Page 1636 - Clinical Small Animal Internal Medicine

1574 Section 15 Preventive Care

psychological causes and that medical treatment pets’ aggression, referral to a veterinarian with
VetBooks.ir only addressed the former. For example, a cat that expertise in using and ability to prescribe behavior‐
continues to urinate outside the litter box
modifying medications is best. Additionally, cases
despite elimination of its cystic calculi may have
of future legal involvement. Documented referral
concurrent feline urologic syndrome (physical involving human‐directed aggression may be at risk
cause), litter box aversion due to inadequate clean- to a veterinary specialist or another veterinarian
ing by the client (normal behavior) or a learned lit- who establishes their own veterinarian–client–
ter box aversion because urination in the box had patient relationship may be preferable to referring
been associated with pain (psychological cause). to a nonveterinarian in these cases. If a veterinary
– Both physical and psychological. Diagnose and behaviorist or veterinarian with behavior experi-
treat the physical component. Assess whether the ence is not locally available, consider a veterinar-
behavioral clinical signs are normal or abnormal ian‐to‐veterinary specialist consultation via phone
and follow Step 1 accordingly. For example, a dog to discuss treatment and/or referral to another
that is aggressive when he is lifted into the car behaviorist.
may be painful due to osteoarthritis (physical – Common problems (mild). A common behavior
cause) but also fearful of car travel (psychological problem is one that, while abnormal, occurs fre-
cause). Similarly, an elderly cat that vocalizes at quently in that species. When they are mild in
night might have hyperthyroidism (physical severity, common behavior problems typically do
cause) but has also been reinforced by his owners not require behavior‐modifying medication and
because they fed him when he cried (normal, may be addressed through consistent behavior
learned behavior). modification and environmental changes. Although
– Psychological. A primarily psychological etiology is it is always appropriate to refer to a veterinary
diagnosed once physical causes have been ruled out behaviorist, these cases suitable for referral to a
or addressed. Unlike problems due to normal well‐qualified trainer or nonveterinary behaviorist.
behaviors, “abnormal” behavioral problems typi- – Common problems (moderate to severe) or atypi-
cally stem from an underlying emotional (e.g., fear cal problems. This category includes any behav-
or anxiety) or neurochemical pathology rather than ior that is moderate to severe in intensity,
a lack of training or opportunities to express spe- frequency or duration, atypical for that species or
cies‐typical behavior. Simply reinforcing com- signalment, or for which a typical trigger or pat-
mands in these situations is unlikely to alter the tern cannot be discerned (e.g., behaviors that are
animal’s underlying emotional response to a situa- idiopathic or occur “out of the blue”). These are
tion they find threatening. These cases should be cases in which medication and extensive, long‐
referred to a behavior professional both adept at term behavior modification may be necessary.
interpreting canine or feline body language and These cases should be referred to a veterinary
behavior and who understands the clinical applica- behaviorist or veterinarian experienced with
tions of learning theory. behavior cases.
3) If you prefer not to manage the behavioral aspects of
the case yourself, determine the type of behavior
professional to refer to based on the presence or Referrals
absence of aggressive behavior, the severity of the
behavior problem, and whether the behavior itself is Clients have become increasingly educated regarding
common or atypical. animal behavior and are seeking the advice of veterinar-
– Human‐directed aggression. Ideally, cases involving ians when their pets misbehave rather than resorting to
human‐directed aggression should be referred to a relinquishment or euthanasia. Whether or not to refer
veterinary behaviorist or a veterinarian experi- depends entirely on the individual veterinarian’s comfort
enced in treating aggression cases. Aggression level and experience (Figure 177.2). “Normal” behavior
cases often require extensive and protracted care, problems or mild forms of common behavior problems
including an honest discussion with the owners may easily be addressed by the veterinarian “in house.”
regarding risk assessment, development of a Guidance on how to diagnose and treat canine and feline
treatment plan tailored to the owner and pet and behavior problems is available in various texts (see the
ongoing communication – potentially for months Further Reading list at the end of the chapter). If the vet-
to years – to assess and monitor the response to erinarian does not feel comfortable treating behavior
treatment. Because clients frequently inquire about problems or lacks the time or interest to do so, many
the role medication might play in treating their referral options exist.