How can vets efficiently work up behaviour cases?
Many behaviour issues that arise in our pets aren't some mysterious imbalance in brain chemistry, or a failing of the brain itself. Often, what appears to be a 'behaviour problem' is actually a group of clinical signs indicating a problem with the animal's internal environment (like its physical health), or external environment (such as the home in which it is kept, or the interactions it has with others). With this view in mind, let's examine how vets may be able to more easily identify and treat cases where the most noticeable finding is a 'behaviour problem'.
Safety first, always. This isn't really part of the work-up, but needs to be put in place on the first contact with the client (on the phone or during consultation). Advise the caregiver on techniques to prevent the animal from practicing the behaviour, until it can be addressed. If there is any aggression or other behaviours that may escalate to harm, use management techniques. For example, if one cat is consistently having disagreements with its housemate, even if they aren't getting in physical fights, separate them entirely for now. Warn caregivers of the potential for harm if management fails (this will be dependent on the individual case).
During the first consultation that the behaviour problem is mentioned, consider whether to refer to a veterinary behaviour specialist (e.g. FANZCVS) or a behaviour vet (MANZCVS). Advising the caregiver that this is a possibility straightaway may encourage referral and early intervention, or at least make them aware that there are vets available who have further qualifications in behaviour. It also helps to start this process in parallel with the diagnostic workup, as the wait time for a consultation may be long. Performing diagnostics during the wait will give these professionals additional, extremely useful, information and is an efficient approach.
TIP: Many behaviour vets and specialists offer vet-to-vet consults, so can offer advice on what work up and management may be most useful, or whether it is appropriate to start behavioural medication prior to referral. Qualified positive-reinforcement trainers are also an important part of the behaviour team, but physical and mental issues need to be treated first, so that the animal is in a place where it can learn effectively.
For every behaviour case, a veterinarian should look for possible underlying contributing physical factors. For example:
For animals with food guarding, pica, air snapping, excessive licking of objects, pronounced swallowing, or other unexplained oral behaviours, consider gastrointestinal disorders. Diagnostic workup may include GI panels, hypoallergenic diets, imaging, and treatment trials.
TIP: When doing foreign body removal surgeries take biopsies of the gut, especially if the foreign body is a non-food item.
For animals with itchy skin, gastrointestinal abnormalities are often concurrent, so ask about those too. However, dermatological itching and pain can be enough to contribute to behaviour problems on their own, so these need to be treated in conjunction with a behaviour work-up. Keep in mind that excessive licking of the body may indicate dermatological discomfort, but may be due to pain for other reasons, including musculo-skeletal pain, gastro-intestinal pain, urinary bladder pain, etc.
For animals with tail chasing, consider pain, particularly around the hind end of the dog (anal glands, hip dysplasia, dermatological, gastro-intestinal or neuropathic pain) - but... it could also be related to pain anywhere in the body.
For animals showing agonistic or defensive behaviours (sometimes labelled as aggressive behaviours), pain - or fear of pain - is often a contributing factor. Examine the whole body for possible sources of pain (if possible without causing distress), keeping in mind that animals often won't feel or show pain during a consult in the way that they normally would. If a caregiver or trainer has suggested pain as a possibility, examination (and even imaging!) may not reveal the source of the pain, but these people spend significant time with the animal and their concerns should not be dismissed.
Work up possible pain by asking for 30 second videos of how the animal behaves at home. This may include videos of walking up and down stairs, walking away from and towards the camera, walking across the viewing angle of the camera, ideally with the camera at the animal's height, ideally off and on leash, play, eating, and other day-to-day activity. Make it clear you do not want the caregiver to provoke an episode of aggression or anxiety just for a video. See also my blog post on pain and behaviour.
TIP: Veterinary physios and rehab vets offer gait analysis, and this can be helpful when pinpointing the likely source of subtle lamenesses if you get the feeling that something about the gait or movement isn't quite right.
Ask the caregiver to fill out a survey about subtle pain (you can download one here). This is a tool designed to start the conversation about pain, particularly the reaslisation that pain may be present but show in ways that people often don't notice. Animals in pain may still look happy, run and chase a ball, pounce on toys and so on, just like people may decide they still go out and play a sport even if injury makes this uncomfortable.
Other conditions that have been shown to occur with pain contributing include noise sensitivity or reactivity, separation anxiety syndrome, night waking or vocalisation, and any sudden change in behaviour.
If a source of pain or underlying illness cannot be discovered with examination, video analysis, blood testing (and perhaps imaging if there is a strong suspicion that pain is localised to a particular area), then a 6 week pain trial may be considered. Sometimes pain trials are unsuccessful with one class of pain relief medication and another may need to be trialed. As this can take a while, sometimes it is necessary to start an animal on both behaviour medication and pain relief straightaway. When introducing multiple new medications, it is a good idea to do this in a staggered approach, so that the effects and side effects can more easily be attributed to a single medication.
For every behaviour case, it is important to ask about contributing environmental factors. It often takes a lot of time to gather all the details needed to assess contributing factors, so this is where referral to a behaviour vet or specialist, can be particularly useful. In some cases, highly qualified positive reinforcement trainers and behaviourists can also work with caregivers in their home to assess and improve environmental factors. These may include the presence and interaction with other people or pets in the home, the provision of appropriate resources for the animal, the amount of exercise, mental stimulation or agency the animal has. If the animal must continue to live in conditions which are inappropriate or stressful, then treatment success may be limited.
This broad outline of a work up for a behaviour case should help efficiently identify factors that may contribute towards a behavioural problem. Ongoing care of physical problems, early identification and treatment of pain, and recognition of problems in the animal's environment will all improve an animal's behavioural health. In many cases, this will be sufficient to change an animal's behaviour. Sometimes, behaviour medication may also be required. Setting aside time, or referring for a more detailed behavioural consultation is recommended at this point.
Dr Jen
Dr Jen Nesbitt-Hawes is a behaviour vet (Member of the ANZCVS Veterinary Behaviour Chapter), and runs Pet Perspective - a business dedicated to providing behaviour educational materials for pet professionals and their clients. Please see www.petperspective.com.au for more information.
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