Becoming proactive with firework advice

ALTHOUGH I have not yet been able to learn the native tongue of our canine friends, I’m certain “Help! I must escape! Something’s trying to kill me!” would not be a grossly inaccurate (albeit slightly anthropomorphic) interpretation of the comments from some of our canine buddies during firework season. I say season, as it would appear firework displays are seldom restricted to the traditional Bonfire Night festivities. The emergence of our multicultural society has brought with it several new festivals to celebrate, resulting in fireworks being displayed from October through to February. However, not all dogs are shouting “Help! I’m being attacked!” In fact, many are whispering: “What was that? Is it going to hurt me? Should I be scared?”

Why differentiate fear and anxiety?

Firstly, by differentiating what the dog is asking, we are able to target behavioural strategies more precisely to the questions being posed. Recent re-evaluation of data from studies that assessed response to noise aversion has begun to differentiate risk factors and treatment response in canines that display anxiety rather than fear responses.1 Secondly, other studies have revealed that many dogs that exhibit noise aversions demonstrate concurrent separation anxiety related signs,2 with evidence that the occurrence of either problem alone affects the likelihood of the occurrence of the other.1 In addition, it appears that the neurophysiological changes occurring with stress lead to learning impairments and an increase in fear responses.3 Thus, a dog suddenly showing fear of noises that previously induced no fear-related behaviour may need a review of possible chronic stressors, which include many medical conditions that adjust the threshold for anxiety.4 Here lies an important realisation: a single, dogmatic protocol is no more
suitable for noise aversion than one similarly designed for vomiting. This is true for both the behavioural and medical aspects of treatments.

Short-term chemotherapeutic interventions

One of the great problems with short-acting chemotherapeutic agents is that they require varying dosing strategies and demonstrate variable efficacy, depending on the underlying behavioural aetiology and intensity of the problem. Furthermore, a drug’s pharmacokinetics and pharmacodynamics differ amongst individuals. This is particularly true if we review benzodiazepine medications, detailed more specifically as they are the most commonly, and justifiably, prescribed short-term
chemotherapeutic agents.

Benzodiazepines

Whilst both the laboratory and human studies offer guidance, it should be highlighted that significant differences exist between species. This is demonstrated by examining the halflife of diazepam in dogs (2.5-3.2 hours) versus humans (32 hours) versus cats (5.5 hours).5 Half-life is not the only determining factor for the efficacy and potency of the benzodiazepines, which is influenced by but not limited to: lipid solubility, rate of distribution from the brain to peripheral tissues, rate of dissociation from receptors, protein-binding and the pharmacology of the active metabolites.6 being predominantly lipophilic and highly-protein bound drugs, care should be taken in dosing overweight or diseased animals, especially on a longer-term basis. The importance of this is highlighted because the BSAVA7 and APBC8 both support the use of alprazolam, despite its pharmacokinetics and pharmacodynamics not having been
published or established in dogs. A major reason for its preference is its cited ability to provide retrograde amnesia.9,10 This statement, though, is an oversimplification when exploring
the type of memory, or the precise chanism by which memory is
affected. In addition, most medications have the potential for side effects such as ataxia and aggression.5,6 Although rarely
encountered,11,12,13 they should always be considered and
discussed with every client before benzodiazepines are dispensed. These factors make general guidelines difficult to advise, but it should be noted that the anxiolytic dose is reached
before the sedative dose. In addition, too low a dose may result in paradoxical excitement.6 This is important to realise as some authors suggest test-dosing the medication at low doses. Accordingly, I would advise some caution in this approach unless the clinician is comfortable with benzodiazepine pharmacology. I prefer to test-dose at the elected dose, so any dose adjustment, and concurrent or alternative medication, can be organised.

Zylkene

In rats, the key ingredient, s1-casein tryptic hydrolysate (CTH), has demonstrated some promising anxiolytic properties14,15,16 and could become a welcome addition to the behaviourist’s cabinet if used strategically as part of a longer-term management plan.16 However, having reviewed the current body of scientific evidence,14,15,16,17,18 I presently do not recommend CTH as an alternative to benzodiazepines for short-term treatment. In rats, diazepam has proven to be a more effective anxiolytic14,15 and in dogs, CTH in combination with a
behavioural modification plan took several weeks for improvements in anxiety to be noted.16 It must be remembered that patients presenting acutely are at the higher end of the distress scale. Many dogs with lower levels of anxiety are simply not brought to veterinary attention, as their signs are not overt enough for many owners to recognise. CTH can also now be found in Royal Canin’s Calm Diet. This diet also contains increased levels of tryptophan, which may also be useful in longer-term management strategies if the chosen levels prove to be effective, which are influenced not just by the total dose, but also by the relative levels of leucine and isoleucine in the diet. Furthermore, concurrent use with a benzodiazepine may have the potential to result in antagonism.

Adaptil (formerly known as DAP)

Pheromone therapy appears to have a positive benefit in all
situations. However, much like Zylkene, it shouldn’t be seen as a
direct replacement in a situation where a benzodiazepine would be appropriate. However, there are no problems with contraindications and pheromonatherapy can be offered as an adjunct if necessary. In terms of its potential to modulate the threshold for anxiety and provide “background” antianxiety effects, there appears to be a growing body of scientific literature to support its use.19,20,21 Although some of the studies lack scientific rigour, those that are more robust have yielded positive results. A key point is that although the individual is likely to respond to the aversive stimulus, a faster recovery should be noted. In addition, efficacy has been demonstrated within minutes and hours of use.22

Behavioural modification

Several good resources exist for the behavioural management in the shortterm and modification in the longerterm. 1,23 However, the most important message is that practices should be evolving such that year-by-year fewer dogs require short-term medications which, as highlighted, are difficult to dose accurately. All dogs presented (far lower than the actual number who suffer with noise aversion24) are at the higher end of the distress scale and would clearly benefit from longer-term behavioural modification plans and/or chemotherapeutic agents. These aim to provide genuine coping strategies and change how the dog feels about the noise, rather than just managing or
suppressing the response. This ultimately leads to happy dogs, and thus happy clients.

1. Sherman, B. L. and Mills, D. S. (2008) Canine Anxieties and Phobias: An Update on Separation Anxiety and Noise Aversions. Veterinary Clinics of North America: Small Animal Practice 38 (5): 1,081- 1,106.
2. Overall, K. L. (1997) Fear, anxieties, and stereotypes. In: Clinical Behavioral Medicine for Small Animals, 1st ed. Mosby, St. Louis, Missouri: pp209-250.
3. Shors, T. J. (2006) Stressful experience and learning across the lifespan. Annual Review of Psychology 57: 55-85.
4. Levine, E. D. (2009) Chapter 15 Sound sensitivities. In: D. F. Horwitz and D. S. Mills (Eds) BSAVA Manual of Canine and Feline Behavioural Medicine, Second Edition. BSAVA Gloucester: pp182-189.
5. Plumb, D. C. (2002) Veterinary drug handbook. Iowa State University Press, Ames, Iowa. Available at www.vin.com/Members/Drug/VDH.p… (membership required). Accessed 5th Sept, 2010.
6. Crowell-Davis, S. L. and Murray, T. (2006) Chapter 3 Benzodiazepines. In: S. Crowell-Davis and T. Murray (Eds) Veterinary Psychopharmacology: pp34-69
7. APBC (2010) Association of Pet Behaviour Counsellors (APBC). Annual review of cases 2005. Available at www.apbc.org.uk/apbc/data. Accessed 5th Sept, 2010.
8. BSAVA (2010) Policy Statements: Management and Treatment of Firework Phobias in Dogs. Available at www.bsava.com/LinkClick.aspx?L… &t bid=155. Accessed on 20th Sept, 2010.
9. Kiliç, C., Curran, V.C., Noshirvani, H., Basoglu, M. and Marks, I. M. (1996) Long-term effects of alprazolam on memory: A three-year follow up of agoraphobic patients. European Neuropsychopharmacology 6 (Supplement 4), S4-S4.
10. Singh, N., Sharma, A. and Singh, M. (1998) Possible mechanism of alprazolaminduced amnesia in mice. Pharmacology 56: 46-50.
11. Crowell-Davis, S. L., Seibert, L. M., Sung, W., Parthasarathy, V. and Curtis, T. M. (2003) Use of clomipramine, alprazolam, and behavior modification for treatment of storm phobia in dogs. Journal of the American Veterinary Medical Association 222 (6): 744-748.
12. Herron, M. E., Shofer, F. S. and Reisner, I. R. (2008) Retrospective evaluation of the effects of diazepam in dogs with anxiety-related behavior problems. Journal of the American Veterinary Medical Association 233 (9): 1,420-1,424.
13. Ibáñez, M. and Anzola, B. (2009) Use of fluoxetine, diazepam, and behavior modification as therapy for treatment of anxiety-related disorders in dogs. Journal of Veterinary Behavior: Clinical Applications and Research 4 (6): 223-229.
14. Miclo, L., Perrin, E., Driou, A. et al (2001) Characterization of alphacasozepine, a tryptic peptide from bovine a-casein with benzodiazepine-like activity. FASEB J. 15: 1,780-1,782.
15. Violle, N., Messaoudi, M., LeFranc- Millot, C., Desor, D., Nejdi, A., Demagny, B. and Schroeder, H. (2006) Ethological comparison of the effects of a bovine ás1-casein tryptic hydrolysate and diazepam on the behaviour of rats in two models of anxiety. Pharmacology Biochemistry and Behavior 84 (3): 517-523.
16. Beata, C., Beaumont-Graff, E., Diaz, C., Marion, M., Massal, N., Marlois, N., Muller, G. and Lefranc, C. (2007a) Effects of alpha-casozepine (Zylkene) versus selegiline hydrochloride (Selgian, Anipryl) on anxiety disorders in dogs. Journal of Veterinary Behavior: Clinical Applications and Research 2 (5): 175-183.
17. Messaoudi, M., Lalonde, R., Schroeder, H. and Desor, D. (2009) Anxiolytic-like effects and safety profile of a tryptic hydrolysate from bovine alpha s1-casein in rats. Fundamental & clinical pharmacology 23 (3): 323-330.
18. Rushton, J., Mills. D. S. (2011) The Effects of Alpha-caseozepine (Zylkene) versus Alprazolam on the behavioural and salivary cortisol responses to simulated firework exposure in dogs. Proceedings of the Companion Animal Behaviour Therapy Study Day, 2011.
19. Pageat, P. and Gaultier, E. (2002) Treatment of separation anxiety in dogs with a synthetic Dog Appeasing Pheromone-preliminary results. In: Dehasse, J. and Biosca MArce, E. (Eds) Proceedings of the Eighth ESCVE Meeting on Veterinary Behavioural Medicine, Publibook, Paris: pp49-54.
20. Gaultier, E. and Pageat, P. (2003) Effects of a synthetic dog appeasing pheromone (DAP) on behavioural problems during transport, In: Seksel, K., Perry, G., Mills, D., Frank., Lindell, E., McGreevy, P., Pageat, P. (Eds), Fourth International Veterinary Behavioural Meeting, Proceedings 352, Post Graduate Foundation in Veterinary Science, University of Sydney, Sydney: pp35-55.
21. Sheppard, G. and Mills, D. S. (2003) Evaluation of dog-appeasing pheromone as a potential treatment for dogs fearful of fireworks. Vet Rec 152 (14): 432.
22. Barlow, N. and Goodwin, D. (2009), Efficacy of dog appeasing pheromones in reducing stress related responses in rescue shelter dogs. Proceedings of the Companion Animal Behaviour Therapy Study Day, 2009.
23. Mills, D. S. (2011) www.fearoffireworks.com/dogs.php.
24. Blackwell, E., Casey, R. and Bradshaw, J. (2005) Firework fears and phobias in the domestic dog. Report prepared for th RSPCA. Available at: www.rspca.org.uk/ImageLocator/… asset?asset= document&assetId=1232713012401&mod e=prd. Accessed 5th Sept, 2010.