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Too aggressive to care for?

One question that came up during my rewarding webinar "Putting your patient first" was about an aggressive dog that had been refused by other clinics due to the level of aggression.  Some medications had been tried, and the dog was too difficult for the owner to muzzle.  So, part of the question was " is this dog too aggressive for care?".  I am sure many of us in practice have often wondered this.  Can this animal become safer to handle?  Is the risk of trying worth doing for both the staff and the owner? Are some pets not able to become less aggressive? 

The short answer is going to be yes,  there are some dogs and cats  that you will not be able to "break through" the aggression level and come to one that is manageable.  Or the owner may not comply or feel comfortable with the risk at all in even trying premeds, rewards or anything else.  So that would leave you with a chronically aggressive animal that is dangerous and from the animal's perspective not feeling good either.  Like a diabetic that is very difficult to regulate, would you persist in trying to regulate in the face of seizures, weight loss, and further internal damage? 
A longer answer would be it depends.  Have the best antianxiety medications coupled with tranquilizers been used at the best doses long enough before travel  ( a common trigger to the anxiety about exams) to decrease fear?  Was rewarding and stress reduction begun as soon as that pet and owner came to the office - no big barking dogs in the exam area, exams on the floor rather than table, male vs. female staff? Does this dog get upset during the drive?  Adaptil on a bandana, Alprazolam or Composure with a trial drive to check effectiveness would be worthwhile to evaluate what works for this pet.   Is a house call possible?  If this dog is fine with strangers and not a problem at home, a house call with a tech to assist you may be worth a try.

Has chronic pain been addressed?  This is very important in our large breed dogs and older dogs.  Starting a pain reliever before an exam can be extremely helpful to have safer exams.  Oral buprenex can be given by the owner before entry to the clinic and will have benefit for the pet rapidly.  A sample of an NSAID could be sent home for a few days before an exam as well to minimize pain triggers. 

So in all fairness to the pet, have all the triggers to aggression been identified and controlled?  Certainly it can be difficult to know where pain may be coming from pre exam so consider the age and history of this pet.  Response to therapy is valid in many medical cases so why not for behavior? 

At this point you may not want to deal with counter conditioning the aggression at your office.  That is your decision.  A dog like this will take more time and work.  It may not be what your office wants to do or feels prepared to do.  That is fine.  Find a veterinarian behaviorist to take this case on.  AVSAB has listings of member veterinarians who take consults.  There are non board certified veterinarians who are experienced in handling a case like this.  They are the best one to handle a case like this.  A trainer who has certification by IAABC or CPDT may be able to help counter condition this dog for veterinary exams.  Be sure to talk to the trainer directly about their methods, and education in behavior before making any referral about aggression.

Owners can be very torn about whether they should continue to keep an aggressive pet.  Often a behavior consult is needed to screen for aggression in the home to make a recommendation about this pet.  With a full behavior evaluation you can help your client understand this may be more than difficulty at the office.    Even a short screen for the most common triggers to aggression - food, handling the head/collar at home, inter dog, unknown people with a few yes/no questions would be very helpful to know what you are dealing with.

Many problematic dogs and cats do improve with the right rewards given throughout the exam experience.  Some can even like coming to the veterinary clinic.  Sadly there are a few that do not improve.  Be sure to record in the medical record for all to see what rewards this pet and reduces it's stress about veterinary visits.  Consistent handling is what builds on better behavior for each exam. 

If you have done this, then you can accurately determine if this pet is too aggressive to care for.

Sally J Foote, DVM  CFBC-IAABC
Okaw Veterinary Clinic Tuscola IL

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