Tough choice for your dog: medical or mental health?

Blog post by dog behaviourist Laure-Anne Visele, The Hague: on the psychological damage of painful medical treatment.
Privacy and safety: Out of respect for their privacy, I do not share the name of the colleagues with whom I discussed  my dog’s case. I also do not share the names of the behaviour medication used as I am not a veterinarian and each case is different.
Written in: July 2018.
Illustration credits at the end of the post.

About the author: certified dog trainer in The Hague

My name is Laure-Anne and I am the dog behaviour therapist at Canis bonus, and Head Trainer at OhMyDog! (dog training school) in The Hague.

I help people from The Hague, Rijswijk, Delft, Westland and region with their dog behaviour.

I have a degree in Zoology, am a certified dog training instructor, and have a Postgraduate in applied animal behaviour (Magna cum laude).

If you want dog-friendly and evidence-based tips, drop me a line briefly explaining the problem and I’ll tell you if I think I can help.I am so proud of my dog!

When an ear infection can mean the end

I cracked the other day. I called a friend, in tears, contemplating the worst for my dog.

I couldn’t do this anymore. I couldn’t keep sabotaging my dog’s painfully slow (behavioural) treatment with frequent painful (veterinary) treatment.

My big crisis? My dog stared at my hand and pulled back when I tried to put medication in his ear canal. This was the first time he refused treatment by us in months.

The veterinarian’s perspective

The vets were confused by the idea of a fear-free approach to medical treatment.

They often mistook my reluctance to push him past his limits with spoiling or over-protecting him. They mistook his growling and desperate escape attempts for ‘bad’ behaviour.

They make the point that: “Treatment needs to happen. Nobody likes it. Grit your teeth and get it over with.”

The behaviourist’s perspective

A dog with established fear- or pain aggression, of all dogs, must be kept “below threshold” during medical treatment. You must keep the level of Fear-Anxiety-Stress so low that it won’t poison him against his next vet treatment, making matters 1,000,000 times worse.

Unpleasant memories with treatment isn’t such a big deal for dogs who visit the vet’s twice a year – although, as a behaviourist, I even disagree with that. But patients with chronic conditions can become so averse to treatment that euthanasia becomes a serious option.

A tough choice: mental or medical health?

So I cried. After months of behaviour work to fix his aversion to vet treatment, my dog was pulling back again. And consistently so.

I was caught between a rock and a hard place: either I’d grit my teeth and undo months of behaviour work, or I’d neglect a  health issue that could turn nasty.

Low stress veterinary handling

All things considered, my dog is actually a great patient. At least in our home. We’ve come a long way since the days he would growl at us for just looking down at his paw.

Now, he’ll stay relaxed and engaged when:

• We smear painful sores on his paws
• He sits through a 15-minute medicated bath.
• He gets an injection.
• We manipulate his ears.

It took months of patience and pretty much all the low stress handling and fear free veterinary treatment tools in the box, but my husband and I taught him:

• A word for each treatment, so he could see it coming.
• To tell us when something was getting to be too much, so we could take a break.
• To stretch his comfort zone to even more invasive treatments.
• To position himself so he could be involved in the process.

He was also, slowly but surely, getting more relaxed at the vet clinic and with the vet staff.

You can’t train a dog to like pain

We’d achieved so much that it hadn’t crossed my mind there could be limits.

I seriously expected him to lean into the pain with his latest painful otitis.

Looking at it from a distance, it is actually crazy how docile many pets are when undergoing even painful treatment. Think about this: The have no idea that it’s for their own good. Let that sink in for a minute.

It took me ridiculously long to realize that I could practice as often as I’d like, I would never train a dog to love pain.

After days of trying to treat the ear below threshold, we were getting nowhere on the medical treatment and he was pulling back from his other treatments too.

It pays to have friends in the dog biz

So there I sat. On the floor. With my bottle of ear meds in my hand. Angry at myself for not having been able to ‘train’ this. Angry at the dog for all the time we’d sunk into this. Angry at my husband for husbands are there to be blamed.

I called a friend in tears and said:

• If I can’t prevent him sensitizing against treatment again, are we headed for the bad old days again?
• How are we going to keep up with the daily treatment and preserve our behavioural progress?
• What is going to happen to his still ineffectively treated ear infection?
• What good has all that behaviour modification been if it comes crumbling as soon as things get real?

We talked it through and I felt a little better, but I still hadn’t solved the behaviour-medical health conundrum.

The next day, I reached out to dog pro friends to get some perspective:

1. a trainer,
2. a vet nurse, and
3. a behaviour-savvy vet.
4. I am also lucky  enough to be friends with The Netherlands’ only board-certified veterinary behaviourist, Valerie Jonckheer-Sheehy (DVM, EBVS) so I got some gold advice there.
5. And of course, I touched base with the vet in charge of his treatment at the excellent Wateringseveld fear-free veterinary clinic.

That was as bunch of conversations but it was worth it. A strategy was starting to form. It turns out that just changing a couple of things got us back on track.

Pain without trauma: the strategy

The idea is to surround the moment of pain with a sea of tranquility. You don’t entirely give up on your fear-free oath, but you don’t let it get in the way of treatment.

Here’s how we broke the vicious cycle (note that every dog is different):

• Carry out the session as you would any low stress handling session (food, warning word, minimum restraint, maximum choice, etc.) but be resolute and quick.
• As you apply the treatment, give tons of treats (Not after. At the same time). And use his absolute favorite. We’re talking ostrich steak here.
• Don’t drag it out with unnecessary prep sessions. If you’ve done your homework before, he’ll be desensitized to all the steps leading up to the pain. No need to rehearse this again and again before applying pain. Just get it done.
• Contemplate using a muzzle (if your dog is muzzle-trained!). Your fear of getting bitten might be making you nervous, and therefore getting in the way.
• Do a few rehearsals of the treatment immediately afterwards (not up to the pain point, of course), and couple them with treats as usual.
• If your veterinary behaviourist or veterinarian approves, contemplate a light painkiller before the treatment. Particularly if the treatment is only short-term.
• Ask your veterinarian (or veterinary behaviourist) about medication that keeps the fear/anxiety/stress under control.

I’ve tried this over the past two days and we are getting solid results: he stays relaxed during treatment, and does not seem to sensitize afterwards.

So it turns out I don’t have to view behaviour modification as the enemy of vet treatment. With a bit of flexibility, they can still work hand in hand.