Page 16 - Winter 23/24

continued from p15
With Laura (that’s the name of her human companion) they live quietly in the house, but the patient is located anywhere, she is not on top of her. You can always listen because there are 2 environments. She sticks to it when affected by noises from the trucks.
She doesn’t cry when she is left alone. She is not aggressive, “... She is zero aggressive, very submissive, one can whip her, hit her and she does not try to bite, she defends herself by screaming or fleeing.” With other dogs she lowers her head and ears and puts her tail between her legs, just like when she is reprimanded. When you challenge her, she shrinks and is left with “exorbitant” eyes, with attempts to flee and hide (sometimes). It is “hard”. In a few seconds, she sits down.
With injections, for example, she doesn’t scream but looks at the flank. “When she sees the needle, she flutters her eyes and dilates her pupils but she doesn’t shake or anything.” She is very submissive, Laura knows that “she wants to leave but she stays”.
Before the move she was scared, but not as scared as she is now. It all started 20 days after the move. She travelled in a truck; the move was made in 3 parts. And she was always locked in an empty room. The patient believes that the patient associates the confinement with the noises of the trucks, which was the only thing she heard.
I note that “... Every time I take the keys to the house, and they make a sound, she goes out into the yard and hides, and is waiting for them to look for her.”
If you walk with her on the street she stops, no matter how much you pull on the leash. If she is off lead, she runs out of control.
General
Dream: She sleeps stretched out next to Laura. Sleeps 14
through the night. If you don’t cover her, she covers herself. She sleeps very soundly, “...She is unconscious. You can change her position and she doesn’t wake up.” Sleep in a stretched-out position on either side and decubitus. She falls asleep early, 9 pm, and wakes up at 6 am with the noises of trucks; otherwise, sleep soundly until 9.30 am. She even takes a nap, between 2 and 3 pm, and also sleeps deeply.
With the noises of the trucks, she wakes up suddenly and starts screaming.
Weather: “She’s very bothered by the cold. If the temperature drops one degree she begins to tremble. She sleeps on the bed and if she is cold, she gets under the blankets. She spends time in the sun, even in summer.” Food modalities: She likes fruit, “enjoys it with passion”, eats everything they give her of fruit. Watermelon and apple “disappear”, melon, banana, peach, lettuce, tomato, potato, pumpkin, she also likes beets, “... She loves it, she sees you eating it and pesters you; she annoys you when you eat watermelon, apple or beets.” She also likes bread, rice alone, noodles.
“She projectile vomits raw meat,” after 40 minutes of ingesting it. “She vomits it as she ingests it.” She vomits, she doesn’t regurgitate.” Raw chicken she does not eat, she barely gives it a go when it is cooked. “
“If you eat something more than you need, you vomit. You can’t go beyond a certain amount of food.”
“Too quiet to eat. Eat very slowly, little by little. Before the arrival of another dog, she ate like a cat. Now eat in one, but slowly.”
Case analysis: this is a patient who presents a fearful, sensitive, and submissive behaviour, as a characterological profile. The clinical diagnosis is that of a simple, post- traumatic phobia.
It is a phobia because the reaction to the aversive stimulus is fear and to an extreme degree, without any adaptive behaviour. It is simple because the stimulus is easily identifiable, unique and homogeneous (noise from trucks), although there seems to be a generalisation of the phobia of pyrotechnic noises, or it is in the process of becoming generalised. And it is post-traumatic because it is triggered after a specific episode. Similarly, it could also be orthogenic, since in the story Laura mentions that the patient “... always was fearful but not as scared as it is now. It all started 20 days after the move...” Several authors postulate that 80% of animals that present with post- traumatic phobias are dogs that have a weak sensory homeostatic level.
From the first moment I told Laura the possibility of treatment using homeopathy, she was very much in agreement but because of the desperation of the clinical picture in general, both the patient, and, mostly, Laura, added to my inexperience. I decided to start a conventional pharmacological treatment with clonazepam, because it is an effective and fast-acting drug in these cases, but not in the long term.
On 24/04/08 I prescribed Clonazepam (Rivotril®) 0.1 mg/kg/12 hrs for behavioural therapy. On 23/06/08 I made a follow-up, I withdrew the Rivotril® until I found a minimum effective dose and that did not give the patient so much drowsiness and incoordination. Laura notes that she is more manageable, that she comes out of crises easier, but it is stimulating her. I instructed not to acknowledge this behaviour, to continue ignoring it, not to caress or feed her (to avoid accidental reinforcement of unwanted behaviors).
She also observed that the episodes occur when the dog hears the keys and realises that her human companion puts on the jacket to leave; She begins to tremble and