Purina Nutrition Exchange: June 2022

Sponsored by Nestlé Purina Company

Multimodal Therapy is the Optimal Approach for Managing Patients With Anxious Behaviors

Julia Albright, MA, DVM, DACVB

Q: How do you differentiate stress, anxiety and fear? Is it important to do so?

“Stress” and “anxiety” tend to be used synonymously but from a biological or neurobiological standpoint, they’re not the same.

Stress is a fairly generic term. Most of the time we really mean “distress.” There are two arms of the physiologic stress response that help animals avoid danger: the sympathetic nervous system—which does things like producing adrenaline, helping glucose get to muscles quickly, and accelerating heart and respiratory rates to prepare for fight or flight. And then there’s another arm called the hypothalamic-pituitary-adrenal (HPA) system, the major outcome of which is cortisol production.

Anxiety has been taken from the human literature and usually refers to what is causing the stress, which typically isn’t physically present. For example, a dog or cat with separation-related distress may start feeling anxious any time their owner starts walking toward the door; or if a pet had a perceived negative experience at the veterinary clinic, signs of anxiety may be noted in subsequent car rides. Anxiety tends to be low-level and can be chronic. If an animal is panicking, that’s not anxiety.

Fear is a negative but adaptive emotional state that allows an animal to survive a perceived threat by mobilizing fuel for fight, flight or freeze in the face of danger. However, constant exposure to fearful stimuli can cause damage to the brain and body.

Q: Anxiety/anxious behaviors can sometimes be traced to problems with socialization early in life. What kinds of behavior problems typically result?

Behavior is a function of both nature and nurture. Genetics play a role as does the maternal in utero environment. One of the most important periods of development is the sensitive period for socialization. In dogs, that’s from about 4 to 14 weeks of age and for cats it’s from 2 to 7 weeks of age. It’s during this time that pets are most open to learning about the world around them, including any type of social attachments.

If cats or dogs have poor early socialization, they’re more likely to have generalized anxiety problems, meaning their baseline level of anxiety stays high. These are often the dogs pacing and panting around the house or the cats that are always hiding under the bed. The behaviors are not necessarily linked to a specific trigger but animals whose socialization was inadequate are also more likely to have specific fears and phobias.

Q: How do you determine which therapy or combination of therapies is needed for a pet with anxiety?

I never recommend a pharmaceutical or a supplement alone. I recommend veterinarians talk with clients about avoiding stressors when starting a supplement or a medication, and start with a conservative therapy if the problem seems mild or the client is unsure about prescription pharmaceuticals. If the pet has elevated and constant anxiety, starting with something like Purina® Pro Plan® Veterinary Supplements Calming Care can be a great first step. It can also be used in combination with other medications, although staggering start times will be beneficial to tell which modalities may be helping.

Veterinarians will achieve the best results when they use these therapeutic tools in conjunction with behavior modification. Decreasing fear opens a pet’s mind to learning more positive behavior patterns. For example, if a dog panics during a thunderstorm, you need to help the dog be less fearful. If you can train him or her to think ‘Every time I hear thunder, here comes the cheese or here comes the ball,’ you can change the meaning of what the trigger is for that animal. Medications and supplements can help facilitate this type of behavior modification therapy.

Additionally, assessment tools such as these (purinaproplanvets.com/assessment-tools) can help you proactively detect anxious behaviors in your patients and engage clients in the process of addressing them.

When Managing Pets Displaying Anxious Behaviors Hits Close to Home

Avi Shaprut, DVM

When a dog or cat experiences anxious behaviors, both the pet and household are affected. Not only is the pet distressed, but the behaviors can also stress the pet’s human family.

I know this from personal experience. Three years ago, our family adopted two rescue puppies. It quickly became clear that one of them, Storm, had ongoing anxiety, as evidenced by her being situationally anxious to new events and sounds in our house—particularly with our two young children.

As soon as we became aware of her anxious behaviors, we started Storm on Purina® Pro Plan® Veterinary Supplements Calming Care. Calming Care is a probiotic supplement that contains a strain of beneficial bacteria, Bifidobacterium longum BL 999, which has been shown to help dogs maintain calm behavior and is supported by a blinded crossover design study.

After four weeks, we noticed improvement in Storm’s anxious behaviors and that she seemed less nervous. After six weeks, we observed further improvement but assumed this could be due to the behavior modification strategies we had implemented and her acclimation to our household.

To test this assumption, we discontinued Calming Care to see if things would change—and they did. Within a week, we noticed that some of Storm’s anxious behaviors had resumed. We reinstituted her Calming Care routine several days later and she soon returned to her new calmer baseline.

Over the next two years, we tried stopping Calming Care two more times as we continued Storm’s training. Both times, her behavior regressed to the point that my wife strongly requested we put Storm back on Calming Care. She remains on the supplement to this day.

Based on my personal and general practice experience, as well as what I’ve learned from other veterinarians and behavior experts, I recommend the following considerations when using Calming Care in your practice.

Employ a Multimodal Approach

Calming Care can be part of a multimodal program, whether it is combined with behavior modification, medications and/or a wearable (like a snug shirt) for noise sensitivities. Consider administering Calming Care six weeks in advance of stressful periods like thunderstorm season as well as prior to starting behavior modification, as the ability to learn new behaviors improves when a pet is calm.

Emphasize That It's a Supplement, Not a Medication

Calming Care is a nonpharmaceutical, noninvasive approach, which is appealing to many clients. Even as a monotherapy, dogs given Calming Care have shown an improvement in displaying anxious behaviors such as excessive vocalization, jumping, pacing and spinning. Improvement has also been shown in cats displaying anxious behaviors such as pacing. Calming Care helps promote positive behaviors in cats such as playing and seeking out social contact.

Consider Using Prior to Surgery, Rest and Rehabilitation

Calming Care can be used when there is a prolonged recovery requiring a change in routine and location. For example, if a dog has been diagnosed with a ruptured cruciate ligament and the owner is willing to do surgery, I recommend we start Calming Care right away. During the recovery period from surgery, the dog may then be better able to cope with the changes in routine. Purina research has shown that Calming Care takes up to six weeks to reach full effect, so it’s important to begin supplementation early enough to have an impact.

Engage Clients in Monitoring Progress

Since some improvements can be subtle and may occur over a period of several weeks, owners may not realize they’re even happening. I recommend that clients and other family members each fill out a behavioral assessment questionnaire (purinaproplanvets.com/assessment-tools) before therapy and again at the six-week mark to more accurately gauge improvement.

Understand Both Patient and Client to Effectively Manage Pets Displaying Anxious Behaviors

James Matthews, DVM

Hardly a day goes by where I don’t see at least one patient that suffers from anxiety. And while it is pets that are directly affected: successful management is highly dependent on open communication and collaboration with owners.

Identifying anxious behaviors in dogs: A veterinary visit can be stressful for any patient. If a dog’s body language indicates fear, anxiety or stress, with signs like tail tucking, heightened alertness, raised hackles, and either avoidance or constant maintenance of eye contact, I want to understand if that is simply due to the pet’s discomfort with the clinic environment or indicative of a larger underlying problem. If an owner tells me a dog is prone to exhibit anxiety either on a more generalized basis or when faced with certain triggers—like noise or new people—I initiate a discussion about intervention.

Identifying anxious behaviors in cats: Cats are more challenging because most of them don’t like novel environments and experience at least some anxiety during veterinary visits. With cats, I rely more on what the owner tells me about the cat’s home behavior to determine if there is an issue. Behaviors like urinating outside the litter box, being aggressive or hiding—or even just not being very interactive—can tip me off. I also consider the cat’s medical history and look for certain conditions that can be triggered by stress, like herpesvirus flare-ups or feline idiopathic cystitis.

With both species, the two fundamental questions I ask are:

1. How severe is the problem?

2. Is the problem generalized or brought on by specific triggers?

For example, a dog with thunderstorm anxiety will require a different approach than a dog that is hypervigilant or has separation anxiety.

Counseling clients: a step-by-step approach. I recommend a behavioral consultation with a trusted trainer for all patients with anxiety and I refer pets suffering from more severe issues to a board-certified veterinary behaviorist. I find that the accountability of a structured behavioral management plan can help both owner and pet be successful. Not every client is willing to put in this kind of effort but I always recommend it.

Owners are frequently resistant to the idea of their pet taking medication for anxiety. Some owners mistakenly fear it will change their pet’s personality. The good news is that even clients who don’t want to give an anxiety medication are typically willing to try a product like Calming Care from Purina® Pro Plan® Veterinary Supplements, because it is a probiotic rather than a medication that helps pets remain calm. It’s effective for many animals and easy to administer—an important factor, especially with cats. In addition, for patients that are helped by Calming Care but need something more, I find it’s easier to move on to an anxiolytic medication after the owner has become used to giving a supplement.

Behavioral medicine is an emerging field for veterinarians in practice today, with more tools to help more patients. Understanding owners, as well as pets, is key to implementing a successful strategy.

KEY TAKEAWAYS

• Decreasing fear through behavior modification opens a pet’s mind to learning more positive behavior patterns. Medications and supplements can help facilitate this type of therapy and ultimately help ease anxiety and stress.

• Calming Care can be used as a monotherapy or with behavior modification and/or medications to help dogs and cats maintain calm behavior.

• Owners who are resistant to the idea of medical intervention for pets with anxiety may be more comfortable trying a probiotic supplement first.