Is it time we re-evaluate how we approach behaviour problems as owners, Vets and Behaviourists?
By Suzanne Gould – Behaviourist and Dynamic Dog Practitioner
Any good dog owner knows that when their dog starts behaving out of character or displays new unwanted behaviour they take their dog to the Vet for a check up to rule out a physical cause such as pain or illness.
You, as the dog parent, go in and tell the vet how your dog has started barking at unfamiliar dogs, doesn’t like being left on their own alone any more and has started to randomly snap and growl …. The list goes on. Everything else seems normal.
A typical Vet check will include some questions about the behaviour, what other factors could be involved in the dog’s life. The dog is weighed, then they will check heart rate, respiratory rate, pupillary diameter and blood pressure, as increases can indicate pain. Then the Vet feels the dog over to look for signs of pain from the pressure and touches. If nothing is found, you are told the dog is physically fine, and your dog is likely to have a behavioural problem.
You may be referred to a Veterinary or Clinical Animal Behaviourist, who generally will only accept a referral from a Vet, giving a clean bill of health or with a medical condition under control. Or you may be advised to seek out a Behaviourist, who will also check your dog’s medical records.
This is all done in under 15 minutes as our Vets today are placed under huge time pressures to stick to time limits and see as many clients as they can. They only have time to check and use a sticky plaster approach to anything they uncover, which must be a massive source of frustration for them.
It doesn’t seem right that a complete Vet check, looking for potential pain, can be performed in such a short space of time. The truth is it can’t. If the pain is acute, say an injury that has recently happened, then yes the vet will find it. But What about long term chronic pain that can not be uncovered in minutes?
‘It is almost impossible to diagnose pain by examination in the consultation room’ Gwen Covey-Crump BVetMed, CertVA, DipECVAA, MRCVS, pain specialist at Langford Veterinary Hospital, Bristol.
A typical Vet check not only has time restrictions going against it, there is the dogs behaviour/mental state to consider. A dog who is uncomfortable or unhappy in a Vet setting will likely be experiencing some form of stress, anxiety or fear and displaying one of these responses.
Fight – the dog is reacting by barking, snapping growling.
Flight – the dog is trying to get away from the room, vet and entire situation.
Freeze – the dog is overly compliant in the hope they can leave sooner.
Fidget – the dog unable to stand or sit still, constantly trying to investigate the room and avoid the Vet.
When any of these responses happen, adrenaline followed by cortisol floods the dog’s body. Adrenaline is a natural source of pain relief for the dog, helping them stop feeling pain as they deal with the situation they are facing. Which means it’s impossible to accurately check a dog over for pain in a Vet check.
In fight, flight or fidget a hands on assessment is going to be limited at best and not an option at worst.
I mentioned chronic pain earlier, that is because dogs with chronic pain and discomfort may express that pain via behaviour changes. Epstein 2015 stated1 ‘Because behavioural signs of pain are often overlooked or mistaken for other problems, the healthcare team must be vigilant in recognizing those anomalies in the total patient assessment’
The link between Pain and Behaviour is starting to become more widely acknowledged in large thanks to new research including Dainel Mills et al, who in 2020 published a paper Pain and Problem Behaviour in Cats and Dog2s.
They found that up to 82% of their veterinary behaviour cases covering both cats and dogs, revealed the patients had some form of undiagnosed pain that was either causing the unwanted behaviours, contributing to the unwanted behaviour or as a result of the unwanted behaviour. However, this does not mean that if there are no behaviour problems the dog is not in any discomfort, some dogs are incredibly good at hiding it and will compensate to get around the pain through adjusting how they move etc.
On the low end, that means there is a potential 3 out of 10 dogs who are being diagnosed with a stand alone behaviour problem when actually they are likely to be dealing with underlying pain.
Think about how chronic pain affects us as humans. You start out with a niggle in your lower back, you may alter the way you sit or stand, you might be slower to get out of bed, you might shift your weight more to one side, you adapt to protect yourself.
Over time as that pain comes and goes, it does get progressively worse. You compensate for it consciously and subconsciously too. You also might be more irritable on the days it flares up, you might start avoiding activities you usually enjoyed. You probably reached out for some form of pain relief to help.
“Chronic pain can be suppressed from consciousness but processed by emotional and cognitive changes” Dr. Kathy Murphy BVetMed, DPhil, CVA, CLAS, MRCVS Chief Scientific Officer, Behaviour Vets.3
We all at some point will deal with chronic pain. We just don’t put much thought into it. Dogs are no different, although they do not ‘speak’ directly about what is happening in the form of whining or crying. They do express it through behaviour for example reactivity, avoiding previously enjoyed activities like running or walkies or moving away from touch.
‘Dogs suffering from chronic pain often experience frustration and anxiety because they often have difficulty in accessing its daily needs’ (Mills et al., 2020).
This brings us back to the 15 minute Vet check. The physical assessments are based on a scoring system to look for acute pain not chronic pain. The assessment of pain in dogs is for the most part based on the recognition of behavioural changes in response to pain, which can vary between individual dogs.4
Pain Scoring
The most basic pain scoring system in veterinary practice is Simple Descriptive Scales (SDS)5. This scale usually has 3-5 grades of choice defined by a short description. for example 0, no pain; 1, medium level; 2, moderate level; 3, severe level.
Short Form Glasgow Composite Measure Pain Scale (SF-GMPS)6 is the pain scale commonly used in Vet Practice. It was designed as a practical decision-making tool for dogs in acute pain, and can be applied quickly and reliably in a clinical setting.
Both of these focus mainly on acute pain and they are also subjective as outcomes vary between different Vets and the dogs themselves may respond differently to different people.
When a Vet is able to get their hands on a dog to do the physical assessment, the dog is highly likely to tolerate the exam because just like us humans, they have been able to build up a tolerance to their chronic pain and do not forget the input of pain relieving adrenaline7.
Next, we have to think that if a dog is experiencing chronic pain in their hip for example, but their expression of the pain is barking at unfamiliar dogs, it makes the clinical assessment harder. A Vet can only do so much in the short time and again, are unlikely to find a clinical cause of the behaviour.
So how can pain or discomfort be ruled out?
First and foremost, a true hands-on assessment for chronic pain will take between 50 to 90 minutes, these can be performed by Vet Physios or Specialist Vets.
A physio will do an assessment and also review your dog’s medical history. The assessment is hands-on as they observe a stance to assess symmetry plus gaits of your dog on and off lead. A physio will palpate the muscles to identify any alterations in muscle tone, muscle spasm or trigger points before assessing joint range of movement.
The physiotherapist may also carry out a range of assessment to ascertain the dog’s awareness of it’s position in space, reflex response and response to pain in neurological cases. Any problems will be identified and then an individual treatment programme will be planned.
For this to be accurate, the pain assessment must be done in an environment that is relaxing for the dog. This will mean dogs who are reactive, anxious or stressed are still going to struggle and will still have adrenaline flooding them which will affect results.
For the dogs who struggle with stress, anxiety or fear in a Vet setting or Physio setting there is a Dynamic Dog Assessment. This is a hands-off functional assessment of a dog’s gait, posture, conformation, daily life activities and unlike physios and vets, this goes into detail about the dog’s behaviours too, and can be used to help a vet make a more informed diagnosis.
A qualified Dynamic Dog Practitioner will talk extensively with you, to uncover as much detail as they can about their dog, covering topics from sleep, daily life, toileting habits and much more.
Videos and photos of the dogs in their relaxed and safe settings are taken by you and submitted to the Practitioner. The videos and photos are reviewed over a number of hours, allowing the Practitioner to go into detail to see exactly how your dog is using their body, and identify any abnormalities.
A detailed report along with the visual evidence is created for the GP Vet, which allows the Vet to focus on a specific area of the dog and tailor their clinical plan. All of this is done without the dog being placed under stress, without the limitations of time and more importantly taking into account the dog’s behaviours as a part of the investigation.
The abnormalities found can usually only be picked up by someone trained to understand how a dog should correctly move, use their body and know what faults look like such as a Dynamic Dog Practitioner, Vet Physio or Orthopaedic Vet Specialist. Interestingly, general practitioner Vets are not taught this as part of their veterinary education.
Yet with all this knowledge and skills existing to help our canine friends, we still put all the emphasis on giving a dog a 15 minute Vet check to rule out potential pain or discomfort as a factor of worsening or new behaviour problems.
Pain Management Guidelines for Dogs and Cats by Epstein et al 20158 stated that ‘it is now accepted that the most accurate method for evaluating pain in animals is not by physiological parameters but by observations of behaviour’.
Think of the benefits that everyone would reap, if we were able to work as a team when it comes to dogs with behaviour problems, Vets, Behaviourists, Dynamic Dog Practitioners, Vet Physios and owners all working with the goal of ensuring pain is not a factor in the dog’s behaviour and day to day life.
If pain is discovered, it can be dealt with as a multidisciplinary team with Vets providing any medical care, Physios creating physiotherapy, hydrotherapy or laser therapy plans and Behaviourists providing the training plans, all while supporting you and your dog.
It is time the Veterinary industry and also the Dog training and behaviour industry changed their view of what Vet checks really do achieve. It would also be better for the dog and owner if there were less emphasis on getting more patients through the door and more emphasis on realising that we are still learning about dogs. Working as a team will only lead to healthier dogs and happier owners.
At the moment a Vet telling an owner their dog is physically fine after less than 15 minutes, it’s a behaviour problem is nothing more than a false sense of security. It delays finding out about any potential pain or discomfort until the condition has severely progressed.
A dog in pain will struggle with behaviour modification to some extent, until the pain is dealt with, which means we are setting dogs and their owners up to fail.
Is it time we re-evaluate how we approach behaviour problems as owners, Vets and Behaviourists?
Suzanne Gould
Canine Behaviourist and Dynamic Dog Practitioner
Book a call with me Here or Find out more about a Dynamic Dog Assessment Here.
Case Study.
Old English Sheepdog 20 months old. Entire.
Reason for Vet Check – Dog had randomly snapped at owners when getting scratched. Also randomly snaps when people walk by him as he sleeps.
History – previous lameness at Right forelimb after a fall aged 6 months.
Dog did not allow his forelimbs to be handled by Vet – Vet Advised rest and to consult a Behavourist.
Behaviourist – Due to the random nature of behaviour, suspected pain is involved. As the dog doesn’t like to be touched a Dynamic Dog assessment was completed.
Findings – Right hind weakness, with off loading of weight onto Left Fore. Suggested imaging for front and hind limbs.
GP Vet – did not agree with Dynamic Dog Assessment, suggesting they felt it was OCD in elbows. Referred the dog to Orthopaedic Specialist Vets. CT Scans were requested for front limbs only by GP Vet. Owner following the Dynamic Dog Assessment pushed for CT scans of hind limbs at the same time.
Diagnosis – Bi-lateral hip dysplasia
In this case had the hind limb scans not been done this dog would have been labelled as aggressive. He is now on pain relief and showing behaviourial improvements. Now waiting for Physiotherapy to start.
Case Study
Romanian Rescue – 18 months old
Reason for Vet Check – Behaviour of anxiety outside was becoming increasingly worse. Also the dog starts to lunge for the owners in the home, when suddenly disturbed.
GP Vet – Found no problems physically, the dog was very compliant in the check up.
A Dynamic Dog assessment was completed due to the dog’s anxieties. It revealed Right hind weakness and hip hike.
Vet did not agree with assessment, as they still found the dog physically fine in the check up. The vet prescribed behaviour medication.
Behaviour medication had no effect on behaviour. This was switched to a pain relief trial which proved successful and subsequent X Rays revealed hip dysplasia at Right Hind.
The dog is now in Hydrotherapy with a plan to come off pain relief medication.
Case Study
Wire Haired German Pointer – 2 years old
Reason for Vet Check – Hyperactivity, unable to stop and rest, limited sleep. Also abnormal gaits noted by the behaviourist. Triple tracking, hip hike and roached spine. Advised they speak to their GP Vet and seek out X-rays
History – tail dock after breaking it in a fall aged 18 months.
GP Vet – Dismissed concerns, stating ‘that’s just how your dog is’ and found him to be healthy. Clients pushed for x-rays of hips, lumbar Spine and knees.
Diagnosis – Bi-lateral hip dysplasia and Spondylosis at lumbar spine.
The Vet advised they keep their 2 year old active dog on short lead only walks for the rest of his life. After further discussions with their Behaviourist they got a referral for a Vet who specialises in Stem Cell treatment and have started physio. The dog is now able to relax and is not constantly on the move.
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References.
- Epstein ME, Rodan I, Griffenhagen G, et al. 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. Journal of Feline Medicine and Surgery. 2015;17(3):251-272. doi:10.1177/1098612X15572062 ↩︎
- Mills, D.S.; Demontigny-Bédard, I.; Gruen, M.; Klinck, M.P.; McPeake, K.J.; Barcelos, A.M.; Hewison, L.; Van Haevermaet, H.; Denenberg, S.; Hauser, H.; et al. Pain and Problem Behavior in Cats and Dogs. Animals 2020, 10, 318. https://doi.org/10.3390/ani10020318 ↩︎
- Vets, B. (n.d.). Selecting drugs for pain trials -What is a Pain Trial & Why is it Important. [online] Behavior Vets. Available at: https://behaviorvets.mylearnworlds.com/course/pain-trial-meds [Accessed 19 Jun. 2023]. ↩︎
- Reid J, Nolan AM, Scott EM. Measuring pain in dogs and cats using structured behavioural observation. Vet J. 2018;236:72–79
↩︎ - The Veterinary Nurse. (n.d.). Pain assessment and pain scoring models: a review. [online] Available at: https://www.theveterinarynurse.com/Review/article/pain-assessment-and-pain-scoring-models-a-review. ↩︎
- Bloor, C. (2017). Pain scoring systems in the canine and feline patient. [online] The Veterinary Nurse. Available at: https://www.theveterinarynurse.com/review/article/pain-scoring-systems-in-the-canine-and-feline-patient. ↩︎
- Hernandez-Avalos I, Mota-Rojas D, Mora-Medina P, Martínez-Burnes J, Casas Alvarado A, Verduzco-Mendoza A, Lezama-García K, Olmos-Hernandez A. Review of different methods used for clinical recognition and assessment of pain in dogs and cats. Int J Vet Sci Med. 2019 Nov 18 ↩︎
- Epstein ME, Rodan I, Griffenhagen G, et al. 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. Journal of Feline Medicine and Surgery. 2015;17(3):251-272. doi:10.1177/1098612X15572062 ↩︎
