Just Ask the Expert: Managing storm phobias with difficult patients—and clients
Dr. Tynes welcomes behavior questions from veterinarians and veterinary technicians.
What is the best way to manage a greyhound with a serious storm phobia? Paroxetine and alprazolam have not calmed the dog enough for behavior modification, and the owner is a bit of a challenge, too.
OPTION 1: JUST GETTIN' BY
If a pet owner wants to just get by during storms, it will be easiest to do if he or she lives in an area where storms are relatively rare and usually predictable. In those circumstances, the pet owner can provide a "safe place" for the pet where it can avoid, to the greatest extent possible, the stimuli associated with the storm.
This safe place can be a dog crate or cage that is placed in a basement, closet, or internal room in the house (anywhere where sounds can be muted and lightning flashes avoided). The crate should be left open at all times and may even be covered with heavy blankets or other material that can help insulate it from sound. The dog is then taught to go to the crate by using special long-lasting chew treats or food-dispensing toys. Once dogs discover that the crate is a safe, quiet place to hide out, most will learn to use it whenever they feel the need to escape aversive stimuli.
Another tool for a storm survival kit is an anxiolytic medication that can be given on an as-needed basis. I cannot overemphasize the fact that acepromazine is not an anxiolytic and should rarely, if ever, be the first choice when treating an anxiety-related condition. The anxiolytics that are usually effective for this purpose are the benzodiazepines.
In order to use benzodiazepines safely in practice, you must be aware of how dose-dependent their effects are. At low doses, benzodiazepines are primarily anxiolytic, while at higher doses they can be quite sedating. You must educate your clients about this feature and help them understand that it will be critical that they test the drug dose before a storm occurs. This way, if they think that the drug has no effect on their dogs at a lower dose, they can, after consulting with you, increase the dose to the next highest level that you suggest and see if it is more effective. In this manner, you can work with clients over a period of a few days, if necessary, to determine what benzodiazepine dose produces mild sedation. That is the dose they will give their pets about 30 minutes to an hour before the next storm is expected. If the dose turns out to be ineffective in the face of a storm, then the dose can be adjusted again for the next storm.
Also emphasize to clients the fact that many animals will experience paradoxical excitement or agitation when given a benzodiazepine. This response is another reason why it is so critical that owners give a test dose before the storm is ever expected. If they determine that the dose given causes an increase in excitement or agitation, then you can recommend that they try a higher dose. In many cases, that dose will be effective. Another option is to switch to another benzodiazepine and see whether the paradoxical reaction still occurs. In some cases, a dog is unable to take any benzodiazepine, and other drugs such as clonidine may need to be considered. Be sure to inform clients that if they wait to give medication until after their pets begin experiencing the anxiety associated with a storm, then the medication is unlikely to be effective.