Behavioral Medicine Roundtable
July 24, 2019
Veterinarians weigh in on better ways to address pet behavioral issues with behavioral medicine.
It’s no secret that practices are faced with pet behavioral issues every day. Behavior is one of the most common problems clients struggle with – whether it’s training a new puppy, trying to manage separation anxiety, or dealing with a wide range of other issues. And, clients often look to their veterinary team for help.
To help you – the sales rep – provide the latest insights and solutions to clinics in your territory, we invited the following experts to weigh in on this subject:
- • James Bascharon, DVM, CEO & Founder, Vetnique Labs;
- • Heather A. Davis, DVM, DACVS-LA, PRN Pharmacal;
- • Dr. Josh Middleton, TSV for Vetoquinol USA; and
- • Cristiano von Simson, DVM, MBA, Director of Field Veterinary Services, Virbac North America.
We asked each of them the same five questions that address what will help you the most today. Perhaps their responses will spark new ideas for talking with your customers.
Vet-Advantage: What would you say are the most common pet behavior issues that clients are struggling with today?
Dr. Bascharon: “Separation anxiety is definitely a major behavioral issue for pets. As our lives become busier, there is added stress for both people and pets. Our busy schedules also mean we leave our pets at home (or in doggy daycare) for longer and longer hours and dedicate less time to allow our pets adequate exercise and outdoor time. Pets are like children, and many of the same challenges we face with our children can be manifested in our pets as well.”
Dr. Davis: “Research tells us that the most common behavioral problems in dogs appear primarily as aggression or fear-anxiety related conditions.1,2 Research shows some variability in the types of behavioral problems across dog breeds.3 However, all behaviors are influenced in varying degrees by genetic, environmental, and social factors, including the quality of human-animal bonding. Regardless of the underlying cause, unwanted behavioral problems are the number one reason for relinquishment of pets or euthanasia and a contributing factor 100% of the time to the human-animal bond.4”
Dr. Middleton: “Separation anxiety and noise sensitivities/noise phobias are two of the most common things I see. I also see struggles with a number of situational scenarios. This might involve a pet who is perfectly content under typical daily conditions, but who struggles with situations that are out of the ordinary for them. This includes moving to a new home, a new baby being brought into their life, a new pet, traveling, holidays where suddenly the normal routine is turned upside down with lots of house guests, boarding, grooming, vet visits, etc.
These are all situations that potentially may add additional stress short to intermediate term and there are things that we can do to help them cope with these changes.”
Dr. Simson: “Clients are struggling with bringing cats to the vet – getting them in the crate, the car drive and the vet visit. Dog owners are needing help for dogs that fear loud noises (thunder, fireworks, etc.) car rides, new people in the household or other environmental stressors.”
Vet-Advantage: How can veterinary practices help their client, overall?
Dr. Bascharon: “The primary role of the veterinary practice is education and awareness. Because behavioral problems are so difficult to correct once they’re started, it’s important to help clients stay ahead of the problems and establish good behaviors early on.”
Dr. Davis: “Veterinary practices are poised to help because they can proactively start conversations with pet owners. Veterinarians have a vested interest in preserving the human-animal bond, which is key to sustaining pet ownership. Research indicates that about half of dog owners reported that their dog was scared of some sort of noise. Yet only one-third of those pet owners responded that they would ask advice for treatment.5 This shows where a veterinary practice could help identify if a noise phobia is the underlying condition. If diagnosed, a number of treatment options could be discussed to help preserve the human-animal bond.”
Dr. Middleton: “I think that in many cases, we need to make sure that we are discussing these things and in particular, discussing them early. Too often, our patients’ emotional health gets overlooked and we will miss early/mild problems if we are not actively engaged in this conversation. The best time to deal with something is when there are early/mild behavioral issues. If these things are not consistently asked about and discussed during routine wellness visits, then we have missed the window where we could have drawn out the problem and had the greatest chance of significant improvement in that patient. This sets us up for failure and in the worst-case scenarios, may lead to relinquishment of that pet or euthanasia. Behavioral issues are the number one cause of death for dogs under 3 years of age (this is supported in the AVSAB Position Statement on Puppy Socialization).”
Dr. Simson: “Asking about this issue can uncover serious problems that might go unreported. Many owners don’t know that the veterinarian can also help with these behavioral issues.”
Vet-Advantage: What specific best practices can veterinary teams follow to help clients manage pet behavior issues?
Dr. Bascharon: “Setting aside specific appointment blocks of times (and fees) to deal with behavioral issues is paramount. Just like seeing a human psychologist requires a much longer appointment time, a best practice is to reserve a longer appointment slot for these types of appointments. This ensures the veterinarian does not feel rushed and the client has adequate time to go through all the behavioral issues and background information.
It’s also helpful for the practice to provide printed or digital resources for the client to take home. Prescribing supplements and medications when necessary are also very helpful in managing behavioral problems.”
Dr. Davis: “Boarded behaviorists – recommending veterinarians proactively initiate conversations with pet owners – is a common, best practices approach. Behavior cases may appear more time consuming and complicated to some general practitioners, so they may be inclined to avoid it. However, universal tools to help all veterinarians implement behavior management in their practice are available to help clinics get started.
Examples may include client checklists and broad-based behavior modification training recommendations for new pet owners. This type of approach can help all practitioners increase their comfort level in managing behavior cases.”
Dr. Middleton: “Consistent success is based on a team-based approach and starts with having the whole hospital team involved:
Receptionists trained with scripts to inquire about common behavioral issues on the phone when scheduling appointments.
Technicians trained to ask specific behavioral health questions when taking a history.
Veterinarians that are comfortable with taking the time needed to address behavioral issues or referring to a boarded veterinary behaviorist if/ when they feel that is the best plan of action. In some cases, this may involve a brief discussion during the initial visit and having them reschedule to allow dedicated time for working up the behavioral problem and creating a treatment plan.
Having a working relationship with a boarded veterinary behaviorist if one is available in your area. Telemedicine consults are available through several veterinary behaviorists if one is not located nearby.
Having a working relationship with a local trainer(s). It is important to know more than just “there is a trainer in the area and here is their info.” We need to know what training methods they utilize, both in terms of what they do but also perhaps watching them hands-on for a training session to ensure they utilize the methods they verbally say they do. Interviewing local trainers and observing a training session will help us to know if that person is worthwhile for us to make a professional recommendation for when we need a trainer as part of our treatment plan. When their training philosophy and methods match up with our treatment plans, a trainer can be an extremely valuable asset within our multi-modal, team-based treatment plan. If their methods do not match up, they can cause more harm than good and set up our treatment plan for failure.”
Dr. Simson: “Have the conversations with pet owners and educate them in basic techniques to reduce the stress and fear. Supplements… can help many dogs going through behavioral therapy. [For instance], Anxitane® promotes relaxation without causing drowsiness, so the pet can be re-educated to better tolerate the stressful stimuli. It is also very tasty, so it can be used as a positive stimulus, or reward. For the more serious cases, a referral to a behavioral specialist is the best solution.”
Vet-Advantage: What anecdotes have you seen or studies related to improved outcomes?
Dr. Bascharon: “Just like any other issue, the more the root cause is identified, the more likely the chance for a better outcome.”
Dr. Davis: “Study results are the basis for evidence-directed intervention. Research indicates that improvement is more likely to be achieved using more than just one type of treatment approach.6 For example, behavior modification and medication will likely achieve greater success than just medication or behavior training alone.7 It is also important to ensure an accurate diagnosis and to consider any potential confounding household conditions or underlying diseases. Once veterinarians more frequently incorporate behavior cases into their clinics, they can start to see similarities among patients. This will help increase confidence in diagnosing and treating, and in ultimately yielding positive behavioral outcomes.”
Dr. Middleton: “Recently, there has been a good amount of data becoming available in the behavior space. Many of these studies focus on a given condition and a specific treatment for that condition. There are also studies that look more broadly at behavior.” [One such study is, Evaluation of the association between attendance at veterinary hospital based puppy socialization classes and long term retention in the home.] “This study showed a dramatic increase in puppy retention (94%) when these puppies were given advice at their puppy visits that was based on positive reinforcement and the owners were offered the opportunity to attend 5 weekly ‘Puppy Kindergarten’ socialization classes at the veterinary hospital. This 94% retention is in stark contrast to the approximately 33% retention of puppies remaining in their homes when they retrospectively looked back into the records of puppies that were seen at the clinic previously, when protocols for behavior advice given at puppy visits was based on punishment and an ‘alpha’ dominance philosophy. In essence, this supports what we talked about above: early intervention can have a dramatic impact on these pets’ lives and leads to better outcomes.”
Dr. Simson: “I have heard of many cases where the pet and pet owner have reduced their stress levels considerably, thanks to expert advice on behavioral therapy, environmental modification, and products that help the pet relax.”
Vet-Advantage: How can a distributor sales rep help practices provide the best solutions for pet behavior?
Dr. Bascharon: “By educating practices on the latest supplements, medications, and literature for (both the practice and the clients) is definitely a value add for helping with pet behavior.”
Dr. Davis: “Distributor representatives are in many cases likely to hear about new products or educational resources provided by manufacturers before the veterinarian/end-user. That favorably positions the representative to become a valued resource when he/she passes along insight to the clinic.
As a manufacturer, we continuously expand our reach with educational offerings based on guidance provided by industry experts. In this case, in-clinic behavior tools mentioned earlier, such as checklists, diagnosis flow charts and behavior training programs, are just two of the offerings available in which distributor representatives could use to initiate behavior conversations with clients. PRN® Pharmacal, in partnership with Dr. Debra Horwitz, just launched a RACE-approved CE course to help veterinarians accurately diagnose and treat separation anxiety in dogs.”
Dr. Middleton: “Seek out a behavior track at the next conference you are at and sit in on some lectures. There is generally a lot of discussion about recent research along with the fundamental concepts of behavioral health and behavioral medicine.”
Dr. Simson: “Remind the veterinarian and staff to ask about typical behavioral products and explain how this is a growing concern for pet owners and growing business for the vet clinic is already a big help.
There are various kinds of products that can help, including devices, pheromones, supplements, drugs, etc. Practices will need help to understand the features and benefits of these products, so that they can decide what to stock and prescribe.
A good sales representative should know at least the most popular of these products well, so that she can educate their customers.
Manufacturers provide training resources (in Vet-Advantage or other training tools) and access to behavioral CE. Sales representatives should leverage these training opportunities.”
What’s your plan to bring up pet behavior with your customers? We recommend jotting down your key takeaways from these expert tips, and asking practices what they’re doing to help address these common issues.
References from Dr. Davis, PRN Pharmacal
1. Landsberg G, Hunthausen W, Ackerman L. Handbook of behavior problems of the dog and cat. Third edition. 2003.
2. Sherman B, Mills D. Canine anxieties and phobias: an update on separation anxiety and noise aversions. 2008.
3. Tonoike A, et al. Comparison of owner-reported behavioral characteristics among genetically clustered breeds of dog. 2015.
4. Overall K. The manual of clinical behavioral medicine. 2013: 2.
5. Blackwell EJ, Bradshaw JWS, Casey RA. Fear responses to noises in domestic dogs: prevalence, risk factors and co-occurrence with other fear related behavior. Appl Anim Behav Sci. 2013; 145: 15-25.
6. Ogata, N. (2016). Separation anxiety in dogs: What progress has been made in our understanding of the most common behavioral problems in dogs? Journal of Veterinary Behavior: Clinical Applications and Research, 16, 28–35.
7. Landsberg GM, et.al Effectiveness of fluoxetine chewable tablets in the treatment of canine separation anxiety Journal of Veterinary Behavior: Clinical Applications and Research, Volume 3, Issue 1, 12 – 19.
In: July Digital Edition 2019Topic: Sales