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Dog with OCD, Hyperkinesis, and Attention Seeking Disorder

American Veterinary Society of Animal Behavior Forums Members Members General Discussion Dog with OCD, Hyperkinesis, and Attention Seeking Disorder

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    <span style=”color: #000000; font-family: Calibri;”>I am hoping to get a bit of advise on a young hunting dog with OCD that I have been treating since taking over the case from a colleague a few months ago.  </span>

    <span style=”color: #000000; font-family: Calibri;”>Loki is an 18mo FS Springer Spaniel that presented to my colleague on 1/4/2016 and was diagnosed with the following behavioral diagnoses: OCD, Hyperkinesis, and Attention Seeding Disorder.</span><span style=”color: #000000; font-family: Calibri;”>  </span>

    <span style=”color: #000000; font-family: Calibri;”>The following is a summary of her original assessment:</span>

    <span style=”color: #000000; font-family: Calibri;”>She was obtained by the family at 4mo of age from a professional breeder as a hunting dog and a family pet.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>The owners describe her as a “very busy dog” spending most of her time pacing and whining while chasing lights and shadows.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>These behaviors starting around 6 months of age.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Owners feel she is an excellent hunting dog.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She is able to focus on her job and does not display compulsive behavior while working.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>In the consultation room Loki was in constant motion, walking in repetitious patterns, usually circles.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She kept her nose pointed towards the ceiling trying to catch lights or shadows.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She would gently bump the owners’ legs as she passed by on her course.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She continued this behavior through the visit.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Occasionally she would stop to try and get a water bottle or treats from the counter.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>These breaks in circling the room were brief, only lasting a few seconds, followed by an immediate resumption of pacing.</span>

    <span style=”color: #000000; font-family: Calibri;”>Initial treatment:                                                                                                                                                                           </span><span style=”color: #000000; font-family: Calibri;”>Clomipramine 20mg (1mg/kg) q 12h                                                                                                                                     </span><span style=”color: #000000; font-family: Calibri;”>Alprazolam 0.5-1.0mg q 12h </span><span style=”color: #000000; font-family: Calibri;”>-paradoxical reaction; stopped</span>

    <span style=”color: #000000; font-family: Calibri;”>Clonazepam 2mg q 8h (started after Alprazolam stopped) </span><span style=”color: #000000; font-family: Calibri;”>-loss of coordination, falling; stopped</span>

    <span style=”color: #000000; font-family: Calibri;”>Trazodone 50-100mg q 12h prn </span><span style=”color: #000000; font-family: Calibri;”>-minimal effect</span>

    <span style=”color: #000000; font-family: Calibri;”>Behavior Modification:                                                                                                                                                                       </span><span style=”color: #000000; font-family: Calibri;”>Mark and reward calm behavior                                                                                                                                                 </span><span style=”color: #000000; font-family: Calibri;”>Redirect attention seeking behavior                                                                                                                                                </span><span style=”color: #000000; font-family: Calibri;”>Interrupt rituals                                                                                                                                                                                    </span><span style=”color: #000000; font-family: Calibri;”>Work on Protocol for Deference</span>

    <span style=”color: #000000; font-family: Calibri;”>1/20/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner on medications: </span><span style=”color: #000000; font-family: Calibri;”> </span><span style=”color: #000000; font-family: Calibri;”>All short term drugs have been stopped. She seemed to respond to the Clomipramine in about 3 – 5 days.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>We saw that she was able to have some quiet moments, and relax, but still did pacing.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>However, in the past few days, things have changed. </span><span style=”color: #000000; font-family: Calibri;”> </span><span style=”color: #000000; font-family: Calibri;”>She paces rapidly, stares at ceiling and we had an incident where she jumped up and snapped at something no one else could see.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>We keep the lights low to try to not cause too many reflections or shadows and she still makes her pattern and stares up.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Exercise is key, but not key to stopping the pacing at this point.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She can run for 1 – 2 hours and still come home and pace, even after being on the med.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Mornings are better for her, but I think that may be because if we are both at work, but the time we get home her anxiety and potential separation issues have amped up by being alone.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Not sure.</span>

    <span style=”color: #000000; font-family: Calibri;”>Clomipramine increased to 30mg q 12h</span>

    <span style=”color: #000000; font-family: Calibri;”>4/4/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Behaviors have been reduced a lot now only does the spinning and chasing reflection occasionally.</span>

    <span style=”color: #000000; font-family: Calibri;”>4/14/16 – Behavior evaluation 2:</span>

    <span style=”color: #000000; font-family: Calibri;”>Loki has made great progress.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>In the evening she will have some pacing, but it is not every night. Occasionally she becomes a little more obsessive, it is usually after eating and getting her pill and these behaviors seem to increase with more people around.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She does pace more when they are not able to run as much.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki does well in the morning and is able to lie at owner’s feet while he is having coffee in the morning. She still has a ton of energy even after 2 hours of training in the field, she is ready to go. Loki will still chase shadows, reflections off of watch or i-pad. She immediately goes to chase it. When the sun is going down she purposely moves the blind just to chase shadows.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Pacing is not gone, but now will only last for up to 1/2 hour.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>It is hard to get her attention when she doesn’t want to stop, but can be distracted with treats.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Bruce has let her pace and she will calm herself after about a 1/2 hour.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki is now able to calm down, when before she would do it non-stop.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She is always up and alert but can lie down without showing compulsive behavior</span><span style=”color: #000000; font-family: Calibri;”> </span>

    <span style=”color: #000000; font-family: Calibri;”>Observations: Loki greeted staff and was very excited to be in the clinic.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She was hyper but was able to lie down and focus on a peanut butter kong. </span>

    <span style=”color: #000000; font-family: Calibri;”>Treatment Plan Continued:                                                                                                                                                                      </span><span style=”color: #000000; font-family: Calibri;”>1. Brain Game for Dogs written by Claire Arrowsmith.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>You can also look at dogwise.com for some additional fun training books.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>This will help keep her mentally stimulated.                                                                                                                          </span><span style=”color: #000000; font-family: Calibri;”>2. Re-Introduce puzzle toys, you can alternate the toys to keep them fresh and new for her to help reduce boredom from playing with the same toy.                                                                                                                                                             </span><span style=”color: #000000; font-family: Calibri;”>3. Start Clonazepam 1 mg once or twice per day.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Start with once daily and you can increase it to twice daily if needed. </span>

    <span style=”color: #000000; font-family: Calibri;”>Current Medication: Clomipramine 30 mg twice daily We will re-introduce the Clonazepram at a lower does to see if that helps her calm down without making her too sedate</span>

    <span style=”color: #000000; font-family: Calibri;”>4/25/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Owner tried 1/2 tablet (1mg) of Clonazepam, seemed to make her worse and more agitated.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>OCD behavior seem to be worsening again.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Will even see her own shadow and chase that and she becomes obsessive, started again at the cabin this weekend.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Will chase pattern around the living room.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>In the evening she is back to pacing and it is hard to interrupt her to stop.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She will settle if placed in her kennel in another room.</span>

    <span style=”color: #000000; font-family: Calibri;”>Ow instructed to stop the Clonazepam.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Owner advised to use a kennel as needed and train to settle to a mat or specific place. </span><span style=”color: #000000; font-family: Calibri;”> </span>

    <span style=”color: #000000; font-family: Calibri;”>5/23/16 – Behavior evaluation 3:</span>

    <span style=”color: #000000; font-family: Calibri;”>Loki seems to have reverted back to where she was when the they first came in.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She will jump on walls, chase reflections from outside sources, TV, watches.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki can do well if she has something to focus on.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She can lie down and relax by chewing a bone.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>They are also able to work on her relaxing on a mat in living room, they tried to kennel her to help calm her down but that made her cry and whine.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Last night she paced for 45 minutes until they finally gave her something to chew on and she was able to calm down.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>They are able to interrupt her behaviors by saying her name or asking for a toy, she will go get the toy and bring it back but instantly will start to pace, she shows no interest in playing with them or the toy she went to get.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She is always moving fast and never just walks.</span>

    <span style=”color: #000000; font-family: Calibri;”>Loki loves to work on hunting training and is able to focus the entire time and does her job very well.</span><span style=”color: #000000; font-family: Calibri;”> </span>

    <span style=”color: #000000; font-family: Calibri;”>Owners have tried the Thundershirt and OTC supplements but she chewed off her Thundershirt and the supplements did not seem to affect her.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki was kicked out of day care after her bite wound incident. The day care facility blamed Loki’s fast paced behavior affecting the other dog that made them react to her.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>They were told that she was playing well with the other dogs but since she is high energy the other dogs could not read her.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki doesn’t seem to have a big interest in her puzzle toys</span>

    <span style=”color: #000000; font-family: Calibri;”>Loki will get tired and want to go into her crate at the end of the night and will kennel up with “night, night” cue and only needs to be asked once.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>This is her resting place and they feel at the end of the night she is ready for a break.</span>

    <span style=”color: #000000; font-family: Calibri;”>Treatment plan continued:                                                                                                                                                                      </span><span style=”color: #000000; font-family: Calibri;”>1. Wean off Clompramine.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Start by decreasing to 20 mg every 12 hours for 14 days, and then 10 mg every 12 hours for 14 days, then 10mg every 12 hours every other day for 14 days, then stop this medication.                                                    </span><span style=”color: #000000; font-family: Calibri;”>2. Start an SSRI (Fluoxetine) 10 mg daily.</span>

    <span style=”color: #000000; font-family: Calibri;”>6/9/2016:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Loki seems to be exhausted and owner doesn’t think that it is related to heat – she is her normal active self in home.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>When they go outside to play and throw the dummy she will run and fetch about 5 times or under 5 minutes of play and then she is exhausted like she has been hunting all day.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She comes into the home and is alert and not wanting to sleep but finds the cold tile and lays down and drinks more, panting.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki seems to follow the shadows of the dummy or owner (not the actual toy).</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki was doing really well right after they started the Fluoxetine – they were at the cabin and left her in the yard and she found a cool place to lay down and seemed comfortable (O now wondering if this was just due to her feeling so tired).</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She was doing really well but this last couple of days she started to fixate on shadows again in the evenings and stays focused all night long on shadows until bed time.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Her pacing has increased and she is tougher to redirect.</span><span style=”color: #000000; font-family: Calibri;”>   </span><span style=”color: #000000; font-family: Calibri;”>Loki is acting like her physical movement is draining her, but she is still alert and gets up if owners walk away.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Mr. owner is also out of town, normally the less people she is calm and able to relax more – when they are home together Loki paces more to see what each of them are doing. Seem to have started right after starting Fluoxetine.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Eating and drinking fine and everything else seems normal.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Fluoxetine was started on May 24th, started to decrease Clomipramine on 5/31, today is day 10 at 20 mg q 12h.</span>

    <span style=”color: #000000; font-family: Calibri;”>This is where I became in charge of the case.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>My plan:</span>

    <span style=”color: #000000; font-family: Calibri;”>Consider alternate Clomipramine dosing as per Dr. Overall. Loki has been on as high as 1.5mg/kg, but we can comfortably go to 3mg/kg.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>I recommend we try this before we say Clomipramine will not work for Loki.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Plan to do a quick wean of the Fluoxetine (EOD x 5 doses, then stop) as she has been a very low dose for a short period of time and then increase the Clomipramine dose to see if the higher dose is more effective w/o the side effects.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Can also add Gabapentin to her medication regiment very safely.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Owner happy to try as the current plan is not working for Loki.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Plan to increase Clomipramine to 40mg BID (starting tomorrow morning) for 2 weeks, then increase to 50mg BID for a minimum of 3 weeks, then long term if doing well.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Start EOD wean of Fluoxetine now.</span>

    <span style=”color: #000000; font-family: Calibri;”>7/12/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Loki is still challenged with shadows and light which results in pacing. </span><span style=”color: #000000; font-family: Calibri;”> </span><span style=”color: #000000; font-family: Calibri;”>We have not moved her up to 50mg yet which is our miss as time got away from us.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>I think she is a little better, or we are just used to it.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She still paces a pattern and exhausts easily.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She has been at hunting training since June 29, so we need to give the trainer a call to see how she is doing.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>I can update you again once we hear from him also.</span>

    <span style=”color: #000000; font-family: Calibri;”>7/19/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Loki is doing pretty good.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She was pacing this morning, slowly, BUT was ignoring the casts of light on the floor which at times she goes nuts over.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>So, we see glimpses of change and I think have figured out “her normal”.</span><span style=”color: #000000; font-family: Calibri;”>   </span><span style=”color: #000000; font-family: Calibri;”>The trainer didn’t think any of her behavior was that odd, but he doesn’t live with her. He did see her react to light off glass, but said other dogs do this.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>He of course does not live with her in a house setting, which is a different dynamic.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She was released from training two weeks early as the trainer said she is doing great and just needs to get time in the field.</span>

    <span style=”color: #000000; font-family: Calibri;”>Continue Clomipramine 50mg q 12h                                                                                                                                                </span><span style=”color: #000000; font-family: Calibri;”>Start Gabapentin 300mg q 24h</span>

    <span style=”color: #000000; font-family: Calibri;”>7/28/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  L</span><span style=”color: #000000; font-family: Calibri;”>oki is doing well – they added in Gabapentin and they have seen small improvements like last night she laid down and didn’t pace or chase lights or anything when it was time to watch TV and relax.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Melanie was nervous because last night 5 minutes after giving meds she ran in circles in the home and was very excited and hyper so put her outside and she ran in circles and did several laps around the yard, and came to sit next to her and followed her in the house.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>O is thinking it was just a burst of energy since she has not done that before.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki actually sat in her lap which she has not done before.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>O thinks there is a glimmer of hope with her current medications and is feeling good with her progress.</span>

    <span style=”color: #000000; font-family: Calibri;”>9/13/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Loki seems to be tiring more easily and panting more with exercise.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Could be related to the Clomipramine, but may also be weather and physical condition. Ow plans to continue to condition her and see how things go as we have cooler weather.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Loki has evenings where her OCD behavior is well controlled, and then evenings where she will spin and spin and not be able to settle until owner puts her in her kennel.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Seems to be worse when there is more people around, likely due to the increased stimulation.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Ow is hoping for better OCD control.</span>

    <span style=”color: #000000; font-family: Calibri;”>10/3/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>In the evenings Loki is pacing and staring at the ceiling, going back to some of the normal behaviors that originally started this.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Yesterday she did nap which is normally unheard of.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She was going through a period of getting worse a couple of weeks ago, maybe 3 weeks.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Never have good days in a row, on occasion will have good days.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Seems to get winded when she is out running and playing and then just lays down with Frisbee, O worried that may affect her hunting.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Her first big hunt will be the 19th this month.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Mr. owner is starting to get her training for start of the season.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Owner gave last Gabapentin last night, seems to be more subdue in the am, wondering if giving at wrong time of day.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>O wondering if should wait to change meds until they see how she does with her first hunt, maybe she will have less OCD since she will be hunting almost every weekend, and will also be able to see if she gets too tired when hunting or if her instinct kick in and she is still really good and has the stamina for hunting.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Has been to dog park last couple of days and doesn’t seem to be exhausting when they are there.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Life in the home is the same pacing and looking and last night she was really bad, and the QOL on a normal day could be better.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Mrs. owner cannot think of what the correlation is to her bad days.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She doesn’t think Mr. owner wants to change meds before hunting she will be gone from the 19th to the 23 for 5 days. O needs refill on medication Gabapentin 300mg and Clomipramine 50mg.</span><span style=”color: #000000; font-family: Calibri;”> </span>

    <span style=”color: #000000; font-family: Calibri;”>Plan to leave medications as they are and see how Loki does after her first big hunting weekend. </span>

    <span style=”color: #000000; font-family: Calibri;”>10/26/16:</span>

    <span style=”color: #000000; font-family: Calibri;”>Update from owner:  </span><span style=”color: #000000; font-family: Calibri;”>Prior to going hunting, we actually stopped giving her Gabapentin entirely.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Her behavior really didn’t change.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She still has high anxiety or what appears to be as evening approaches.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Her pacing is increased in the evenings.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Not sure if is pent up energy or if she is tired, or if having all of us home is causing anxiety.</span><span style=”color: #000000; font-family: Calibri;”>  </span>

    <span style=”color: #000000; font-family: Calibri;”>Bruce took her hunting last week and she hunted Thurs, Fri, and Sat. most of day and couple hours on Sun.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>He would crate her at times to make her rest.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Bruce said she was awesome. Her hunting instincts are top of game and she listened, obeyed and was a great dog.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She retrieved birds in water holes, mud up to her belly and basically was a machine.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Since coming home on Sunday, she has been pretty stiff and sore and moving slow, not much pacing and if she does it is slow.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Bruce has given her 1/2 pain pill through today to help her through.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>She is sleeping in evenings also, which is not common, but welcomed.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>So, exercise obviously helps, but if she were to run this much all the time she probably would gain a stamina and not be so tired.</span>

    <span style=”color: #000000; font-family: Calibri;”>We are really questioning if the Clomipramine is even doing anything frankly.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>So not sure what to do.</span><span style=”color: #000000; font-family: Calibri;”> </span><span style=”color: #000000; font-family: Calibri;”> </span>

    <span style=”color: #000000; font-family: Calibri;”>My questions: </span>

    <span style=”color: #000000; font-family: Calibri;”>1.</span><span style=”font: 7pt ‘Times New Roman’; margin: 0px; font-size-adjust: none; font-stretch: normal;”><span style=”color: #000000;”>       </span></span><span style=”color: #000000; font-family: Calibri;”>Do I dare increase her Clomipramine any further?</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Will it even help?</span>

    <span style=”color: #000000; font-family: Calibri;”>2.</span><span style=”font: 7pt ‘Times New Roman’; margin: 0px; font-size-adjust: none; font-stretch: normal;”><span style=”color: #000000;”>       </span></span><span style=”color: #000000; font-family: Calibri;”>Change to Fluoxetine? Different SSRI?</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Use a combination TCA/SSRI?</span>

    <span style=”color: #000000; font-family: Calibri;”>3.</span><span style=”font: 7pt ‘Times New Roman’; margin: 0px; font-size-adjust: none; font-stretch: normal;”><span style=”color: #000000;”>       </span></span><span style=”color: #000000; font-family: Calibri;”>This patient did not respond well to BZD, other appropriate options?</span>

    <span style=”color: #000000; font-family: Calibri;”>4.</span><span style=”font: 7pt ‘Times New Roman’; margin: 0px; font-size-adjust: none; font-stretch: normal;”><span style=”color: #000000;”>       </span></span><span style=”color: #000000; font-family: Calibri;”>Owners are not convinced the Gabapentin is helping, but I am inclined to continue and even increase her dose to 300-400mg q 12h.</span>

    <span style=”color: #000000; font-family: Calibri;”>5.</span><span style=”font: 7pt ‘Times New Roman’; margin: 0px; font-size-adjust: none; font-stretch: normal;”><span style=”color: #000000;”>       </span></span><span style=”color: #000000; font-family: Calibri;”>I am not sure how well the owners are following the behavior modification protocols.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>Will we have any lasting success with medications alone without continued behavior modification as well?</span>

    <span style=”color: #000000; font-family: Calibri;”>Thank you so much for the help.</span><span style=”color: #000000; font-family: Calibri;”>  </span><span style=”color: #000000; font-family: Calibri;”>I was feeling good about my success with this case initially when it seemed like she was doing so well over the summer, but now it seems as though we are right back where we started.  </span>

    <span style=”color: #000000; font-family: Calibri;”>Cassie Engmann</span>

     

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