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Aggression Reject - Killer K9's

One of the questions posted during my webinar series was "How should the staff handle a large dog that has been 'fired' from other veterinary clinic for aggression?" Where do we  start with rewarding or less stressful handling?

This is a real life situation.  A dog is aggressing  so badly that it is very difficult to perform  an exam safely for the staff or dog.  Tranquilizers did not have the desired effect.  What to do?  Can this dog be treated safely?  Should we take this case on?

There is a long story and a short story.  The short story - if this veterinary clinic does not feel confident to  work positively  with this dog, then refuse to take on the case.  There is not any short, sweet, guaranteed  solution for  positively handling an aggressive dog.  Refer to a veterinary behaviorist.   If you are weak in the skills of less stressful handling refine your skills on easier patients before you take on a challenge like this.  It is not a cop out to say "You need to go to a specialist"  it is responsible to the patient and may make the seriousness of aggression more evident to the owner. 

I look at this like referring a complicated fracture to a surgery specialist who knows more and has more skills than I do. Sometimes in this discussion, the nature of the aggression is revealed to be much more involved.  Then it is possible that the best solution is to euthanize this dog. Aggression is a learned and innate behavior.  If the degree is so advanced that triggers cannot be identified or controlled safe handling is not possible. The dog is also suffering - it takes a lot of fear/anxiety/ or other physical problems to have a dog be this difficult.  Not all aggression can be trained or medicated down to a safe level.  This is one of those times it is really tough being the veterinarian.  If your dog is aggressing for treatment please approve the suggested medications to help your pet and your veterinarian before it gets to this point.

Now the long story - If you decide to work with this patient, then you need to get some history from the owner and previous veterinarians.  Find out when the dog begins to show signs of anxiety - pacing, panting or barking.  How well does this dog travel?  What methods have been used in the past?  If forceful methods of restraint were used in the past, that would be a big reason for the advanced aggression.  Creative techniques for handling that are not forceful,

Coupled with anti anxiety medications, supplements, pheromones or tools such as thundershirts would be very important in changing the experience for this dog.  One must be aware of any painful problems that the dog has even if the dog is not acting painful.  Consider the breed type - an older Rottweiler?  Could have hip dysplasia.  A dose or two of Rimadyl or other NSAID could greatly improve the attitude of this dog.  Chronic pain is often an aggravator to aggression.  Of course it is best to diagnose what the problem is before any treatment, but sometimes the problem is barring the veterinarian from making the diagnosis.  Pain relief can be used as a diagnostic tool.

So where would one begin?  If ,an exam is needed immediately,  dispense a combination of an fast acting antianxiety medication with tranquilizer. Typically Acepromanzine is combined with Alprazolam .  Acepromazine alone is not a good medication for aggressive dogs.  The dog or cat is  sedate but this medication can actually increase sensitivity to noise and heighten anxiety.  Dr. Karen Overall presents this information very well on this video http://www.youtube.com/watch?v=6-GsmrFYHKk .  Use a muzzle and make it a reward mask.   One can still give rewards through the muzzle with this combination to positively condition the dog to the visit ( see my you tube video "Muzzle for Rewards").   Often after a few visits, the medication can be reduced to just the alprazolam and weaned off. 

Bite dysinhibition is a concern when using any psychotropic medication.  There may be more confidence with the  medication so the dog uses  aggression as a tool to keep fearful things away.   There is a broad dosage range for some of these medications as well.  So how do we know if the medication will make things better or worse?   The solution - try the medication out before an exam. Give the oral medication in your office and board the dog observing the dog's behavior . Or if the client is willing, they can give the medication at home.   If this dog is worse on the medication, at least there was not added risk for treatment.  In that case, inject able  deep sedation or anesthetic combinations should be given immediately on arrival  before the dog has a chance to get upset.  Even with these drugs there can be bite dysinhibition  so do not let your guard down. For these really difficult  dogs, look everywhere for any pain stimulus.  If there is not any evidence of chronic  ear, teeth, or orthopedic pain, refer this dog to a veterinary behaviorist as soon as possible. The American Veterinary Society of Animal Behavior has a listing of DVM's who take behavior consultations.  Go to www.avsabonline.org to find someone near you. Dogs with aggression need more than training.  Seek a DVM with additional behavior expertise for help.

Exams outside of the office can also be helpful.  I have one client where I do the exam, vaccinations and blood work in the front yard of my office.  Her dog  becomes very nervous in the exam area  and is much more calm outside.  I also do house calls with a tech which can result in a much better experience. Be creative and continue to counter condition these dogs.  Many can turn around and become not only less aggressive but calm, social dogs at the veterinary clinic.  The key is to reward throughout the exam and use tools that decrease fear, pain and anxiety.

Sally J Foote, DVM  CFBC-IAABC
Okaw Veterinary Clinic Tuscola IL
drsally@drsallyjfoote.com

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