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July/August 2014 Today's Veterinary Practice 63 On YOur BesT BehaViOr Peer reviewed tvpjournal.com Ilana Reisner, DVM, PhD, Diplomate ACVB Reisner Veterinary Behavior & Consulting Services, Media, Pennsylvania Q & A : The presentation of behavior problems during routine appointments is one of the inevitabilities of today's vet- erinary practice. Behavioral drugs can help manage these problems—but not all drugs are equally useful, and their use is not always indicated. The plot thickens when some clients demand medication, while others re- fuse to use it despite veterinary recommendations (see Addressing Client Reluctance). WhY use BehaViOraL MeDiCaTiOn? Augmentation of Behavior Modification The treatment goal of any behavior problem is modi- fication of that behavior. However, the term behavior modification is vague and depends upon the individu- al patient and behavior being addressed. 1. Management of any problem behavior requires recognizing and avoiding the stimuli that trigger the behavior in question. 2. The dog needs to learn to behave differently in response to the stimulus. The term differently is intentionally nonspecific because it is tailored to the individual animal and context in which the problem behavior occurs. Behavior modification might include anything from counter-conditioning a fearful dog; actively training an appropriate, alternative behavior to a cue; or desensitiz- ing a separation–distress dog to its owner's leaving the room. Thus, behavior modification can play an impor- tant role in management of a problem behavior. The Use of Medications in Canine Behavior Therapy Y our longtime client, Mrs. Jones, presents Buttercup, the Papillon, with "a behavior problem": For several months, Buttercup has been biting houseguests. Through questioning and observation, you determine that Buttercup is anxious. She was "shy" as a puppy, exhibits fearful postures when unfamiliar people try to pet her, and—as a home video of her behavior reveals—runs away from guests trying to interact with her. Addressing Client Reluctance if behavioral medication is indicated, but the client is reluctant, discuss- ing specific concerns educates the client about the benefits of medication. Common concerns include: 1. My pet's much-loved personality will change. This is not the goal. The only personality charac- teristics targeted for change with drug therapy are those associated with anxiety and reactivity, or such problems as repetitive (compulsive) behavior. Because psychopharmacology can have unexpect- ed effects—for example, one client reported that her dog seemed less inclined to play with toys after administration of a drug—it is also important to reassure the client that his or her pet's response will be monitored, and the medication effects can be reversed or limited by reducing the dose or switch- ing to a different drug. 2. Drugs are unhealthy or unsafe. There are many behavioral drugs, and most are quite safe to use—even with chronic administra- tion—in healthy patients. Medication is prescribed only after a physical examination and, if the medica- tion will be administered for a long period of time, screening blood analysis should be performed. This testing, including CBC, serum biochemistry profile, and urinalysis, is recommended: • annually for patients receiving behavior drugs for over 1 year • semiannually for patients over 8 years of age that are receiving behavior drugs, or more frequently if there are concurrent medical issues of concern. 3. My pet will be sleepy all the time. unless sedation is the goal, such as during thun- derstorms for phobic dogs, nonsedating drugs are used, so sleepiness should not be an issue. if unexpected sedation is a side effect of behavioral medication, the drug dose can be reduced or a dif- ferent medication can be prescribed. While it is not uncommon for behavioral drugs to cause transient sedation initially, it can often be avoided by starting with a lower dosage, then increasing it over several weeks to the desired dose.