Monday, September 27, 2010

About Lily: We Get a Prognosis

"You didn't create a monster," Dr. Nichol assured us as we left the small exam room at Albuquerque's Veterinary Emergency Center. "You were dealt this problem."

After six months of incidents involving aggressive behavior of our dog Lily toward our dog Shayna, and two other dogs in the neighborhood--each incident of which has caused injuries, and repeated trips to the vet for the other dogs--we were at the end of the line. We had consulted a trainer, purchased crates, used calming collars, instituted behavior changes, each of which had been cause for hope, and each of which appeared to achieve a certain measure of success--for a little while. After a quiet period that lasted 4 months, Lily has once attacked Shayna again, and this time it took a dry-firing of a 22 to get Lily to disengage. Poor Shayna had both staples and stitches, and she is becoming increasingly reactive to sudden movements and loud noises. Not a good situation for a dog that lives in a house with a family.

When Shayna was being treated at ABQ Vet Urgent Care Center, Dr. Fizpatrick told us that we ought to consult a behavior specialist, and she recommended Dr. Nichol, who is working on his board certification for Veterinary Behavioral Medicine. "This pattern is not going to get better," she said. "In fact, it is going to get worse each time. Exponentially. Unfortunately, he is not cheap," she continued, "But Jeff is well known throughout the region. He's among the best."

So last week, the Engineering Geek worked from home for a day in order to babysit the dogs, and he spent an hour on the phone with Dr. Nichol's research assistant. We both filled out long questionnaires and submitted them by e-mail. The questions not only required that we detail the agressive incidents, we were also asked why we had chosen this dog, what her daily habits are, where the dogs sleep, how all the dogs and the cats interact, and more. From our detailed answers Dr. Nichol was able to glean quite a bit about our dogs, even before he met us--and them.

On Wednesday afternoon, I loaded all three of our canines--Lily, Shayna, and Umbrae into the Honda, and drove over to the Veterinary Emergency Clinic. There, the Engineering Geek met us, and we went into a two-hour consult.

Dr. Nichol met us in the foyer, greeting the dogs first. A promising sign, I thought. He complimented us on the use of the Gentle Leader head-collar for all three dogs. When we got into the consult, he got straight to business. He had read our questionnaires, and he had many questions. Most of the consult was related to the questions, and near the end of the consult, he also listened to and responded to our questions.

According to the information we had been given about the consult, sometimes dogs are examined and given a battery of lab tests to screen for underlying health conditions before behavioral interventions and any medical treatment begins. When I asked about the blood work toward the end of the interview, the mood got very serious.

Before we get into that, I would like to discuss with you the prognosis for this dog, he told us. Basically, he said that we have a very complicated situation. We have two dogs with behavior problems--Shayna, who is very shy and reactive and may not be using normal signalling to other dogs, and Lily, who displays fear agression that has become physical in the past six months. Umbrae, on the other hand, is a well-adjusted dog. This is not surprising because he has been raised by us since he was a very young puppy. He is not part of the problem at all, and may even mitigate it to some extent.

Now, as if a switch has been thrown in Lily's brain, her threatening behavior towards other dogs, which was always present to some degree, has become outright attacks on other dogs and threats toward people. And because she and Shayna are in the same household, they have begun an transaction in which Lily threatens and then attacks--and her agitation ramps up very, very quickly. In response to three attacks with injuries, Shayna's reactivity has increased, but that also increases the chances of another attack. If we keep both dogs in the same household and do nothing the attacks will certainly worsen in ferocity and the resulting injury over time. And threats towards people will most likely become attacks on people, something that we cannot allow.

The question thus becomes what to do. "What are your goals?" asked Dr. Nichol.

Our first response was to say that we wanted peace in the house, that we want the fighting to stop. When pressed by Dr. Nichol, we expressed that we wished to rehabilitate Lily if possible, and to bring Shayna to a point where she is less reactive and more obedient towards others in the household. (She obeys me, but if I am around she ignores commands from others).

Given these goals, Dr.Nichol discussed with us two broad actions, the second of which has two possible directions.

1) Keep both dogs in the household, treat both with anti-anxiety medication, and institute a program of behavior modification for both of them. (Umbrae would continue with his therapy dog training, as he is not part of the problem anyway).

Prognosis: We may see limited success for a period of months or even years. But we can never trust Lily with strangers or with other dogs--even our own, and the likelihood of another, and more severe attack months or even a few years down the line is high. Bottom line is that we could spend thousands upon thousands of dollars, and completely change our behavior and we still will have to be very vigilant toward Lily for the rest of her life with us.

2) Remove one dog from the household, and treat the other dog.

Here, it was clear from the beginning of our discussion that the dog we were all considering removing is Lily. She is the one with aggression problems, and they pre-date Shayna's advent in the household. As I noticed that this was the subtext of the conversation, I interrupted the conversation. "If Lily is removed from the equation," I asked, "Do we have a better chance rehabilitating Shayna?"

"Definitely," came the reply. Shayna does not have problems with agression. Any aggressive looking response she gives Lily is defensive in nature. However, these attacks will eventually make the behavior more entrenched, so a decision should be reached before we end up with two aggressive dogs. Although treating Shayna's fear and anxiety, which was present prior to any interactions with Lily, will not be a walk in the park, a combined approach of medication and behavior modification has a good chance of succeeding.

We discussed two possibilities regarding removing Lily from the household: re-homing her and euthanasia. Separately, both the Engineering Geek and I had answered on the questionnaire that we had thought about euthanasia. Bruce also indicated that he had thought about re-homing. My response to the re-homing question was a little different. I had written that I had thought about it, but was reluctant to pass on a dangerous dog to others.

According to Dr. Nichol, rehoming isn't really an option for Lily at this point. First, he pointed out, she does have issues with aggression and they are persistent and entrenched. Even if we managed to find a new home for Lily, having been direct about the problems, and even sharing with the new owners the report for Dr. Nichol and getting them to sign a waiver of liability in blood, they could still come back and sue us later should Lily injure someone. Further, part of the genesis of Lily's problem is already that we are at least her 3rd home. She probably had at least one home prior to being a stray, she was then a resident of the shelter, and then she came to us. By the time she came to us, she had made and broken attachments in at least two other places. Each such transition is hard on most dogs, and particularly hard on one that has fear-aggressive issues. "Frankly," Dr. Nichol said, "Your home is the last stop for both of these dogs." He was talking about Lily and Shayna.

So at this point, we stand on the cusp of a weighty decision. Rehoming Lily is off the table. So is doing nothing and hoping the problem will go away. Shayna cannot take more of this. So the decision is whether we ought to begin treatment of both dogs with anti-anxiety medications, along with behavior modification supervised by a trainer, or whether we ought to euthanize Lily and treat Shayna. Certainly this issue has financial considerations attached. It is also a highly emotional decision that cannot be taken lightly, and that despite the emotional cost, must be decided rationally and thoughtfully, taking into consideration the impacts on every member of the family and upon the household as a whole.

And making such a decision is going to take some time. How do we deal with the dogs in the meantime? There are more questions than answers at the moment. We (the humans) of Ragamuffin House have to each make a choice of our own, and come to terms with it, and then we have to talk it out, reaching a choice as a family. We must take into consideration the needs of all the non-talking residents--Lily, Shayna, and Umbrae--who are involved in the dynamics that have gone so terribly wrong, and who are impacted by our decision. In the process, we will undoubtedly wrestle with the mistakes that we have made with these dogs, as well as the problems that we were dealt unknowingly, and the sense of failure that humans feel when no choice has a happy ending.

It is hard enough to consider and make the choice for euthanasia when a dog is old and ill. To contemplate putting a dog down before end of life decisions would ordinarily be made is harder.


Karen said...

Elisheva - I feel for you. This is not a lightly made decision. You have given Lily a good home, and not shorted her in your choices. We can always second guess ourselves.

As a long time dog owner, I understand the challenges of both options. Given the situation, I would probably choose option 2 myself. Living with dogs that do not get along is no picnic, even at a lower level of physical reaction.

You don't mention it, so I'll bring it up - there is also the concern brought if the Chemistry Geek Princess and her Knight are considering starting a family during Shayna's likely lifespan. A bite to an adult might be seriously damagine; a bite to a toddler might be fatal.

To continue forward with both dogs would likely mean both of them spending a great deal of time in isolation, which could potentially raise more anxiety issues for either or both. Then there is the anxiety the family will likely feel and telegraph to the dogs through the long rehabilitation trial.

It may be time for Lily to find a greater measure of peace, granted by a loving family.

I wish you and your family peace with your decision.

Elisheva Hannah Levin said...

Karen: thank you, and yes, I have thought about the issues with possible grandchildren. We believe that if the stress on Shayna is reduced, she has a real chance of becoming a less reactive dog. We don't think that she will ever be calm and goofy, like Umbrae, but she has a lot of potential for improvement. But if Lily remains in the household, this will almost certainly not happen.
And you are right--the need to isolate the dogs from one another is already having an impact on both of them.