Clinical Case Challenge: Animal Behavior Clinic

Digital StillCameraCase Description

A 2.5-year-old miniature dachshund named Otto, presented to the Animal Behavior Clinic at Cummings School of Veterinary Medicine at Tufts University for the sudden onset of aggression to his owners. The aggression consisted of growling, lunging, snapping and biting. Lifting him, attaching a leash and approaching him while resting triggered an aggressive response. He used aggression to guard valued resources, such as his food bowl, long-lasting treats and objects he had taken that did not belong to him. He growled or snapped when petted. He was more likely to attack when he was on an elevated level, such as a sofa or lap. The aggression was intermittent, giving the impression of unpredictability to the owners.

Otto’s referring veterinarian conducted a thorough physical examination. A CBC, chemistry and total T4 were within normal limits. Medical causes of behavioral changes secondary to hypothyroidism, hepatic insufficiency, painful conditions, such as IVDD or orthopedic issues were ruled out.

What is your diagnosis and what treatment would you recommend?

Diagnosis

The correct diagnosis is conflict aggression, which is characterized by aggressive behavior directed toward owners in response to a perceived provocation. Triggers can be separated into three categories: resource guarding (e.g., resting places), postural interventions (e.g., lifting, petting, nail trims) and when owner takes on a leadership role (e.g., grabbing the collar, removing from furniture, reprimands, physical punishment). A dog with this problem may behave differently to different individuals in the family. The behavior may also appear unpredictable to owners because it is intermittent. For example, a dog may tolerate being picked up one day and not the next. However, close questioning reveals that there is generally a predictable set of triggers that at least sometimes, will lead to an aggressive response.

This diagnosis used to be called Dominance Aggression. However, our current understanding is that this form of owner-directed aggression is rooted in anxiety, not confidence. Conflict-aggressive dogs are temperamentally bold. However, their anxiety renders them impulsive and reactive toward members of their social group. Studies have shown that conflict-aggressive dogs have lower levels of the transmitter serotonin. (Çakiroǧlu 2007). This condition can be inherited genetically, as seen by its increased frequency in certain breeds, such as dachshunds, chihuahuas, Australian cattle dogs, and others (Serpell 2008). Insufficient early socialization can also predispose dogs to conflict aggression. While the seeds of conflict aggression are planted early in life, it usually manifests at social maturity (9 -24 months of age.)

Important differentials are Irritable Aggression, Fear Aggression and Rage Syndrome (partial complex seizures). Irritable aggression occurs when a dog has a painful medical condition that lowers his or her aggression threshold. Fear aggression is commonly directed at people outside of the dog’s inner circle of family and friends. Rage syndrome occurs in response to a trivial trigger or no trigger at all. It is prolonged and often accompanied by a pre- and postictal behavior change. Dogs may have multiple diagnoses.

Treatment

Treatment consists of behavioral modification in which triggers of aggression are strictly avoided and steps are taken to improve the owner’s benign leadership position in the eyes of the dog. Changes in diet and exercise are also part of the treatment regimen.

Exercise and Diet:

The owners were instructed to provide Otto with an hour a day of aerobic exercise. They were also told to feed a diet low in protein and free of colorings and preservatives. Exercise and diets lower in protein may help to stabilize serotonin in the brain.

Neutering:

Neutering was recommended as it has been associated with a decrease in aggression. (Tsu 2010)

Avoidance of Conflict and Triggers of Aggression:

The list of triggers was discussed in depth with the owners, and strategies were developed to avoid them. It was explained to the owners that avoidance is therapeutic in that it prevents Otto’s continued sensitization to interactions that he does not like, thereby building trust. The owners were told to no longer permit Otto on laps or furniture and to leave him alone when he rested in his own bed. He should not be lifted up the stairs or into the car. He should not be given any chews or toys he would guard. If he had a stolen object, the owners were instructed to let him have it if it were not dangerous for him or valuable to them. If it were necessary to take it away from him, they were instructed to use a distraction technique such as ringing the doorbell or asking him to go for a walk, then picking it up when he left the room. They were instructed to decrease the frequency and duration of petting sessions. The owner developed a very clever leash and collar combination that could be slipped over his head and fixed onto him from a standing position.

Leadership:

The owners were instructed to strengthen their leadership position by having Otto obey a command before both of his twice daily meals and all food treats. Once his food was prepared, Otto was told one time to sit. If he obeyed, the food was put down instantly and the owner was to walk away. Otto was given 15 minutes to eat. All uneaten food was picked up to prevent guarding. If he did not obey the command to sit, his food was put away and he was not to be fed again until the next meal. If he anticipated the command by sitting before he was told, he was given a different command, such as down. The owners were also instructed to ignore demanding and attention-seeking behaviors.

Medication:

Fluoxetine (Prozac) was prescribed at 1 mg/kg once daily. Fluoxetine is a selective serotonin reuptake inhibitor that stabilizes mood, increases confidence and decreases reactivity and impulsivity.

Follow-Up

Weekly follow-up phone calls were instituted to check in about the program. Each episode of aggression was discussed in detail and the behavioral modification plan was adjusted. The dose of fluoxetine was adjusted once. Otto was neutered.

Outcome

Three months after the consultation, aggression decreased from one episode per day to one per week. Six months after the consultation, aggression occurred less than once per month.

References

  1. Duffy D, Hsub Y, Serpell JA, Breed differences in canine aggression Applied Animal Behaviour Science, Volume 114, Issues 3–4, 1 December 2008, Pages 441–46
  2. Çakiroǧlu D, Meral Y, Sancak AA, Çifti G, Relationship between the serum concentrations of serotonin and lipids and aggression in dogs Veterinary Record 2007;161:59-61 doi:10.1136/vr.161.2.59
  3. Hsu Y, Liching Sun L, Factors associated with aggressive responses in pet dogs, Applied Animal Behaviour ScienceVolume 123, Issues 3–4, March 2010, Pages 108–123 

At Your Service: Animal Behavior Clinic

The Animal Behavior Clinic at Cummings School of Veterinary Medicine at Tufts University provides comprehensive services aimed to help pet owners address many common animal behavior problems, including:

  • aggression directed at people or other animals, inside or outside of the home;
  • anxiety, including specific fears and phobias (e.g., separation anxiety and thunderstorm phobia);
  • compulsive disorders, such as tail chasing, shadow chasing, flank sucking, acral lick dermatitis, psychogenic alopecia, and wool sucking;
  • species-typical behaviors, such as urine spraying; and
  • nuisance behaviors such as excessive barking, digging, and nipping

Founded in 1986 by internationally renowned animal behaviorist, Dr. Nicholas Dodman, the Animal Behavior Clinic was one of the first of its kind in the country.

Providing Access to Specialized Animal Behaviorists

The clinic is home to individuals who are board-certified by the American College of Veterinary Behaviorists, as well as licensed veterinarians who are either involved in or have completed their residency training. As the only veterinary teaching hospital in New England, you will appreciate knowing that our animal behaviorists have access to a wide range of veterinary specialists, who may be consulted if a medical issue is found to be a factor related to an animal’s behavior.

Meet our Team

Nicholas Dodman, BVMS, MRCVS, is a Diplomate of the American College of Veterinary Behaviorists, and Professor, Section Head and Program Director of the Animal Behavior Department of Clinical Sciences at Cummings School of Veterinary Medicine at Tufts University. Dr. Dodman is internationally recognized as one of the world’s most noted and celebrated veterinary behaviorists. Shortly after joining the Tufts faculty in 1981, Dr. Dodman developed a strong interest in behavioral pharmacology and the field of animal behavior, and in 1986 founded the Animal Behavior Clinic. The list of accomplishments that define Dr. Dodman is extensive and reflects his wealth of experience and prestige in the field of animal behavior. He has authored four acclaimed bestselling books: The Dog Who Loved Too Much (Bantam Books, 1995), The Cat Who Cried for Help (Bantam Books, 1997), Dogs Behaving Badly (Bantam Books, 1999) and, the latest, If Only They Could Speak (W.W. Norton & Co., 2002). Additionally, he appears regularly on radio and major television programming, is a Pet Expert for Time, Inc. and also writes a monthly “Expert Advice” column for LIFE magazine.

Stephanie Borns-Weil, DVM, earned her doctorate in veterinary medicine at  Cummings School of Veterinary Medicine at Tufts University in 2007. Prior to joining the Behavior Service as a resident, Dr. Borns-Weil was in general practice on the North Shore. As a general practitioner, she focused on educating owners about animal behavior and making the visits stress free for the pets. In 2010, she opened a behavior house call practice that served the Boston area. Dr. Borns-Weil has had a lifelong interest in the human-animal bond as well as animal behavior. She holds a Masters Degree from Harvard Divinity School, which has helped her to develop the tools to communicate effectively with pet owners. Dr. Borns-Weil is deeply committed to working closely with clients to solve their pets’ behavioral problems and support their important relationship with their pets.

Ronni Tinker, animal behavior clinic’s office manager, is responsible for the business operations of the Animal Behavior Clinic. Ronni is well known with existing clients for her friendly and compassionate personality when booking clients for in-house appointments or VetFax consultations. She is the “go to” person for all the information and materials you will need to set up a behavior consultation for your pet. As a veterinary teaching institution, we are committed to training the veterinarians and animal care specialists of the future. These students rotate through our clinical services and are integral to the entire veterinary team.

Services We Offer

There are two different ways a pet can come to receive care from our animal behaviorist team. Some pet owners may self-refer or you as a primary care veterinarian may recommend our services.

  1. Veterinary Behavior Consultations
    A pet owner will participate in a ninety-minute consultation with either Dr. Nicholas Dodman or Dr. Stephanie Borns-Weil at which time he/she will receive a diagnosis, behavioral explanation, prognosis, and treatment plan for the pet’s behavior problem. The program includes a six-month follow-up period during which our Animal Behavior team will help the owner implement the treatment suggestions.
  2. VETFAX
    You may refer one of your pet clients for an animal behavior consultation, which will involve a veterinarian–to–veterinarian consultation. You will work with your client owner to provide a written account of the behavior problem and mail or fax this report to Tufts Behavior Clinic. Dr. Dodman and his assistant will make a three- to six-page consultation response to the you within one week.

In both cases, an extensive questionnaire is required regarding the pet’s behavior, health and lifestyle. We will then provide a full explanation for the behavior, develop a behavioral management and treatment program, and work closely with you/your client, providing ongoing support via telephone and e-mail communication to address questions that may arise as the recommended behavior modification are implemented.

Treatment typically involves a combination of behavior modification for pets and management changes for owners. In some case, drug therapy is required to resolve the problem.

Established behaviors take time to change with a minimum course of behavioral treatment to be about eight weeks. Pharmacological intervention takes longer, and typically requires a 6-12 month course of treatment.

Scheduling a Consult

We recognize that animal behavior problems play a significant role in the breakdown of the human/animal bond in families that own pets. At the Animal Behavior Clinic, we are dedicated to providing the most compassionate experience for pets and their loved ones. If you would like to arrange for a VetFax consult, you may contact Ronni Tinker at 508-887-4640.

At Your Service: Ophthalmology

The Ophthalmology Service at the Foster Hospital for Small Animals is home to two faculty board-certified ophthalmologists, two ophthalmology residents, an ophthalmology technician and a primary liaison, all dedicated to providing medical and surgical management related to injuries and diseases of the eye. We recognize that, in most cases, as a primary care veterinarian you can identify and treat most routine eye problems. In some cases, however, you may want to seek the advice of a specialist. We view our relationship with referring veterinarians as a partnership and welcome referrals for patients who clearly need the care provided by an ophthalmic specialist, as well as those for whom you may just be looking for advice or a second opinion. Through our evaluation process, we will maintain an open line of communication with you and, if appropriate, the pet owner, whereby we provide clear and complete explanations of the diagnostic testing results, treatment options and the cost so that you and your client can make the most informed decisions.

The Foster Hospital for Small Animals Opthalmology Service offers among the most advanced and comprehensive diagnostic and treatment practices in New England for small and large animals. The majority of our cases are canines and felines, and we also treat horses and exotics. We provide both scheduled and emergency services for animals with vision or eye problems. From routine eye exams to specialized surgery, including laceration repair to corneal grafting to cataract removal, we provide a full range of diagnostic and surgical services. Our ophthalmology team works closely with its peers in anesthesia, pain management and other specialty areas, providing a full continuum of coordinated care for your client.

Specialized Services

All patients will receive a complete examination of their eyes and in many cases patients will require specialized diagnostic testing procedures. Our ophthalmology clinic is fully equipped with the most advanced diagnostic equipment, including:

  • Low and high resolution ultrasonography
  • Magnetic resonance imaging (MRI)
  • Electroretinography (ERG)
  • Computed tomography (CT)
  • Slit lamp biomicroscopy
  • Gonioscopy
  • Ophthalmoscopy (direct and indirect)

Tufts is also proud to provide access to advanced diagnostic technologies that are not readily available in this region. These include:

  • Optical coherence temography (OCT), which is helpful in diagnosing corneal and retinal problems
  • Fluorescein angiography, which provides insight into the circulatory system of the eye through the use of a camera, allowing early detection of changes to the blood ocular barrier

As New England’s only veterinary school, we also have clinical research studies under way that offer your clients access to innovative treatments not available elsewhere.

Surgical Procedures

Tufts Ophthalmology Service offers a wide variety of surgical procedures, including but not limited to:

  • Numerous eyelid procedures, including laceration repair, correction of entropion/ectropion, eyelid mass removal
  • Replacement of prolapsed glands and scrolled cartilage involving the third eyelid
  • Conjunctival grafts
  • Corneal transplants and corneal laceration repair
  • Cryotherapy for removal of distichia
  • Cataract removal surgery – phacoemulsification
  • Diode laser therapy, allowing non-invasive treatment of cysts and/or intraocular masses
  • Glaucoma management
  • Cyclosporine implants for the control of equine recurrent uveitis

Referring to Tufts

Upon referral, our clinical liaison team will facilitate care, schedule appointments and serve as the contact point between Tufts clinical specialty departments, referring veterinarians and pet owners. Their commitment to keeping the lines of communication open ensure that you receive the highest standard of care for your patients. If you are in need of emergency services, the Ophthalmology Service is available 24 hours a day, 7 days a week. To make a referral, you may contact the Ophthalmology Liaison at 508-887-4696 between 8:00 a.m. and 5:45 p.m. After regular business hours, you may call emergency services at 508-887-4623.

For large animals, please contact the Tufts Hospital for Large Animals at 508-839-7926 for care during any time of day.

Ophthalmology Team

Christopher Pirie, DVM, DACVO, a board-certified veterinary ophthalmologist and faculty member, is a graduate of the Ontario Veterinary College, University of Guelph, where he pursued a veterinary degree. He later pursued an ocular pathology fellowship at the Comparative Ocular Pathology Laboratory, University of Wisconsin. Dr. Pirie joined the faculty and ophthalmology staff following completion of his residency in ophthalmology at Tufts in 2009. His research interests include clinical optics and diagnostic imaging. He is focused on the development of more cost effective ophthalmic imaging devices, with the ultimate goal of increasing availability, improving upon early detection and treatment of a variety of ophthalmic conditions.

Stefano Pizzirani, DVM, PhD, DECVS, DACVO, a 2004 board-certified ophthalmologist and Tufts faculty member, is a 1979 graduate of Pisa University (Italy) and a 1999 PhD graduate from Messina University (Italy). Dr. Pizzirani spent 22 years in a specialty practice in his hometown of Florence before relocating to the United States and serving as clinical assistant professor at North Carolina State University. In 2004 he joined the Cummings School of Veterinary Medicine at Tufts University as assistant professor. Dr. Pizzirani is also a board-certified, inactive-member of the European College of Veterinary Surgeons. His fields of interest include intra- and extra-ocular surgery and the pathophysiology of canine glaucoma.

Kara Gornik, DVM, a third year ophthalmology resident, is a 2010 graduate of the University of Georgia College of Veterinary Medicine. She completed her internship at Michigan State University. Following her rotating internship, Dr. Gornik spent a year pursuing research in vision and genetics at Michigan State University before starting her ophthalmology residency at Tufts in 2012.

Alex LoPinto, DVM, a first-year ophthalmology resident, is originally from New York, graduating from New York University in 2009 with a degree in Biology. He subsequently received his veterinary degree from Cornell University in 2013, where he performed a research project on methicillin resistant staphylococcal infections of the canine cornea. After graduation, he completed a small animal rotating medicine and surgery internship at Red Bank Veterinary Hospital in Tinton Falls, New Jersey. Dr. LoPinto enjoys all aspects of veterinary ophthalmology, but is particularly interested in corneal diseases, cataracts, and intra-ocular surgery.

Tracy Elmes-Young, a veterinary technician specialist, is a 1987 graduate of Mt Ida College and an integral member of the Small Animal Internal Medicine team. She came to Tufts in 1986 and worked for the department of small animal medicine as a technician and senior technician until 2011 when she joined the Ophthalmology department. She is a charter member of the Academy of Veterinary Internal Medicine and is currently the credentialing committee co-chairperson.