Sunday, July 2, 2017

Your Dog On Drugs

It's almost time for the loudest holiday in many cities- July 4th. Fireworks, firecrackers, sparklers and lots of bright lights in the evening. While many of us get to enjoy the festivities, this night can be a harrowing one for dogs who have aversions to noise. How do you cope? Well, you start by working on desensitizing way before July 2nd. You may feel your dog needs medication and you may be right, but that can be where the real frustration starts.

It seems as though we are a society more and more dependent on pharmaceutical intervention. This is a great thing much of the time- people are living longer, better lives, and doing more with illnesses that would have limited them severely in the past. The same is true for our dogs- since dogs are similar metabolically to humans in some ways, your veterinarian can prescribe similar medication (or the same at a different dose) to help with a variety of disorders and diseases. Antibiotics, anti-fungal, insulin, thyroid medication, even anti-anxiety medications can be commonly prescribed. The world of canine medication has advanced significantly and our dogs are (usually) living better lives because of it.
I want to say this: I am not inherently against medication at all. What I am cautious of is over-prescribing and inappropriately prescribed medications. I am not a veterinarian and have no legal right to prescribe or recommend medications for any dog. That is a discussion to have with your veterinarian. If your veterinarian is unsure about behavioral medications, they should get in touch with a veterinary behaviorist. Many veterinary behaviorists across the country will consult with your local veterinarian for free or for a low fee to help out if your area is under-served in that specialty. Let me be clear- medication can work wonders for dogs, but it has to be the correct medication for your dog, so ask your vet and seek out a veterinary behaviorist if necessary.

Generally, I see problems in dogs who are put on a medication that is essentially a tranquilizer to aid in anxiety. Let's look at Acepromazine, which is regularly used pre-surgery in cats and dogs and likely too often used in an effort to reduce anxiety in them. This medication has been around since the 1950's and works by blocking dopamine receptors in the brain. Dopamine is responsible for perceiving pain, pleasure, aiding in motor function and digestion. The patient's blood pressure, heart rate and temperature are all decreased on this medication. This is acceptable in surgery, since all those will be monitored the whole time anyway. The problem comes when the medication is used in an anxious dog because it tends to be the opposite of helpful. I will explain why in human terms.
You are out at a bar with a friend. Your friend goes outside to take a phone call and warns you it will take more than a few minutes, which you are kind of ok with- you don't really like being alone in this poorly lit place, but you figure you can handle a few minutes. As you sip your drink, you realize that you aren't able to move as well as you should be, your motor skills are not where they should be. Either your drink is really strong or someone has put something in your drink. You look around for your friend but suddenly the lighting seems worse and you can't see much. You try to get up and stumble off the barstool...
That is what it's like for (many) dogs on acepromazine. Imagine if you are a person who already has a very high level of stress associated with a bar and this happened to you. Would you feel better not being able to respond to what you perceive as threatening, realizing you physically cannot do what you want? It actually makes anxiety worse, but the symptoms are masked by the medication so to the untrained eye the dog looks "fine". In surgery, the drug is given IV and the dose is relatively low since it is only needed short term and the muscle relaxation is useful in that context. After all, nobody wants a twitching leg in the middle of an ACL repair! Now, acepromazine is just one example; there is a world of drugs out there and new ones are developed regularly. What I want to stress is the importance of getting the right drug for your dog, monitored by you and your veterinarian. Most of the time, a simple sedative is not the right choice for anxiety or aggression and will likely make those behaviors worse. Remember that aggression or fear is a response on the dog's part to a perceived threat, however unjustified we may see that perceived threat. The right medication may take weeks to take effect and you will also need to do some behavioral modification training with a certified trainer fluent in reward based training (adding in the stress of a physical corrections, shock, pinch or prong collars does no good). In the best case scenarios, a dog is on a medication for a period of time, goes through training which includes desensitizing, counter-conditioning, and teaching more appropriate responses to triggers and is able to be weaned down to a low dose or no medication at all. (study questioning the ineffectiveness of acepromazine not long after it was introduced into human mental health) (use of operative and pre-operative drugs)

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