’s anxiety is not necessarily the one that will work in a different individual. Effective doses for any dog will vary similarly. For example, over the years I have prescribed 0.03 mg/kg of alprazolam to many dogs with separation anxiety and had owners report it did absolutely nothing for the patient’s behavior. I have also prescribed the same dose to a dog and have the owner tell me the next day she set her alarm to wake her up every hour all night long to be sure her dog was still breathing after having given him a single test dose. Individual responses to these drugs are a fact of life we must be prepared to navigate. This will be easier if we educate owners with the very first conversation about the need to test doses and to communicate closely with the veterinarian or staff regarding their dog’s responses to the drug. Medications for separation anxiety can be divided into two basic categories: event medications and daily-use medications (See chart to the right). Event medications can best be described as those that act quickly, but for a short period of time—typically six hours or less. These medications are ideal (and possibly even critical) for pets with separation anxiety whose owners have to leave them alone for whatever reason. Depending on the drug, the dose should be given 30 to 90 minutes before the owner departs or before the dog typically begins exhibiting signs of anxiety associated with departure. Before giving any of these medications to their pet, the owner must be taught the importance of testing the initial dose while they are home and know they will not have to leave the dog alone for several hours. By doing so, they can confirm there is no unusual reaction to the drug and that the patient’s anxiety is effectively decreased. If the effect appears to be minimal, the dose can be adjusted upward (but within the recommended range) until the desired change is seen or an undesired outcome is noted (i.e. sedation). Daily-use medications include those drugs that typically require several weeks (four to six in most cases) to have the desired effect. These medications cannot be given on an as-needed basis if treatment is to be successful. They must be administered at the recommended dose daily and the pet owner encouraged to be patient and wait for them to take effect. They cannot say after two to three weeks, “This drug isn’t working, so I am going to stop giving it.” The pet owner must give it four to six weeks before determining if it is effective or not. Dosages of these medications can also be increased (within the recommended range) until the desired effect is seen. Generally speaking, dosage should begin at the bottom to middle of the dosage range, depending on the patient’s signalment. After one to two weeks, if desired, the dose can be increased and the medication given a few more weeks to take full effect. However, if inadequate results are achieved at the maximum recommended dose after four to six weeks, consider switching to a different medication. Daily-use medications should be considered in severe cases of separation anxiety where owners must be gone for long hours on a regular basis. Multimodal therapy (i.e. where a daily-use medication is combined with one or more event medications, nutraceuticals, and pheromones) may also decrease the chance that very high doses are required to successfully treat the problem. In this case, veterinarians are encouraged to be even more familiar with how these drugs work, the neurotransmitter they target, and other aspects of their pharmacokinetics to safely give them to a patient. To ensure the pet’s best welfare, event medications should always be started first in cases of separation anxiety. Daily-use medications can be added shortly thereafter, if desired. Encouraging a discussion Destructive behavior while alone in the house may be a sign a dog is anxious. Pet owners often do not ask questions about their pets’ behavior or mention behavior changes. In most cases, staff members must prompt this conversation with a few simple questions or through the use of a short history form. Suggest receptionists or customer service representatives ask the following when making an appointment: Have you noticed any changes in your pet’s behavior you would like to discuss? If the answer is yes, either make a note for the nurse to ask more questions during the appointment or direct the pet owner to your website to complete a detailed history form prior to the appointment. Additional questions to ask include: Have you noticed your dog pants, paces, salivates, or vocalizes when you prepare to leave? Has your dog ever (since adulthood) been destructive in the home while alone? If yes, does this only occur in your absence? Does your dog ever eliminate in the home, but only in your absence? Is it impossible to crate your dog safely? Does your dog attempt to follow you closely throughout the home at all times and become distressed if forced to stay in a room without you? If the client answers “yes” to any of these questions, they should be urged to collect video of their pet after leaving him or her alone in the home. The dog may be experiencing separation-related distress when alone and will need a form of intervention to prevent further suffering. Pet owners should be reassured that many solutions exist for helping pets with anxiety, and that their veterinarian is there to help. If the pet appears anxious about being left alone, the problem will worsen with repeated experiences of the owner leaving the house. There is no question about this. Anxiety, by its nature, gets worse with experience, so the owner should act quickly to prevent it from escalating. The longer the problem exists, the more difficult it becomes to treat. If the veterinarian, in consultation with the owner, determines the anxiety is still mild, initial treatment with dog-appeasing pheromones and possibly a calming nutraceutical should be started right away. If these interventions prove to be inadequate to completely resolve the pet’s anxiety (based on the results of video of the dog home alone), anxiolytic medications can be given. But I don’t have time for a behavior conversation Understandably, veterinarians feel ever-pressed to do more in less time. The idea of having long and complex conversations with owners can be daunting. So, don’t do that. Behavior cases, such as the ones described here, lend themselves perfectly to telemedicine. As long as you already have a valid veterinary-client-pet relationship (VCPR) and you have verified the pet has no health problems contributing to anxiety, schedule a behavior appointment by phone or video for a later date. This gives the pet owner time to collect the video (see the article on page 39) and the veterinarian the opportunity to review the case and prepare for the discussion. When behavior problems are complex and/or do not respond readily to the commonly used interventions described here, the veterinarian should not hesitate to reach out for a consultation with a behaviorist. Let your clients know about the availability of these specialists. Even if the behaviorist is located several hours away, the client can be fully informed about the options to support their pet. Owners must understand behavior is a science and that a great deal of evidence-based help is available to their pet. This prevents them from going to the internet, family, or friends with their pet’s behavior problems. The information they receive there may be ineffective at best and is often harmful. The bottom line Pet owners often miss signs of anxiety in their pets or fail to realize how damaging chronic anxiety can be to their health and welfare. With a minimal investment of time, veterinary staff can screen pets for potential separation-related anxiety prior to or at the beginning of an appointment. Initial interventions can be recommended and additional appointments scheduled as needed. Not every pet develops separation anxiety due to abrupt changes in the owner’s schedule, but the ones that do deserve our help. The problem can severely impact the health and well-being of those pets. We don’t know exactly how to prevent separation anxiety, but we do know the management suggestions recommended here will “do no harm.” Further, they will very likely improve the welfare of any dog. Finally, the time invested to educate pet owners about such important matters is never wasted. GETTING ANXIOUS PETS READY FOR THEIR CLOSE-UP Encourage pet owners to set up a camera so you can see how the dog reacts once they leave the house. Ensure clients know they need to get in the car and drive away for a realistic view of how their dog behaves when they depart. Photos courtesy Valarie Tynes Taking video of a pet’s behavior when alone is critical to accurately diagnosing separation-related distress. Smartphones and tablets make collecting pet video easier than ever. Yet, owners may be hesitant or unable to capture what’s needed without clear instructions. To identify the signs of separation anxiety, clients should be instructed to record the crate or other confinement area. (This assumes the pet can be safely confined.) If the pet is left loose in the home, good video can usually be collected by placing the smartphone or tablet near the door through which the owner typically leaves the home. The camera should capture the widest possible view around the departure area. Even if the dog goes out of view, vocalizations can be heard. If the dog doesn’t remain around the door area at all, the owner can try again on another day after noting where the pet appears to be going or spending time. This picture illustrates how to position a smartphone for a view of the area your dog frequents. (Note the phone propped up in the upper right-hand corner.) Turn it on and drive away for five to 20 minutes. Also, inform pet owners they must actually leave the home. They cannot pretend to leave and spy on their dog through a window—they must drive away. Most dogs, especially those with separation-related problems, recognize the sound of the owner’s car. They may not reveal the intensity of their distress until they hear the car drive away. In most cases, 10 to 20 minutes of video will help make a diagnosis. However, if the owner wants to collect just five minutes of video because they fear leaving the dog for a longer period, that can still be very useful. Video should never be collected if it puts the pet at risk. Once the owner discovers how best to collect video of their pet, they should continue to use this method to monitor the results of different treatment strategies. Valarie Tynes, DVM, DACVB, DACAW, received her DVM from Texas A&M University. She completed her residency in clinical animal behavior at University of California, Davis in 2003 and has been a diplomate of the American College of Veterinary Behaviorists since 2003. Dr. Tynes received her board certification in animal welfare in 2018. Her special interests are the behavior and welfare of pet pigs, exotic pets, and zoo animals. She joined Ceva Animal Health in October of 2014 as a veterinary services specialist, but continues to provide consulting services to zoos. Tynes lives on a ranch in West Texas with her husband, Michael, and Labrador retriever, Grace.