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Wednesday, August 10, 2016

Severe Anxiety....Euthanize Or Not?

This question comes from Nicole, and I'm sure many dog owners can relate to her situation.

I have a question about euthanasia. Not for health reasons but for quality of life reasons.

We have a 12.5 year old German Shepherd / Husky / Boxer mix. (We know she is definitely 50% husky as her mother was a purebred Boxer - they speculate her father had to be a GSD/Husky mix bc of Bella's appearance)

Bella has had destructive separation anxiety and noise anxiety her whole life. She outgrew the separation anxiety, for the most part, by the time she was 3 or so. She used to rip through solid wood doors (at 4 months old), try to dig through floors, rip of rugs, etc.

We have not found a crate to hold her. She shredded one year breaking out of one of those black metal crates on more than one occasion. We switched to the plastic airline style crate and she ripped off claws and teeth trying to break out one night when the neighbors were lighting fireworks.  She put a hole in her skull when she broke through the sliding patio door during a thunder storm - she, for some reason, wanted to get under the deck outside. At some point she tried to stand up under the 8" tall deck and got a nail through the top of her head. She hides under our bed during most storms and, at least one time, has tried to stand up under the bed and lifted us up (I weigh 300 lbs, my husband 200 lbs, plus the weight of box spring and mattress) so high that she's been able to jump out between the box spring and bed frame.

Her reaction to storms, fireworks, and now loud bass from passing cars is getting worse and worse. Her heart beats so hard and so fast it feels like it's going to explode. She was given 1mg Xanax 2 years ago by a vet after being treated for the nail through the head. I take 1mg Xanax myself and it knocks me out within minutes. It gets her to at least lay down instead of pacing and harming herself, but she's still looking panicked & bug-eyed and panting. After 1-3 hours she'll eventually drift off to sleep.

Add to this, she slowing down a lot. She was always the kind of dog to chase a ball and run around the yard. The last two summers we noticed her slowing down, but this year it's so much worse. She used to love being outside. Now we go outside and the other two dogs want to play and she drags us towards the house and wants to be let into the basement where she just lays on a dog bed. When I can convince her to stay outside, she will lay near me and growl at the other dogs if they come near her or she'll just walk circles around my chair 'til I eventually bring everyone in the house.

And she seems to be less able to see and hear us. We will call the other dogs "lets go potty" and she won't even perk up her ears or acknowledge that were speaking to her. We've been right in front of her saying "Bella, let's go potty" and clicking the leash "hook" and she doesn't show any recognition that were speaking to her. Her house have been kind of cloudy since she was 7 or 8, but the past 6-8 months they're sometimes so clouded over I wonder if she can see at all. (Amazingly, sometimes they're clear so I don't even know what's going on)

But our main question is, with her FREAKING OUT during storms and noise in general, should we consider euthanasia?  We know it's a tough choice bc we had to euthanize one of our Beagles in 2009 when her kidneys were failing and it was the most painful thing to watch Daisy go. We just don't want Bella to be miserable and anxious every day. I have severe anxiety myself and I know what it feels like, I don't want her to feel that way, too.

Thanks for any input you can offer.

Nicole, it doesn't sound like you've exhausted all possibilities with her, and I think that there are still some things that help.  As someone who has dealt with various degrees of anxiety and clinical depression myself, I understand what it can feel like for these pets, and I completely sympathize. 

I am in complete disagreement with vets who only prescribe sedatives for anxiety, even noise-related problems.  Acepromazine is a common tranquilizer that even I used to prescribe until I learned better.  Sedatives don't actually fix anxiety.  They make the animal too sedated to do much, but the anxiety is usually still present.  So really they are still feeling anxious but can't work up the energy to do much about it.  I don't think that's the right way to treat this kind of problem.

Alprazolam (Xanax) and trazadone are two common medications used for short-term anxiety.  They are nice because they absorb quickly into the system and start to work immediately without the need to build up in the body.  The down side is that they are short acting, usually being effective for only a few hours, typically no more than six or so.  So these drugs are good for patients who are usually free of anxiety but experience some during a limited, relatively predictable circumstance such as fireworks or thunderstorms.  Because of their short efficacy time they aren't really good options for long-term control of anxiety.

Better choices are drugs like fluoxetine and clomipramine. These are good for long-term problems and are designed to be used on a daily basis.  They take three to six weeks for full efficacy, so it's not a short-term solution, but they are good for long-term use.  In fact, they can be used along with the shorter acting medications above.  I've had patients that are pretty well managed on fluoxetine daily, but still get anxious during storms.  In these cases we'll use alprazolam for that day.

It doesn't sound like you've exhausted the possibilities in controlling your dog's anxiety.  There are actually many options left, including various medications, behavioral therapy, and desensitization techniques.  I would strongly recommend finding a vet who is skilled in treating behavioral disorders.  This may take a bit of calling around, as many vets don't take the time to get the training to handle behavioral problems in the appropriate way.  If you don't have a vet who you feel is qualified in this area, ask your vet about a referral to a board-certified behavioral specialist (a member of the American College of Veterinary Behavior, or similar organizations in other countries).  You do not want a pet trainer!  You need a veterinarian who can prescribe medications as well as discuss non-medical ways to help her behavior.

I definitely do not recommend euthanasia until you have investigated these other options and have seen no improvement whatsoever.  But because you still have many options, please look into those before deciding on such a final option.

5 comments:

  1. I disagree wholeheartedly with the vet who responded. I've tried it ALL on my severely anxious greyhound. After SIX years of a ridiculous amount of increasing stress, I am done. YOU deserve a life, as do I. And your dog deserves a peaceful ending, as does mine. Your dog was old in 2016 when you posted and it sounded like he was ready to go and not enjoying life. And mine is 11.5 yrs old and has gotten more anxious beyond management. I hope you made the right decision. Euthanasia is RIGHT around the corner for my boy.

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    1. If she had tried all options, I would agree with considering euthanasia. However, if a person has NOT tried appropriate options for anxiety (as in this case) then euthanasia is not indicated. Your case is different than the one to whom I responded, and you should be able to see the differences. I would also ask what you mean by "tried it ALL". Have you worked with a behavioral specialist? Have you tried different categories of medications? Have you tried combinations of therapeutic methods? If so, then yes, I could support euthanasia. But if you haven't there are still options that haven't been explored.

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    2. I agree with Dr.Bern... I have 4 dogs, that have various degrees of seperation anxiety. I have been raising dogs all of my life. Show some compassion & patience. Behavior modification takes some time, but with your dedication to your,pup, it can be done. There have been times, that I couldn't even go to the mailbox without all 4 howling..., Please..., to euthanize an animal for a behavioral issue, is really not the right move. All dogs are different & some need more training time w/ reward system & your time & a calm demeaner, most dogs will respond very quickly & I have never had a dog, that wasn't afraid of storms. Also, some dogs just want to be in a one dog family. Whatever it takes, this dog deserves a happy & secure life & LOVE. You said that you deserve a life, and I agree..., but so does your pup... If you can't handle this dog, please try to find a family that has the time & love & compassion, to allow this dog to thrive. It may only need a different environment, to do so. Please consider this alternative, before choosing to end this dogs life.

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    3. I treated our beloved yellow lab Daisy for 6 years with Flouxetine, Xanax and Trazadone (not at the same time) under the care of her vet. At 11.5 she became fecally incontinent. So, aside from being afraid of her own shadow and having a breakdown anytime I was away from the house, she was now trying to clean up after herself because she was unaware that she needed to poop. Other than that she has been a loving and very passive dog. She is a sister to a brittany spaniel and a peek-a-chu.

      My point is that even with all the drugs she has still suffered for the last 5 years. I am putting her to sleep this afternoon at 3:30. I am the one that sleeps on the floor at night with her when she is in panic mode (every Wednesday night because of garbage day). I am the one that cleans up after her (if I can get to it first). I take her to the vet 4 times a year for check-ups - she hates the vet. I give her medicine 2-3 times daily. I hired a house sitter for her - I stopped going to work when she quit (luckily I own a small business and have that flexibility).

      I look back now at everything I have done to help my dog, and none of it has really worked. I made her somewhat more comfortable but all I really did was keep her alive long enough to become incontinent and feel shameful. I am sorry for my selfishness. I have kept my Daisy alive for me - not for her. I will miss you sweet girl, and its not your fault.

      Amy (mom)

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  2. I just looked this question up tonight. I have a nearly 14yo German shorthair pointer that has just entered an acute phase of anxiety she's on one of the suggested meds for short term use but it isn't helping. She now nervously licks one of her fatty tumors so much she's in a cone 24/7. It doesn't seem like a great life for a dog who's had a great 14 year run to be riddled with anxiety.

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