Instructions
First, read the two articles by Radostaand Yuschak(both are attached).
Next, chart the program that was developed for Milo's storm anxiety using the Behavioral Change Chart(attached).
Finally, write a summary that identifies the role of biological preparedness in this case, and apply at least one theory of cognition to describe the treatment strategy described in the articles.
Your article review should be at least two pages, not including the title and reference pages. Please copy and paste the Behavior Change Chart into the document.
You must use a minimum of two sources, which should be properly cited. All references should be formatted in APA style.
Behavioral Change Template (delete contents and add your own) Old Behavior Smaller Sooner Reward New Behavior Larger Later Reward Goals/Sub-goals Potential Obstacles Stimulus Control Example: Snacking while watching TV Example: Comfort food Example: Decrease snacking Example: Less weight gain Example: Eat regular meals, without skipping any Example: Family members snack in TV room Example: Buy only healthy snacks Habit Increase healthier food choices Better control of blood sugar Decrease total intake of sugar Take snack trays and tables out of TV room Decrease grocery expenses Eat only while sitting at the table with a plate July 2016 Veterinary Team Brief 33 Milo, a 6-year-old, neutered, mixed Chihuahua-dachshund (ie, Chiweenie), presented for trembling, hypersalivation, whining, and hiding during storms while the owners were home. Additional clinical signs included urination and defecation when he was home alone during a storm. At age 3, Milo started showing mild signs (ie, trembling, hiding), which progressed in severity. When the owners were home, they tried giving him food-stuffed toys, comforting him, and allowing him to hide; when they were gone, they confined him to a crate. Nothing had helped reduce his fear or panic during a storm. Lisa Radosta, DVM, DACVB Florida Veterinary Behavior Service West Palm Beach, Florida Storm Phobia in Dogs TEACHING TARGET A MULTIMODAL TREATMENT APPROACH WITH SUPPORT FROM ALL TEAM MEMBERS CAN HELP DOGS WITH STORM PHOBIA MINIMIZE ANXIETY AND LEARN TO COPE DURING STORMS. CLINICAL CASE: STORM PHOBIA / PEER REVIEWED Case Summary Milo could be left alone in the house without any signs of fear when there were no storms. He also did not panic during fireworks displays. Milo was up-to-date on vaccinations and monthly heartworm and flea and tick preventives. Behaviors should be recorded objectively, like clinical signs for any body system. 34 veterinaryteambrief.com July 2016 CLINICAL CASE: STORM PHOBIA / PEER REVIEWED Milo’s Behavioral & Physical Evaluations & Results BASELINE BODY LANGUAGE IN THE EXAMINATION ROOM Milo’s body language during the first 30 minutes included: ! Ears held in neutral position or forward ! Pupils of normal size for ambient light ! Relaxed stance and musculature ! Soft mouth, with mandible hanging slightly open ! Tail at back level, softly wagging ! 4 legs under the body, with hind legs not stretched back, and tail wagging at spine level when offered freeze-dried chicken treats by a team member; eating from the hands of the veterinary nurse and the veterinarian within 5 minutes STORM SOUND-INDUCED BODY LANGUAGE Milo was given 3 sound tests, each 20 seconds long, and allowed 1 minute to recover each time. The first was storm sounds from Sounds Scary and iTunes, played at level-2 volume on an iPad. Next, sounds of rain were played without sounds of thunder, and third, a recording was played with the sounds of rain and thunder. The dog recovered to his baseline body language in 45 seconds in all 3 trials. Responses included: ! Attempts to hide behind the owner’s legs ! Dilated pupils ! Panting ! Tail down ! Trembling FIREWORK SOUND-INDUCED BODY LANGUAGE Firework sounds from Sounds Scary were played for 20 seconds at level-2 volume on an iPad. Milo responded with: ! Relaxation identical to baseline body language and no discernible reaction PHYSICAL EXAMINATION & LABORATORY FINDINGS Physical examination and CBC, serum chemistry profile, TT4, and urinalysis were unremarkable. Follow these steps for patients with suspected storm phobia (ie, irrational fear of storms). Behavioral Evaluation Assessment of a storm phobia patient in the practice should involve evaluation of: ! Body language (eg, does the patient indicate fear, anxiety, stress, or relaxation?) ! Interest in exploring surroundings ! Interaction with the veterinary team ! Mentation, including whether the patient is bright, alert, and respon- sive (BAR) Behaviors should be recorded objectively, without assessment, like clinical signs for any body system. Physical Examination & Laboratory Tests The veterinary team should perform a physical examina- tion, complete blood count (CBC), serum chemistry profile, total thyroxine (TT4), and urinalysis. (See Milo’s Behavioral & Physical Evaluations & Results.) 2 1 Resource ! Overall K. Manual of Clinical Behavioral Medicine for Dogs and Cats. St. Louis, MO: Elsevier; 2013. Signs & Differential Diagnoses Patients generally exhibit signs of hypersalivation, whining, trembling, hiding, urina- tion, and defecation during storms. The differential diagnoses include: ! Cognitive dysfunction ! Frustration-related behaviors ! Incomplete housetraining 3 ! Noise phobia! Separation-related disorders! Storm phobia Treatment Core components of a treatment plan for storm phobia patients can include: ! Counterconditioning during storms (eg, pairing a positive with 4 http://www.veterinaryteambrief.com July 2016 Veterinary Team Brief 35 a negative event to change the patient’s emotional state) ! Creation of a safe zone ! Medication, daily and as-needed (PRN) ! Relaxation conditioning (eg, teaching the patient to relax on cue to induce relaxation during stressful events such as storms) Provide immediate relief with a PRN anxiolytic medication (eg, benzodiaze- pine [diazepam], serotonin antagonist and reuptake inhibitor [trazodone]). Medication, depending on which is chosen, should be given 30 to 120 minutes before the storm. Dogs with storm phobia often need a daily medication, plus a faster-acting anxiolytic medication PRN. Dogs requiring PRN medications whose owners will be away from home for lengthy periods should be given a daily medication and the PRN medication. Daily medication may provide longer-lasting anti-anxiety coverage if the owners cannot administer a faster-acting anti-anxiety medication before the storm. Fluoxe- tine, sertraline, and clomipramine are commonly used as daily medications.1 (See Milo’s Diagnosis, Treatment Plan, & Outcome.) Outcome With well-timed medica- tion administration, counterconditioning, and relaxation techniques, many dogs are able to overcome their phobia and weather storms without incident. Milo’s Diagnosis, Treatment Plan, & Outcome DIAGNOSIS Because Milo showed no signs of fear, anxiety, or stress when the owners were preparing to leave or when stormy weather was not a factor, separation-related disorders were ruled out. Frustration-related behaviors were also ruled out because clinical signs of frustration with his environment (eg, destruction or damage due to lack of exercise or enrichment) were not apparent whether the owners were present or not. Milo showed no fear of other sounds, ruling out noise phobia. He was well housetrained with no accidents reported except during thunderstorms, ruling out incomplete housetraining. CLINICAL TREATMENT Milo was prescribed diazepam, 1.0 mg/kg PO, as a fast-acting PRN medication. Effects of diazepam include anxiolysis, increased appetite, muscle relaxation, and slight sedation. To help ensure the medication would be administered at least 1 hour before a storm, the following dosing instructions were given to the owners: ! Administer 1 hour before a storm based on the weather forecast and a 20% or greater chance of rain. ! Administer just before leaving the house if a storm or a 20% or greater chance of rain is forecast while Milo would be alone. OTHER RECOMMENDATIONS FOR MILO ! Discontinue confinement unless he is comfortable in the crate. ! Use doggy daycare/day boarding during initial behavior modification and medication testing. ! Countercondition with food toys to lower arousal and fear and distract Milo during storms. ! Provide a safe zone. ! Provide relaxation exercises. OUTCOME Milo’s owner was able to go home at lunchtime so Milo was not left alone for more than 6 hours. Because he did not have any concurrent behavioral diagnoses, PRN medication was sufficient. Milo also was conditioned to stay on a mat that served as a safe zone during storms when the owners, who were instructed how to prepare the safe zone, were not at home. (See Learning to Stay in a Safe Zone, page 37). 5 Reference 1. Crowell Davis S, et al. Use of clomipramine, alprazolam and behavior modification for treatment of storm phobia in dogs. JAVMA. 2003;222:744,748. Copyright of Veterinary Team Brief is the property of Clinician's Brief and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. 36 veterinaryteambrief.com July 2016 CLINICAL CASE: STORM PHOBIA / PEER REVIEWED Team Education Sherrie Yuschak, RVT, VTS (Behavior) North Carolina State University Human–Animal Bond Storm phobia, not uncommon in dogs, poses a risk to the human– animal bond and can cause physi- cal harm to the dog and emotional suffering for both pet and owner if untreated.1 The entire veterinary team should be able to identify potential signs of storm phobia, understand effective treatment is possible, and be able to provide clients with the necessary support. (See Signs Associated with Storm Phobia.) When a patient presents with suspected storm phobia, veterinary team members must not only look for behavioral signs but also listen for signs of a weakening human–animal bond. Dogs with storm phobia, like those with other behavior problems, are at higher risk for relinquishment, abandonment, or rehoming. Clients may state openly they are considering these options or more subtly indicate their frustration and decreased tolerance. An emergency consultation may be necessary to provide the patient and client with immediate relief, and boarding or hospitalization may be required while medication therapy is instituted. Signs Associated with Storm Phobia Storm phobia (ie, irrational fear of storms) may be displayed regardless of the owners’ presence. In general, middle-aged dogs are initially presented for storm phobia; however, signs of anxiety or fear in response