Spooky Cash's Drug Problem - Background, Info, ?'s

[greysmom]

I want expert opinions so - of course! - I come to Greytalk! Plus, I needed to write it all out to see if it made sense to me!

 

Background:

Cash came to us at Christmas of 07. We already knew she was a spook and were prepared to deal with her issues whatever that took. We researched remedies, read books, and talked to vets and our greyhound mentors. I hadn't yet discovered GT.

 

Cash was a first-class spook. In her foster home prior to coming to us, she was reported as "scared of everything" and obsessed with certain objects including the ceiling fan and stairs. She didn't bond at all with the couple. She also escaped from this foster and ran around loose for five days before being caught.

 

So she came to us and was a foster for about 5 minutes before w knew she was staying forever! She actually did pretty well with our pack at the time - our Angel Libby, Dude and Copper. She was relaxing and learning everything she should have learned already, and doing really well with her fear issues. Then, after we had had Cash for about a month, in the matter of a week or so, we lost Libby. She was our matriarch and the rock of Cash's world. DH and I were devastated. Cash went to pieces.

 

Everything terrified her - inside, outside, new things, old things, literally everything. We couldn't change the pictures on the wall in the living room without her refusing to go there for a week. She wouldn't come to me or go with the other dogs when it was time to go inside, so she was only outside on-leash. It got so bad that she was spending 99% of her life cowering alone up in our bedroom.

 

We tried everything we could think of before deciding she needed medication. On the advice of our vet, Cash was started on alprazolam. It was a godsend for her and changed her life for the better. She has been on this drug since March/April of 08 and, with the help of behavior modification, obedience training, and adopting another female greyhound, she's come a long ways.

 

Cash is now actually a "normal" dog for 90% of the time. We can move the furniture, change the pictures, vacuum, make loud noises, and do other things Cash would have found extremely scary 1 ½ years ago. She even can go places like our recent vacation without too much stress.

 

But she's at the max dose of alprazolam, and still does have severe issues that can occur daily. The research I've been doing suggests this wasn't and isn't the best drug to have her on.

 

What I think I know:

Alprazolam is a fast-acting, benzodiazapine tranquilizer. It works, basically, by reducing the communication between excited brain neurons and therefore has a calming effect on many of the functions of the brain. This is why it's helpful in the case of separation anxiety and thunderstorm phobia - it's fast-acting, metabolizes out of the body quickly, and helps keep the brain in a calm state. Interestingly, it is also sometimes used in conjunction with phenobarbitol to control seizures.

 

What I believe would be more helpful to her is for her to be on a class of drugs called SSRI's - a Selective Serotonin Re-uptake Inhibitor. This class of drugs inhibits the re-absorption of serotonin. Serotonin is a neurotransmitter in the brain associated with mood elevation and reduced aggression. Increasing serotonin in the brain means less anxiety and a happier attitude. By inhibiting the brain's system for removing used serotonin, SSRIs cause serotonin to linger, lasting longer. The more serotonin we have in our brains, the less anxiety, obsession, and depression we get.

 

There are several drugs of this class now approved for veterinary use: Clomicalm (clomipramine - Anafranil), Reconcile (fluoxetene - Prozac), and Buspar (buspirone hydrochloride).

 

Basically, I think, she doesn't need a drug to tell her brain to not be scared, but a drug to help her brain be happier and calmer.

 

Alprazolam is extremely addictive and I'm concerned about how to manage any switch that involves taking her off this drug. There can also be issues with liver damage, though Cash's blood tests have all been fine since starting the drug.

 

What I need help with:

>Do you think this is an accurate assessment of the problem?

>What more info would you (as a relatively well-informed greyhound owner) need to make an informed decision?

>Are there tests that I should ask about (beyond the normal bloodwork and other routine tests)?

 

>Once I believe I have all the info I can gather, where do I go from here?

 

I really like our vets. The practice has three vets who see patients as they come in and I like all of them and the way they deal with the dogs. But they're really just a dog and cat clinic, not even up to doing surgeries more complicated than a neuter/spay. The vet who prescribed Cash's alprazolam was not familiar with anxiety problems, and, while I think she did do research, she didn't go with the most common drug to begin with - either the Clomicalm or off-label Prozac.

 

>So how do I approach this subject with the vet(s) at our clinic?

>What kind of specialist could I ask to be referred to if it comes to that? Neurologist? Internist?

>Should I just try and find another vet or is this something I can work with a less-informed vet on without being disrespectful?

>In your experience, and beyond the obvious, what questions should I ask about a new drug?

>How do I decide between the different SSRI's? Are there advantages and disadvantages to each that I didn't find?

>What about managing withdrawal from alprazolam?

>What questions or subjects am I forgetting to factor in?

 

Thanks in advance for, first of all, reading all this! And second, for your advice and experience!

 

Gters are WONDERFUL!!!!

 

Edited May 13, 2010 by greysmom

[ahicks51]

Just a way off-the-wall suggestion- I don't even know if it's safe for dogs: 5-HTP is a precursor molecule of serotonin. So, instead of being a "reuptake inhibitor," 5-HTP is a precursor and- therefore- may foster the production of serotonin. It's OTC, pretty inexpensive. Tweaking in the dosage can take some work.

[Guest Greytluv]

Cash

I have no advice for you, I just want to wish you luck.

 

(I take both Xanax and Prozac and I'm one happy girl)

[Guest kydie]

Hi, take this as you may, as a psych nurse for many years, I am sure you are concerned for your pup's health, or you would not have done such massive research ( and good by the by), all that said

here goes, if the drug she is on is helping, SO WHAT, about all the supposed "side effects" all drugs even the ones you may feel are "better" have just as many side effects, for me if she were mine, and she is doing O.K. leave it. If you feel you need to approch your vet on this, do so, speek candidley, after all you are the patient and pay the bills, if you feel you can not communicate with your vet, you need to change vets,,, just my opinion good luck and hope you find your answer

Edited May 13, 2010 by kydie

[Batmom]

Quick thoughts:

 

What are the issues that she still has?

She's been on this for 2 years. Are you sure it's still making any difference at all?

 

I'm not opposed to drugs but in most cases, I think the benefit is to allow training to occur. Once that's well established, I'm not convinced there's still a benefit in most cases. I would be strongly inclined to take her off and see how she does without.

[Guest scfilby]

What issues are you still seeing? You mention that despite being on the drug, she still has issues. Are these issues manageable?

 

If she is at the max dose of the highly addictive drug, she is likely already addicted. It is also likely that the SSRI drugs will also be addictive. I would be concerned of the effects of taking her off the alprazolam.

 

I would talk to your Vet about the effects of withdrawal from the alprazolam. It sounds like you are pretty well informed, so depending on the answers you get, I don't see the need to switch vets.

[CaliforniaGreys]

Not enough experience to offer any advice Chris, but I do know that Cash is safest in your hands

[racindog]

Quick thoughts:

 

What are the issues that she still has?

She's been on this for 2 years. Are you sure it's still making any difference at all?

 

I'm not opposed to drugs but in most cases, I think the benefit is to allow training to occur. Once that's well established, I'm not convinced there's still a benefit in most cases. I would be strongly inclined to take her off and see how she does without.

 

Ditto. I would also encourage you to investigate holistic approaches- perhaps accupuncture and especially flower essences. I am a chemist and there are reasons that these are often effective too. Everything is energy. If her energy is balanced and her pathways open etc. she can't help but show it emotionally and physically. I just went through a harrrowing ordeal with Bobber. She had a terrible fever and the conventional vet could not bring it down-even with intravenous antibiotics. Fearing for her life after almost 2 weeks of this-on 4 different antibiotics and with her appetite beginning to wane- I raced her to my holistic vet for accupuncture and other holistic modalities. She began to improve immediately and 48 hours later was clearly well on the road to recovery and had begun to respond to the antibiotics- the same ones she did not respond to prior to the accupuncture. Now I can't explain what happenned but intuitively it seems logical to me that perhaps the accupuncture etc. opened up her pathways thus allowing the antibiotics to work, because none of them worked before-even iv. Might also consider animal communicator. Sounds like to me though that you're doing the best that can be done for her. Thank God she has you to research and check on things to determine what is best for her. God bless you!

[rycezmom]

Xanax (alprazolam) is very addictive. If you are going to take her off of it, WEAN it off SLOWLY.....

[Guest Swifthounds]

Quick thoughts:

 

What are the issues that she still has?

She's been on this for 2 years. Are you sure it's still making any difference at all?

 

I'm not opposed to drugs but in most cases, I think the benefit is to allow training to occur. Once that's well established, I'm not convinced there's still a benefit in most cases. I would be strongly inclined to take her off and see how she does without.

 

My thoughts exactly.

[gazehund]

Quick thoughts:

 

What are the issues that she still has?

She's been on this for 2 years. Are you sure it's still making any difference at all?

 

I'm not opposed to drugs but in most cases, I think the benefit is to allow training to occur. Once that's well established, I'm not convinced there's still a benefit in most cases. I would be strongly inclined to take her off and see how she does without.

 

My thoughts exactly.

 

x 3.

 

My mega spook Pearl has never had a pill (for her spookiness) in her life. She has been home with us for 7 years now. She went a little off the rails when she lost all three of her original housemates in an 11 month period. Thankfully Pooter was here or Pearl would have been totally alone. Now Dodger is here and he has also been a huge calming influence for Pearl. We just came home from a long weekend in Maine and Pearl was fine. She LOVES to travel. If one didn't know she was a major spook, one might think she is a little shy. Good luck with your girl. Spooks are not for the faint of heart for sure.

[greysmom]

Thanks everyone!

 

Let me see if I can clarify her reactions and answer someof your questions:

 

Regarding homeopathic and naturopathic options - I'm not opposed, but Cash has had very little positive response to any of the remedies I've tried. I have not yet tried accupuncture, though it very well may help.

 

What issues she still has - I have no test results for this, just my feeling, that she has some sort of chemical imbalance. She'll be fine, absolutely fine, until "ZAP" something scares her. It can be a noise or a visual cue that sets her off. It's like her system gets a shot of *something* and sends her out of balance and into a complete fear flight response.

 

I have spent as long as 4 1/2 hours out in the yard with her loose and running because she's too afraid to come to me or go inside. She won't do either until she's completely exhausted. She's not just not coming to me - we've worked on recall training and she's fabulous unless she's scared, then all bets are off. She won't let me walk up to her, and when she does stand still, she's is literally shaking out of her skin to the point I'm afraid she's going to collapse. So I really never let her off the leash at all, even in our backyard.

 

She will become obsessed with watching a thing or a place that upsets her to the exclusion of everything else. She is extremely NOT food motivated, and I'm sure she would nearly starve herself if she was scared. She will stare compulsively at our stairs - her escape route to her safe place in our bedroom - and refuse to eat, even though there is nothing different at all about the room/feeding set-up/food/time of day. Many times I never know what it is that has set her off at any particular time. And things that she is fine with one time will scare her other times - all quite random as far as I can see. I know there must be something, I just can't see/hear/smell what it is.

 

She continues to be scared of our deck and back door. The only way in and out of the fenced back yard. Most of the time. Sometimes she's not scared and will take a treat from me right by the back door. Most of the time, she acts like a tree is going to fall on her if she sets foot on the deck. Unless she doesn't, and it's OK.

 

These "freaked out" sessions have become MUCH MUCH less frequent and of MUCH shorter duration. A thing that would have sent her hiding in her safe spot for a day or two will now just incapacitate her for minutes. She is bouncing back faster to "normal" and doesn't seem nearly as affected physically. But these lesser "freak outs" still happen everyday.

 

Her current medication - I'm not especially concerned if she's addicted to the alprazolam, except as far as it increases the difficulty of getting her off it. She IS doing better, but, given that I feel she does have some sort of brain chemical imbalance, I think she will need some sort of on-going drug intervention. Like I said, she's good now about 90% of the time, but I'd like to see if I can help her get the last 10%. She can't take any more alprazolam, which is why I'm considering switching her at all.

 

She's so darn FUNNY! and CUTE! and ADORABLE! and SMART! when she's doing well, and I'd like her to be able to be like that all the time - for HER sake, not for mine.

 

OK - I think that's it for this round. Does this change anything for you??????

[nyGreys]

Poor Cash.

Good luck Chris. I hate seeing them so scared.

[greyhndz]

I think xanax or any benzo is a wonderful drug and certainly has its place in treating various anxiety disorders (in humans and in dogs). But I'd suspect that dogs, as is true for humans, develop tolerance over time, meaning that they need a higher dose of medication to obtain the same result. This is not addiction (dogs can't develop addiction - this is a disorder limited to humans) but they can become *dependant*, meaning that they will experience withdrawal symptoms if the drug is withheld. All this means is that whenever you or your vet decides to stop xanax, it should be done as a gradual taper.

 

I think behavioral techniques, homeopathy, environmental changes are all good options, but for symptoms as severe and ongoing as as Cash's have been, medications may make the difference between debilitating anxiety and quality-of-life. Disclaimer: I practice allopathic medicine so my training points me toward logical, scientific solutions, but I am very eager to incorporate alternative and integrative treatments as well. But severe symptoms that haven't responded to the extensive efforts that Chris has made, need a different approach. Chris, you have worked so long and so hard, and I can't think of anything that you haven't tried. And I think you're right on target about making a change in her meds. I also think your research has pointed you in the right direction -- in all likelihood, either an SSRI such as fluoxetine or sertraline; a tricyclic such as clomipramine or imipramine, or a different type of drug such as BuSpar, might be a better way to go.

 

That said, I believe that most primary care vets don't have much experience in managing these medications for dogs whose problems are complex. If you can find one in your area, a veterinary behaviorist would be the best person to consult. They are most familiar with each of the meds, can determine which would be appropriate, can discuss with you the benefits/risks/side effects of each med, and know how to make changes if needed.

 

Here are two links which should help you locate a board-certified vet behaviorist. I truly hope this will bring you the answers you seek to make Cash a happier, more secure little girl.

 

 

ACVB

vet behaviorists

[Guest snakes]

From my experience with humans and psych meds sometimes the downsides of a medication are well worth the positive effects. However they constantly have to be monitored to mkae sure that balance stays on the positive side. As someone said, bodies/brains can adapt to having a chemical in thier system. Sometimes a combination of two drugs can be helpfull when one becomes less effective. Just try to distingish anxiety from depression, the two are not necessarily linked, mood elevation may not mean less anxious, that would be a case by case basis that only you and cahs will know.

You seem to have done some great research which is fantastic. I would think finding a behavioral specific vet to supplement your regular vet would be your best course of action, they will know the medication options and dosing the best.

We, after some trial and error for a couple months, had great success with homeopathic remedies for anxiety. these are different from the naturopathic remedies such as flower essences. It works dealing with the energy within the body. A trained homeopathic vet is the best approach.

I would make a specific appointment to talk to the vet about cash's anxiety, that way they have some forewarning to have materials and options available to you. Here are a couple links i found to practices in your area:

http://www.hawthornevet.com/

http://www.hoytacupuncture.com/services-provided/

http://www.holisticpetvetclinic.com/

 

Dr.Pitcairn has written a very good book on natural/alternative remedies for animals, his training is well known, his website lists vets that have completed his training, a few are in oregon.

http://www.drpitcairn.com/referrals/anhc_referrals.html

[Batmom]

I would still wonder whether the meds are doing anything for her now -- it seems quite a lot of adaptation has taken place in your home, which is something for both of you to be proud of!

 

I'm not big on homeopathy etc. as alternatives. I just wonder in my funny little brain -- after being on the med for so long, if it's continuing to be effective for her or if she would be @ the same without it.

[greysmom]

Thank you all so much!!! I really appreciate all the opinions and the links! I'm one of those people who likes to run everything up the flagpole to see what everyone has to say!

 

Batmom, I do think it might be worth a try to see how she does on less medication. I will probably begin (very) slowly stepping down her dosage anyway.

 

Also, I didn't say it before, but Cash's behavior really became a lot better when we adopted Toni. I had discounted the effect of having another girl here, as she had two other greyhounds (Dude and Copper) who happen to be boys. But adopting Toni, a female only a year younger than Cash, really had an almost instantaneous effect. It was like Cash finally decided this was her home now that she had a female companion.

 

I keep telling my DH that we should try adopting *another* girl to see how much that helps Cash!