Merlot is a scrappy little dog, born feral on a tropical island. The papers that came with him from the Caribbean animal shelter say “Location Found — Under Shed.” A difficult beginning. But his life quickly improved when he came to the Vineyard and was adopted by a wonderful family. It is not unusual for dogs with this kind of background to be feisty. It makes sense. They had to be tough to survive, and people were not always kind to them. The first time I met Merlot, he was 5 months old. We worked with him as gently and calmly as possible. He tolerated my exam, allowed a few vaccinations, then decided that was enough. “Not bad for a first visit,” I thought.
Merlot was a good boy when he wasn’t anxious, but he became progressively more defensive and aggressive at my office. Initially he would sometimes let me examine him while one of his owners held him very gently, sans muzzle … but when needles were involved, all bets were off. We soon had to muzzle him here for everyone’s safety. Fear-biters like Merlot are telling us with their behavior that they do not consent to being touched. They are telling us they are scared and want us to back off. Every time we try to force the issue and fail, a fearful dog learns to be even more aggressive because, in his mind, we are not getting the message he is so clearly sending us: Stay away!
There are several goals when working with animals like this. First and foremost, we want to keep all the players safe from bodily harm — both the pets and the people. Secondly, we want to relieve the pet’s fear, reduce their aggressiveness, and make the experience as pleasant as possible for everyone. (Not all aggression is fear-based, so sometimes we have to look at other causes, and modify our approach accordingly.) Finally, we want to get the necessary medical procedures done. The challenge is to accomplish all these things simultaneously. Different methods work for different animals, and the same approach does not always work consistently, even with the same pet.
Merlot discovered that if he immediately started to thrash and bite at anyone within reach, including his owners, we would leave him alone. He’s only about 25 pounds, so one time his dad offered to try just holding Merlot in his arms. This is calming for some patients. Not Merlot. He fought back, gouging his owner with his nails. “This is not good,” I thought, watching blood roll down my client’s neck while Merlot stood angry but victorious on the floor. I was failing on all three goals. People were getting hurt, the dog was upset, and we still weren’t able to treat him.
When I was a young vet, the ethos in the profession was, well, macho. The goal was to “get it done.” This meant a bit of, well, manhandling. OK, it’s not really a gender thing. Let’s just say the archetypical veterinarian was supposed to be unintimidated by the snarling Rottweiler, the hissing attack cat, the rearing horse. Our job was to get the job done, with little regard for our own safety or for the emotions of the animal. Thankfully the veterinary community has come to recognize that this approach is not always the right one. Not for our patients, and not for ourselves.
There are many techniques for decreasing patient anxiety. Make the exam room as comfortable and unthreatening as possible. Greet patients with affectionate pats and delicious treats. Spritz ourselves and the room with products like Feliway or Adaptl, synthetic pheromones that are calming to cats and dogs. Watch our patient’s body language, and adjust our approach to what seems to relax them. Most animals don’t need more than that for us to quickly and efficiently achieve our three goals of minimal anxiety, safety, and getting the job done.
But certain dogs and cats need more. There are two cornerstones for addressing fear-related aggression. The first is behavioral modification through desensitization and counterconditioning — a time-consuming process of slowly getting a pet accustomed to whatever provokes the aggression, while simultaneously replacing fearful associations with more positive feelings. For example, we are having Merlot’s owners put delicious treats on a basket muzzle every day for him to eat. These muzzles are roomy and comfortable for dogs, while still preventing biting. Day by day, we want Merlot to learn he gets wonderful, yummy food when he puts his nose on, and eventually in, that muzzle. The goal is a relaxed pup who will let his owners muzzle him before I come visit.
The second cornerstone is simple. Drugs. Happy drugs. It is better to step away when Merlot gets upset and try again another day with Happy Drugs on board. In the past, veterinarians often relied on acepromazine — a tranquilizer for “mild chemical restraint.” We now know, however, acepromazine is not very good for relieving anxiety. It sedates the patient so they react less, but they may still feel emotionally stressed. This does nothing to help overcome their fears for the next time. Although it is still a useful part of our pharmacy, nowadays we reach for other options first, trying various combinations for the optimum effect. Antianxiety medications, sedatives, tranquilizers, even antidepressants. Drugs such as trazodone, gabapentin, phenobarbital, and dexmedetomidine. (Some of these are not officially approved for use in pets, but are often very helpful.) Figuring out the most effective combination and dose for each case is a matter of trial and error.
Sometimes it makes sense to actually anesthetize fearful aggressive dogs.That way they simply sleep through procedures, without feeling any fear at all. For now, we keep trying to adjust Merlot’s “cocktail” in search of the right mix, while his owners continue muzzle training.
Merlot has come a long way from living under a shed, but we all understand that he needs a lot of extra patience and TLC to overcome his past.