---start--- behavior 11/4/98 Overall: How to take a good history in behavioral medicine with a segue into Cat elimination disorders Something is wrong in our notes: we do not have all the pages to the article on terminology. anyway. what do you need to know in a behavioral history? if you can take a good behavioral history, you can take any good history, but not vice versa. you need to know about different sets of associations. many things we recognize the client does not see in the same sense. signalment: myths and relevance of age, sex, and breed breed - client comes in with a Rottweiler. you will see this in peds/genetics. if it growls when you look at it, client may say 'oh, rotties are supposed to do that.' uh-uh!! not so! and conversely, not all rotties are nasty! sex - are males more aggressive? Well, they are overrepresented in some aggressive diagnoses, that doesn't mean they are more aggressive. age - you have to consider risk of different problems with aging. social maturation and sexual maturation are different. sexual maturity occurs early in humans, social maturity much later. sometimes, MUCH MUCH later (tripp). :) the problem: a) major complaint, eg "dog is growling" b) reason for seeking help, eg "neighbor is suing us b/c dog bit him" if pet's welfare is the main reason person came in, that is maybe more helpful to you. if person came in b/c they are being sued, well... think about it - if you can control social environment, with committed owner, that will help animal more. look at behavioral history like amorous relationship/ you must understand what the other person expects. when you see these clients, they THINK they know what they want - they want animal to be better but they do not know what is wrong. they also feel guilt that perhaps they have made animal worse. Familial history: we know some lines of english springer spaniels have 50% dominance aggression. did anyone else in the family do this, then, is an important question. with breeds, we are doing experiments! breeders are doing genetic experiments. they are breeding animals with certain ideas in mind, for appearance, carrying along a variance/covariance for how animal behaves. you will not find out unless you ask. Dr O thinks there is definitely a familial component to thunderstorm phobia. In the US - you must consider legal implications (she just gave this lecture in norway - totally different). note that extent of injury in NO way reflects how dangerous the dog is. if you pull your arm away from a large powerful dog, you can shred your arm. but the dog might have been just sitting there. so consider: injury, damage, reportable bites, licensing laws. you have to be realistic. most people bitten by dogs are bitten accidentally. we have to redefine "bite." is it always a deliberate malicious act? ask if dog bit. then ask if dog broke skin. then ask if dog put teeth onto your skin! we're busy legislating stuff in the total abscense of information. the only statistically significant finding so far is that male children are bitten far more often than other humans. we're trying to outlaw pit bulls. why not outlaw male kids! reportable bites - you as a vet are going to be called into the mess and need to know local, state, and federal laws. most bites that come into HUP/CHOP are never ever reported. we're starting a study to see if dogs that bite kids are being egged on by kids, or if they have a behavior problem. licensing laws - one covariant in one study was that people who do not license dogs are more likely to have intact animals, roaming animals, unvaccinated animals, and biting dogs. this strongly suggests that there is an owner-related issue that has something to do with dog bites, it isn't the dogs. when taking history - ask about most recent incidents - what happened, when did it happen, what did dog look like, were ears up, was tail down? show pictures. most recent incident may be what happens when dog meets you! if you try to shake hand of client, dog may grab you. pattern: frequency of behavior, frequency of situation, duration of behavior, variability/predictability of behavior. eg, dogs who are aggressive to other dogs. ask how often dog goes after other dogs. if they say once a month, ask how many times the dog is with other dogs. if that is also once a month, well, there you go - the dog is only exposed to other dogs once a month. if you try to walk your dog where there are no other dogs, the only other dogs you find there are the ones who can't deal with other dogs. that's not good. interactions b/w these dogs are bad. ask about when it started to growl, when it started to stare, when it started to bite. a paper on "who gets killed" they found that unpredictable animals are most likely to be euthanised. but if you ask the right questions, you usually can find a pattern. so you can prevent euthanasia by finding out how to predict the behavior, while working on changing the behavior. if it is truly unpredictable, it's interesting - that's very rare. one patient was euthanized yesterday. was last here in 1991. they called b/c they wanted to make sense of their decision to kill the dog. Dr O talked about biology of situation. they came home and found dog had totally destroyed the couch. in 1991, dx mild dominance aggression, some separation anxiety. owners used behavioral modification, no medication, no followup. owner gets home the other day and finds couch stuffing on the floor. picks up the stuffing and starts yelling at dog, shaking stuffing at his face, screaming. the dominantly aggressive dog then cowers, rolls over, she keeps screaming, dog cowers over to husband, shaking. he picks up dog and throws it back to wife. she keeps yelling and gets down in his face and dog bit her. did they leave the dog a choice? plus, it was a minor bite. they killed the dog. the husband has been saying since 1991 and now it is 1998 that the dog was a "time bomb waiting to go off." probably the time bomb is not the dog. someone who throws a dog across the room is perhaps throwing other things as well. actual behavior - the pet, the client. the dog above was not faultless. he had problems. but his management was also poor. watch where people sit when they come into the room. ask people to come in. they put water dish down. if husband and dog sit on one side and wife on other with arms crossed - there is a problem. you have to assess the clients as well. it is all about communication here. watch how they read signals. if you read signals of pet, it will tell you what's wrong. age of onset - this is covariant with how long it goes on. dominance aggression in young female puppies tends to show up at 6 mos or less, and in adult males at 2 yrs. these are not the same things! why is age of onset important? well, maybe we have 2 different problems, can't tx same way. 24 hr history "a day in the life" what's said, what's not said? if you find out client leaves at 6 am and gets back 11 pm and has no idea what dog did all day...that's not good. not everyone needs a pet. you should prefer 10 clients fully willing to work up their pets for their problems instead of 100 who want to euthanize rather than spend $50. find out what approaches were previously recommended, and what was the result. you do not want to look silly, for one, and also you need to know the response. all the stuff we ask about are the data - the data are the behaviors. so finding out what didn't work is really important. the importance of client/pet interactions. students who have been in behavior the past few months are great. one student has asked clients "one final question - what do you want from this pet? what do you want to get from us?" if they want a flawless animal, we probably can't provide that. the animal may have serious problems unrelated to management. just like we can't give back a cancer-free animal without relapse. we don't talk cure. we talk "disease free interval." if client says they want to trust the pet, ask how much they trust their spouse. where do you draw the line? most clients will take less than flawless animal if happy, healthy, safe. addressing client guilt: one set of clients cries every week. usually this happens when Dr O says "this is not your fault." because other people (vet, trainer) kept telling owner they didn't work hard enough. they are victims of literature. clients haul in shopping bags full of books they read. but the truth is NOT out there. knowledge is a function of how well we learn. we do not know that much yet. people who come to this clinic, the busiest and best known one in the world (ahem) do not want to kill their pet. importance of reasonable goals and expectations - critical. other issues - are there any other issues client thinks is important? this is important and many people do not want to deal b/c they may start treating you like a psychiatrist. but you need to find out what is going on. we have a great cocker spaniel patient - very dominant aggressive, nasty thing. now, he's doing great, letting them hold him on lap, tickle his belly - he went from nasty to fabulous with an additional 15 lbs, because they give a lot of treats, and he is hungry from the meds. so Dr O isn't sure why they are here b/c the dog is doing so great. she asked why they were here - what is your concern about the dog, why do you keep coming back? and client started to cry and said their previous dog had died of diabetes and their vet told them it was their fault because the dog was fat. they were afraid they were going to kill this dog by making it fat. so she gave it a nutrition consult, an exercise plan, and left them alone with the social worker. slide: tahiti - one client sent her for vacation there. hoo-rah.. case: 4 yr old female DSH client complaint: not using litter pan reason for getting help: husband will divorce wife if cat doesn't stop defecating in his clothing. so, first, she had to find out if this is really true. so she asked him if he was really going to divorce her. he said no, but he really wants it to stop. that's important b/c if this is really the keystone of their marriage, you do not want to get in middle. recent incidents: all incidents are same, feces found in one of a few spots clothing may be scratched around the feces, but not always (remember, cats do not have to scratch or cover feces) clients never actually see the cat do this, though when she uses the litter box in bathroom they see her often this last happened 2 weeks ago - husband gone for 4 days, and 3/4 days no feces in litterpans, but only in clothes. other history: cat adopted from SPCA at 8 weeks - that's a good age, from a home with teenagers who gave lots of attention from day 1, already had 14 pets though. cat always used litterbox prior to cohabitational change. cat spayed at 8 weeks prior to adoption. wife always took care of all cat needs and loved her, cat never experienced aerobic play until husband moved in. husband gave cat attention when he didn't live with her, but was a little reticent about living with a cat, he'd heard they were standoffish. reticence went away when he realized she would play with him. now he likes cats. pattern: couple were newlyweds - couple for long time, but just moved in together. cat uses litterbox for some defecation and all urination. defecation in clothes seems to occur while he is gone on trips, and right when he gets back. there is no change in frequency of elimination, it has always occurred once or twice a week. cat has never covered her feces (this is normal, could be marking behavior). variability/predictability: started when hubby started going on business trips 2 weeks after moving in. now he keeps clothes hidden, closet locked, suitcase closed, etc. now, cat sometimes defecates outside his closet or dresser or next to his side of the bed when he isn't home. duration: they moved in 6 mos ago, started 2 weeks later at 3.5 yrs of age for the cat. so, there was a change in residence in the midst of social maturation process. actual elimination behavior - has two open litter boxes. she scratches vigorously after urination, completely covering urine; she digs in box before urination. visits litter box when company comes, always urinates right after litter is changed - either likes clean litter, or marking - this is new behavior. never covers feces, but does dig first. never vocalized during elimination so probably not sick or painful. usually defecates once daily - that's ok. uses both pans for defecation but usually when clients are using pantry door in the winter, she uses the pantry one for defecation more often - when there is company over, and when clients use door. also in past year. so this cat is marking! 24 hr schedule - cat gets more attention now, both owners have jobs but they can spend more time at home now since together. hubby grooms, bathes, plays with cat, loves this cat. cat follows hubby around at home, uses litter when hubby goes to bathroom. wife does all the cat related chores. changes litter pan every day, washes weekly, etc. hubby taught cat to fetch, roll over, faint, salute to get kitty treat. they practice nightly. wife is doing all the chores, husband doing all the fun! they walk the cat for an hour each weekend day! cat has pillows near window but sleeps on bed, also. nothing else is ever disturbed. so if she sleeps near window, could see other cats. no other cats visit this window, though. cat goes to bed when clients do unless there is a party, then cat may go to bed earlier. cat greets strangers but avoids noise and kids. lets people pet and rub cat sleeps with clients, positions self to touch both clients PE: no physical problems CBC/biochem profile - not remarkable fecal negative for parasites failed therapy: hubby giving more attention when he is home wife acting like hubby when he isn't there cat locked in bathroom when hubby not home changed litter type (cat does seem to spend more time in box) no problems when locked in bathroom but cat claws curtain and tries to snag people under the door people are using odor product goals/expectation: clients find this disgusting and are concernd there is a deeper problem. they want it to stop, would accept rare events, but would place her in another home with deep regret, if htey are making her this miserable. familial: hubby upset, angry, not serious about divorce. feels betrayed by cat. views behavior as spiteful. wife tries to give cat hubby type attention but cat walks away, wife feels hurt. both are worried b/c hubby has to travel, cat is being mean, will be meaner. relevant factors age at adoption prior history age at neuter parent history windows/pillows age of onset elimination behavior changes in elim behavior relationhship with hubby response to correction client expectation ddx: substrate preference, location preference, **marking** cats will mark if you give them a chance, and they do it in a specific way. nonspraying marking is hard to tell from location preference. may relate to specific people. so, they belled cat, spied on her, startled her when she did this. wife added in more play time. covered litterpan was added to bedroom - cat defecated in it. cat placed on amytriptilline for a few mos, gradually weaned off. finally they talked about possibility of relapse, and we'll see videos next week :) ---end---