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Issue: 55 - Jul 15, 2013
When Behavior Problems Kill Treatment Plans (and the pet)
By: Dr. Sally J Foote CABC-IAABC
Dr Sally Foote

Veterinarians are often presented with the sick pet - vomiting, lethargy, weight loss and more.  Often we can see that this pet has not been sick very long, and the problem though it will take some money and time to work up is likely treatable or manageable.  As you present your client with the treatment plan, the client is weighing the cost/effort of work up and the value this pet has to them.  Unfortunately this may be the time you hear "This dog has been a real problem biting at the kids. I can't see spending the money on him." Great. You had no idea of the aggression, separation anxiety, house soiling or any other behavior problem that has been eroding the bond. Now that problem is the deciding factor on whether this pet will live or die - not the physical health problem you are presented with.  So what can the veterinary staff do to prevent or reduce this scenario?

First of all, at all exams ask specifically how the pet behaves in the home. Ask "Is he/she doing anything that drives you crazy?" You will get a range of answers, some that you may not know how to deal with. That is ok. You got to the real issue which is the pet is doing something that is wearing down the bond. This is the deal breaker when the pet is in need. Listen to what the owner tells you. Some may say there is not a problem with anything. It is still important to ask specifically if there is any house soiling, avoiding any family members, or growling/lunging/snarling behaviors.  Many owners misinterpret their pet's body language. You will be amazed at how many people will tell you that their dog only growls at them when they take them by the collar and that is not a problem (!!!). Or, that the cat is "ornery, or a pain in the rear" and that means the cat is urinating on the carpet 2-3 times a week. It may not be a problem today, but add having to treat this growling dog at home, or if the cat now eliminates daily out of the box, that may be the deal breaker. 

So what if you do not feel educated enough in behavior to know what to do? Is behavior too time consuming and not clear cut as to what will work so you don't want to deal with it. There are ways to offer help. Consider having handouts pre-printed on some of the most common comments or complaints you get. Aggression in early forms, fears and anxieties, body language of fear/aggression, and feline house soiling are good ones to start. Make it easy for your techs to hand out information and make note of it in the record. I have some resources at you can use to help your clients. I keep a file box in my exam rooms with pre-printed hand outs we can give to our clients at wellness exams.  Consider carrying the calming pheromones, supplements, and samples of pain relief.  Make a follow-up call a few days later and ask how the pet is behaving now. When the client sees improvement, they will appreciate what their pet needs. Suggesting a simple urinalysis or baseline blood test may show some illness before it was clinical and resolve some of the problem behaviors as well.

Your staff can call, e-mail or text to ask if the behavior is improving. If it is not, offer a referral to a veterinarian who accepts behavior cases to do a work up. Tell your clients that this problem may get worse and may be a factor in how much they will want to care for this pet when this pet is in need. Show that you care about both the pet and the owner. Do not be judgmental. The problems are often a mixture of owner interactions/ environment and temperament. Try to keep the behavior plan simple - even a small improvement can result in improving the bond with the owner.

When you do have a pet that is in treatment, ask the client how easy this pet is to give medications to.  Listen for how accepting this pet is to handling and care when it feels ok. Offering creative ways to treat this pet according to what the pet will accept shows you care.  A client may want to treat but is afraid of pilling a pet that may bite. Transdermal gels, flavored liquids, medications in food treats are ways to avoid this and still get treatment done.  Perhaps your clinic can give the meds in office with a short tech appointment. We have a number of clients where the staff does the injection or eye drops for the owner for a nominal fee. The problem behavior, such as biting, is not triggered so the bond is preserved. This is really what our job as practitioners is about - the bond between the pet and the owner. Anything that weakens that will diminish what we are allowed to do as veterinary professionals. 

Good luck and I welcome any comments you have. 

Dr. Sally J Foote