A traumatic event that won’t stop haunting you. An expectation of the worst at each and every moment because life is no longer to be trusted. An ongoing nightmare that causes disruption and dysfunction, interfering with normal activities. Patricia Hall knows the awful symptoms of Post Traumatic Stress Disorder, or PTSD, all too well. Not because she suffers from them. Her dog does.
A five-and-a-half-year-old greyhound that Ms. Hall has had since he was 17 months, Star “has always been an active dog, a social dog who loves people, but he has always been on the high-strung side,” she says. “It took us a while to realize that things affected him pretty easily. He’s never been aggressive, just sensitive to things. He can get a little anxious.”
The Halls could live with his anxious temperament, but things started to change after they took him to the veterinarian last February for his wellness visit. When the vet administered his leptospirosis vaccination, the needle hit a nerve, causing a burning sensation. “My vet put an ice pack on him for a few minutes, and he calmed down,” Ms. Hall says, but after that he became hesitant to go see her. He had to get his rabies shot not long after, and only went into the building “with encouragement and minor tugging.”
The real tipping point came in May. “I went to bring in Star from our back yard and saw that he had a pretty severe injury,” says Ms. Hall, “a laceration on his side. He needed stitches, so we went to the vet’s. But he didn’t want to go into the exam room. I was only able to get him in by going through the back door. He was trembling.
“The vet kneeled down to see how big the wound was, and he whipped around growling, showing teeth, snarling, and trying to bite her. This was the same vet he had always seen.
“He had literally never done this. We had to muzzle him so she could give him an intramuscular injection — antibiotics and a sedative. He was screaming and jumping up and down in pain, but the sedation started working very quickly. He started to get really drowsy.
“My vet called me a couple of hours later. The reason he reacted that way was that he was in so much pain. It wasn’t just a laceration. Something had impaled him, going in a good four or five inches; we surmised he must have been chasing a squirrel or another animal, jumped up on our fence, then came down on a branch or something. So when she had gone over to touch around the wound, he just went crazy. While he was under sedation, she had to go up into the wound and stitch the torn muscle inside.
“Four days later we had to remove the drain the vet had inserted so the wound wouldn’t pouch up and get infected. He was fine with my husband and me doing that,” Ms. Hall says, “but when we took him back to the vet clinic for follow-up, he wouldn’t come out of the car. The look on his face was total panic. His doctor had to come out and examine him inside the car.
“Two weeks later, I again couldn’t get him out of the car for his final follow-up. He plastered himself against the back seat.
“Is this just vet buildings? I wondered. So I took him to our local grocery store, with people coming and going. Same thing. He got up from the back seat of the car, saw the building and the people, and I couldn’t get him out.” This has also happened elsewhere. “If I try to pull him, he totally panics and starts screaming,” Ms. Hall says.
A definite canine phenomenon
Nicholas Dodman, BVMS, head of our Animal Behavior Clinic, has seen it before. “The first dog I ever treated for PTSD,” he says, “had been shot by a policeman. The dog couldn’t get through the night without blood curdling, knees-knocking panic, so the owner and his son did tag teams to keep the pet company until daylight. Neither had had a complete night’s sleep in almost two years by the time they brought the dog to see me.
“There seems to be a genetic sensitivity or tilt, in favor of acquiring PTSD,” Dr. Dodman says, which jibes with the anxious temperament Ms. Hall described in Star. “With some dogs,” Dr. Dodman comments, “there might be a terrible shock that rattles them for a few months. It’s post-traumatic, and it does cause stress, but it doesn’t last long. It ends. With other dogs, just like with some people, the experience remains ingrained, and the dog just can’t shake it.” It’s believed that about 20 percent of dogs who undergo a severely traumatic experience, similar to the estimate of 20 percent of people, will end up with the problem. It is not yet officially called a syndrome in veterinary medicine, but, says Dr. Dodman, be that as it may, “PTSD is now a pretty well recognized canine phenomenon. Military doctors recognize that dogs who help soldiers in war zones can suffer from it.”
There’s a “funky” gene that in preliminary research has been associated with its development and is believed by some to affect dogs as well as people. Normally, a dog — or person — has a healthy caution. Says Dr. Dodman, “it makes sense that if you walk by a bee’s nest and get stung by bees, you’ll thoughtfully avoid the nest. But if worrying about bee stings night and day becomes your new norm, and you live your life around that fear, chronically reliving the event through flashbacks to the point that it guide your actions,” the gene has overshot the mark. Your body continually floods with fight-or-flight hormones like norepinephrine, so you’re constantly in an alarmed state, even when there’s nothing to be alarmed about.
Dr. Dodman and Star meet
Ms. Hall knew she could not continue to take proper care of Star if she couldn’t get him into a veterinarian’s office. When he finished healing from the impalement, she thought he wouldn’t need to go back to the vet until his next checkup in March of 2015. But Star sees an internal medicine specialist at a different veterinary clinic for his colitis, and he would not get out of the car there, either. “He wouldn’t even make eye contact with the doctor or the assistant when they came to the car to see him, and he likes both a lot,” Ms. Hall relates.
At least as important, she simply didn’t want him walking around in fear all the time. She had tried taking him to his regular vet’s office when it was closed in order to help desensitize him, but he wouldn’t get out then, either, even with no comings and goings of other people and dogs. “I’d park down the street and we’d walk to the edge of the driveway at the vet’s office, and he’d get that look of panic,” she says. “I then arranged to meet a friend there who also had a greyhound, and after a couple of trips, we were able to get him up to the door of the building as long as the other dog was with him. But when we tried it again when the practice was open, he went into a cold panic all over. He would not go near the place.”
“I think you’ve kind of hit the wall there,” Dr. Dodman said to Ms. Hall.
Star didn’t want to come out of the car for him, either, even though he had never been to Dr. Dodman’s office. But Ms. Hall was able to get him on the grass through trickery — she used her husband’s car, which was easier than her own to get in and out of, and also slid him along by sliding pillow-like objects against him. She got him 20 yards from the hospital, but that was as far as he went. “So I went out to the car,” Dr. Dodman reports. When Star then resisted any more tugs toward the clinic, he suggested, “Let’s just stand here and talk,” understanding that for Star to have received an intramuscular injection when his muscles were in great pain must have been “godawful.”
“We could have dragged the dog inside,” Dr. Dodman says, “but that would have made it worse. You can’t force fears. We tried sedating medicine, but after an hour, it hadn’t sunk in. The dog was a wreck. I agreed with the owner’s diagnosis — PTSD, and it was interfering with life.”
Looking for solutions
“With people,” Dr. Dodman says, “you have talk therapy. ‘Face your fears.’ But that doesn’t work with dogs. With dogs you need to try medications to help keep a dog’s emotions stable in the midst of terror that for him feels life-threatening.”
For the dog who couldn’t sleep at night after having been shot by a policeman, Dr. Dodman used a combination of anti-depressants and Valium, the latter to get the dog through the wee hours. The pet and his owners did then manage to get through the night without having to be awake.
With Star, Dr. Dodman says he’s trying clonidine, which limits the flow of norepinephrine that’s part of the fight-or-flight panic state. “We’re going to see if we can use that on a situational basis,” he says, meaning those times that it’s critical for Star to be examined in the actual doctor’s office rather than outside in the car. “Another drug we might try,” Dr. Dodman says, “is buspirone, which is a mild anti-anxiety medication. I’ve found it to be super-effective in greyhounds. We may also use long-term therapy with Prozac-like drugs in the SSRI category, with or without trazodone, which also treats depression. Both types of drugs are confidence builders in addition to acting as mood stabilizers. So we’ve got a laundry list of things we can try as we go along.”
Star at home
“Right now I am working on testing the effect of clonidine on Star,” his owner Ms. Hall says. “An initial low dosage did not have any effect — I took him downtown to where the vet’s office is and parked across the street, and while I got him out of the car, I couldn’t get him to cross the street. So under Dr. Dodman’s direction I am increasing it a small amount at a time until he does. On the last try, we went back to the grocery store. Star took one step to get out, but then he backed up. ‘No, I can’t do it,’ he was saying. It was a hair better than what it was, but that’s all. So I need to increase the dosage again. But if Star starts to seem sedated from it, then the dosage is too high and it’s most likely not the correct medication for him. We would then move on to other drugs.”
“‘It’s going to take time,'” Ms. Hall says Dr. Dodman told her. “‘It’s going to be like peeling single layers of an onion.’ I’m looking at months and months of this. We need to get him to a point where he can tolerate a vet exam, first maybe just listening to his heart with a stethoscope — not starting with shots.”
Here are some of Dr. Dodman’s other recommendations:
Do not force Star to go into a veterinary hospital, as force will compound the PTSD and make the situation worse.
Inquire with Star’s vet about whether she’ll make house calls for the time being. Taking him for a walk before she comes and the doctor’s going very slowly once she’s with him may help him tolerate an exam and vaccinations. The gentlest techniques, including small-gauge needles and minimal handling, are absolutely necessary. If any procedure is observed to be upsetting to him, it should be conducted with sedation.
Star’s thyroid hormone level should be checked. Low or borderline low thyroid hormone may be a contributor to anxiety.
A Gentle Leader head halter may help Star tolerate frightening situations by increasing his communication with Ms. Hall and thereby boosting his confidence.
Fortunately, the two veterinarians at the clinic that Star goes to have agreed to work with Star and Ms. Hall using the plan suggested by Dr. Dodman. They have willingly committed not just to making home visits but also spending social time with Star minus any medical examination — going on walks with him and the rest of the family, giving him treats, etc.
“I’m very lucky to have them and their support as we work through this,” Ms. Hall says. Indeed, Dr. Dodman reports that one of the vets has already come to Star’s house in “civvies — no white coat. But the dog sniffed her, then ran into a back room shaking.” Future visits will have to include “fresh clothes,” he says, rather than clothes worn underneath the vet’s lab coat while she was treating dogs at the office.
The prognosis: iffy. “This is a work in progress,” Dr. Dodman says. “I haven’t solved it yet. It could be very tricky. You manage things, improve things, but I don’t know that you really cure the PTSD.”