Sunday, February 26, 2017

What even is "bad enough"

"The fear wheels turn and all you can think about is what you'll never be able to do instead of finding what you can do."

A facebook comment on an internet acquaintance's page, who also went through anxiety/fear stuff with her young dog.  It rings very true with me.  How many countless hours have I spent worrying that Ida's life will never be as happy as it could be if she weren't so anxious?  Too many.  And it doesn't matter.  I am much better off focusing that worry-energy into helping her overcome her fears, in boosting her confidence, and making sure that her needs - her true needs, and not the ones that I wish she had - are met.
I don't like going to the doctor either, Ida.

Which brings me to the topic of this post.  I have spent a lot of time justifying to myself that Ida didn't need medications.  She wasn't "bad enough". Her issues are not as severe as the other dogs that I know who are on them. She's not (obviously) suffering at home, and her biggest triggers for fear/anxiety were outside of our property.  Which would be fine if she were in a typical pet home, doing regular pet stuff, and had a regular pet home that was content to let her stay at home for the rest of her life.  For better or worse, I am not that home, and I really want to DO stuff with Ida... which means I need to do more to help her be comfortable outside of our home.  And I didn't think Ida needed meds to overcome those fears.  We have made progress without them, but it has been slow and inconsistent and... if I can safely speed up the process, why wouldn't I?

It's taken me months to come to this conclusion, and I know some people saw it coming befire I did.  But this week we finally saw the vet about medications.  I was on the verge of tears when we started to discuss it.  I explained her issues and how behaviour modification has made some impact, but that we've come to an impasse.  He started by suggesting herbal supplements.  At that point I described what we'd tried (herbal supplements, with minimal effect, the thundershirt which started effective and no longer is), and that I hadn't used the synthetic dog appeasing pheromone because a systematic review that I found indicated little evidence for its effectiveness. I clarified why I was 100% certain that her issues in the car were not car-sickness (no vomiting, no salivation, won't take treats with the car running even if it hasn't moved).  He seemed hesitant to suggest medications until I flat out told him that we wanted to pursue it.  We briefly discussed what her triggers are (traffic, repetitive noises, strange dogs, the car) and training strategies. I was pleasantly surprised when my vet described the DS/CC protocol that I had already formulated in my brain to implement once the drugs are on board.

My vet's hesitancy to prescribe meds was both reassuring and disheartening at the same time.  I wonder how many dogs he sees who would probably benefit from medication, but the owners are not willing to go down that route.  I wonder how many dogs he sees and the owners don't even acknowledge that there is a problem.  And I wonder this fulling knowing that, even knowing the benefits of medications for mental health issues in humans and knowing people with dogs who are on medications and doing great. I can only imagine what it is like to convince people who don't think humans need medication for mental health issues that their dog should be taking it.  Some pieces of our society are so messed up that they would rather refuse to acknowledge that people (or dogs) are suffering than see them take medications for it.

Since publishing this blog article, I encountered this article by a DVM about why behaviour medications should not be a last resort.  This part especially makes a lot of sense:

In my opinion, medication should be considered as a first-line treatment option for the vast majority of dogs with true behavior problems – including aggression, compulsive behavior issues, and any type of pathological anxiety.  When we try to reserve the use of drugs as a last resort, something that we only try if the case is “really bad”, or if nothing else has helped, I believe that we do these dogs a tremendous disservice.
To me, this is similar to saying that we don’t want to use insulin in a diabetic patient unless he’s crashing with DKA, or that we don’t want to treat an infection with antibiotics until full-blown sepsis sets in – it makes no sense to withhold a basic treatment option with minimal risks and lots of potential benefits, until the situation becomes truly desperate.
Far better, if we can, to prevent this from happening in the first place with a well thought-out, comprehensive treatment plan in the beginning.