Many people don’t know about the existence of veterinary behaviorists, much less how they can help us. I didn’t until I got deep into the dog training world. Vet behaviorists can help dogs with canine cognitive dysfunction and many other problems, and they can help the dogs’ owners a lot as well.
In the U.S., board-certified veterinary behaviorists are vets who undergo years of structured training in animal behavior after veterinary school and must pass a rigorous examination before being certified. They are trained to treat behavior problems such as aggression, anxiety, phobias, and many more. They treat underlying medical problems as well and often work in tandem with a general vet and a credentialed dog trainer.
Many people don’t realize that vet behaviorists also diagnose and treat canine cognitive dysfunction. I use that as an example in this interview article, but you will also get a general picture of what a vet behaviorist does.
A situation I hear about a lot is when a dog with dementia is barking and wandering all night and keeping the family awake. I asked board-certified veterinary behaviorist Dr. E’Lise Christensen, DVM DACVB to describe how she and others in her profession would help in that situation. They can improve the dogs’ quality of life, and the family’s too! And often they can extend the life of a dog with canine cognitive dysfunction.
This is our interview.
Eileen Anderson: Is there something pet owners can do when their dog who’s diagnosed with canine cognitive dysfunction is wandering, restless, or barking much of the night?
Dr. E’Lise Christensen: You bet. There are so many things that can be helpful for these pups. And the trick is just finding which one is right for each family and each animal. Every animal responds differently to different interventions. We know we have several different options: supplements, management and behavior modification, and traditional medications that can in some cases help. In fact, just this morning I had a reassessment with a patient we saw for this problem. Vocalization, restlessness, and wandering, especially at night, are the most common reasons cognitive dysfunction patients come to us as veterinary behaviorists.
Unfortunately, clients don’t usually come early in the diagnosis. They tend to come late, when these symptoms are getting so disturbing for the family that they might actually contact a “dog psychiatrist.” If we could get them earlier, we might be able to prolong cognitive function better, because we’d be able to prescribe medications and supplements that may have benefits as far as cognitive support. But we can definitely do symptomatic treatment of the behaviors that families are seeing. So if we have pups that are up and restless, panting or pacing, or excessively vocalizing, there are a number of treatment options.
I know from my experience with one of my own dogs that the bond is still there as a family even if the dog has cognitive dysfunction. Just because they’re acting a little differently doesn’t mean you don’t still love them and want the best for them.
Eileen Anderson: What should a pet owner do if they do talk to their primary vet and she isn’t comfortable prescribing behavioral drugs for this problem? This does still happen once in a while.
Dr. E’Lise Christensen: That’s a great question. I think there’s just never been a better time to be in that position, strange as that sounds, because there are so many ways to get help these days. I’ve been a primary care veterinarian, I’ve been an ICU veterinarian, and I’ve been a cat-only veterinarian. So I recognize the stress my colleagues feel when they’re asked to use a medication group that doesn’t feel comfortable for them, or to treat a disorder that they don’t feel comfortable treating. I remember as a primary care veterinarian this would happen to me sometimes. For instance, I had a case with a very persistent urinary tract infection, and I kept trying to refer the clients to an internal medicine specialist for further diagnostics and treatment, and they wouldn’t go. That’s a heartbreaking and common situation for veterinarians.
In the situation where a veterinarian doesn’t feel comfortable prescribing a medication, it’s really frustrating as a client. At the same time, those are very careful clinicians who are really trying to do the best they can for your animal. But of course it doesn’t change the fact that you don’t have treatment. So there are a lot of ways to work on that.
There are a couple of things that can happen here. First, you could have a clinician who doesn’t feel comfortable prescribing medications or supplements for symptoms of cognitive function. Second, you could have clients who may not electively go see specialty veterinarians, even though they may have the option.
Dr. E’Lise Christensen: One, if your clinician is open to doing a telemedicine consult with a veterinary behaviorist, a number of us do those. I do them.
Some veterinary behaviorists who do telemedicine consults do them only with the general practitioner and without the client present, and that is easier to organize. We do Vet to Vet consults like this for veterinarians who prefer it. At Behavior Vets, I prefer to have the veterinarian and the client on the phone or on the videochat session at the same time. That really helps me as a clinician feel like I have buy-in from both the primary care vet and the client. We can talk in real time about the pros and cons of the available options, and discuss recommended diagnostics in detail. When we do that, I can support the veterinarian in making the best choice of medications, supplements, and other options for that patient.
There are a lot of legalities when trying to help patients remotely. The primary care veterinarian has to be involved, because if a veterinarian doesn’t meet the patient and the client they are not allowed to prescribe any medications. That is frustrating if you live a long way from a veterinary behaviorist, but it is also for the protection of our patients.
So if your veterinarian is open to doing something that is a little complicated and you’re open to paying your veterinarian for their time (because you are using your veterinarian’s office time when they’re doing a consult like that) then a tele-consult appointment may get you the care that you need.
Some veterinarians just will not do these consults, sometimes for such a mundane reason as not having a mechanism to bill it. More often, it’s discomfort with the process, worries about liability, and concerns about how to schedule the appropriate length of time. Especially these days, when the Coronavirus is complicating every aspect of veterinary care, the ability to create new protocols is just not there for some hospitals.
Many veterinarians are very open to specialty consultation, but if yours isn’t and you need specialty support then that’s a time when you can explore other options. You could hire a second veterinarian to help you with this part of your pet’s care, for instance. You might discover that this hospital is not able to provide what you need for your pet and decide to change veterinarians.
It’s really important that you have a veterinarian who fits your family and your family’s needs, if that is not happening then it’s rational to consider looking for a different general practitioner, especially if you don’t have access to seeing a veterinary behaviorist directly. If your closest veterinary behaviorist is too far away, then another place you can check is the American Veterinary Society of Animal Behavior. While the veterinarians who are members of AVSAB don’t necessarily have residency or specialty training, they have an interest in behavior and may be more able or willing to work with you. The American College of Veterinary Behaviorists website has a locator on it now, too. With veterinary behaviorists always check the largest radius on any locator because there just aren’t very many of us. If you check five miles, you’re going to find nobody unless you are very lucky.
Eileen Anderson: Right! You are as rare as unicorns.
Dr. E’Lise Christensen: We don’t joke about that for nothing!
Eileen Anderson: So let’s say somebody’s done this and they have tried their dog on a certain medication. What about when it just doesn’t work?
Dr. E’Lise Christensen: Great question. So that does happen. I wish it didn’t, but what we do is what one of my colleagues calls “trial to success,” as opposed to trial and error. There are a lot of important decisions to be made when choosing a treatment plan. We are going to choose medications and other treatments based on the patient’s symptoms, the available literature, the family’s schedule, how fast we need the treatment to work, the potential side effects, the patient’s other medical problems, etc. The good news is we can almost always find ways to improve the frequency and intensity of symptoms.
Eileen Anderson: That’s great.
Dr. E’Lise Christensen: The reality of it is that most clients are not going to exhaust what a veterinary behaviorist can offer from a medication perspective. I’m not going to say it can’t happen, but it has never happened to me yet. And I’ve been seeing veterinary behavior cases since 2004.
Dr. E’Lise Christensen: As a veterinary behaviorist, what I need to know about a medication failure is, was it that it didn’t work? Was it that it didn’t work long enough? Did it take too long to work? Were there side effects? If so, what were they? Were there behavioral improvements but they came along with side effects? Once I have that information, I can really adjust my next suggestion, because even though it seems from the outside like you’re just shooting in the dark, there actually is more to it than that.
Usually, we’re trying to assess the clinical behavioral symptoms that we’re seeing and choosing our medication based on a number of different factors. There’s a lot of history-taking in veterinary behavior appointments so we can try to get to success as fast as possible, rather than just cycling through meds without any rhyme or reason.
Eileen Anderson: That makes sense. Is there anything else you’d like to say about this?
Dr. E’Lise Christensen: I love seeing cases of cognitive dysfunction. Of course, it’s heartbreaking because we know we’re not going to stop disease progression; this isn’t a disease that we cure. But most of the time we can help support the patient and the family so that they can get more happy weeks or months together, and so that they’re not making a decision to euthanize, for instance, in a moment of extreme exhaustion. My experience is that most patients with cognitive dysfunction get euthanized due to sleep disturbances they create in their owners. They are keeping their owners up at night, so the family gets really tired, understandably. But when they are exhausted they’re not working at their full mental capacities. It’s not a good time to make a decision about euthanasia. If we can help the family get some sleep, they are often more able to proceed with treatment.
Dr. E’Lise Christensen: If we’re in a really hard spot with a dog with cognitive dysfunction, and if the family’s got it in them, we can trial some medications at home. But we may need to hospitalize that patient for a day or so, and just help the family get some rest so that they can recalibrate. And during that time, if we have the opportunity to do so, we can do some medication trials in the hospital. Even though we might not know if they’ll be efficacious at home, we can at least see if they’re helpful in the hospital or if they are having side effects. If the patient has side effects then we’ll just move on to the next one.
If there is an overnight facility that is willing to provide that service, or even a friend or family member who isn’t exhausted and who might be able to take the dog and do some medication trials or maybe just help you get some sleep, that can really help. It sets us up to take a deep breath, start from a rested place, and now we can potentially make some forward movement that we wouldn’t have been able to gain before.
The decision to euthanize because of cognitive decline is so complicated. It’s not as obviously a medical problem as, say, kidney disease where the patient just can’t make urine anymore. His kidneys are not working; that is clear. Our time together is done.
But euthanizing an animal for cognitive symptoms is very distressing no matter how you do it, and it’s complicated in a way that euthanasia for a clearer medical problem isn’t, even though cognitive dysfunction is a medical problem. If you make this decision to euthanize for dementia when you are exhausted, it’s really hard not to circle back to that decision and feel like, gosh, I just… I wonder if I made a decision that just wasn’t quite right because I was so tired.
Eileen Anderson: Right. And going back to the respite care—I had never put it together in my mind that something beneficial could be happening to the dog while the people are getting some rest. So that’s a fantastic idea.
Dr. E’Lise Christensen: Exactly. Unfortunately in our new facilities at Behavior Vets, we don’t have overnight care anymore, but we are still in a position that if we had patients like that, then we could interface with neurology and potentially get some overnight care that way for these patients where we can do medication trials.
Eileen Anderson: That is wonderful. Anything else?
Dr. E’Lise Christensen: Yes. Mentioning the neurologists brought something to mind. Of course, I think veterinary behaviorists are the perfect professionals for cognitive dysfunction patients. But if you don’t have access to a veterinary behaviorist, some veterinary neurologists are quite skilled at managing patients with cognitive dysfunction as well. So that would be another option that you could explore.
Eileen Anderson: That’s a great idea. I don’t hear anybody saying that. And you’re right, some of them do.
Dr. E’Lise Christensen: Yes, they’re trained to be able to do some treatment for cognitive dysfunction, and when I see treatment plans come back from neurologists that have been doing stuff with cognitive dysfunction, I rarely disagree significantly with their approach. And that’s saying something! Cognitive dysfunction is essentially a brain disorder. Of course, behavioral disorders are brain disorders, but they’re often presented to veterinary neurologists as needing rule-outs for brain tumors, stroke, brain inflammation, and things like that. So many neurologists have treated a fair number of patients for cognitive dysfunction.
Eileen Anderson: That makes sense. This is wonderful. I think your words today are going to help a bunch.
Dr. E’Lise Christensen: Thanks! I’m just happy to help. Our team at Behavior Vets has a soft spot for our cognitive decline patients. Treating them can be so rewarding because although we may end up losing control of their symptoms in the long term, improvements can happen quickly. Usually, we can get at least another six months of good comfort care on board for these guys through our practice. And that’s huge for the families who reach out to us.
Eileen Anderson: That is huge, indeed. Thank you so much for your time and your expertise.
Dr. E’Lise Christensen: Of course, Eileen. I’m happy to help anytime.
Dr. Christensen practices at Behavior Vets.
Copyright 2020: E’Lise Christensen, interviewee, and Eileen Anderson, interviewer and writer