Getting a vet check-up for your reactive dog

If you have a dog who barks and lunges, you may be surprised if a behaviour consultant asks you to stop by the vet. Surely there aren’t medical conditions that contribute to barking and lunging are there?

In 2020, Professor Daniel Mills published an influential paper with nineteen other authors from across Europe, the UK, Canada and the USA. In it, the authors state that the links between pain and behaviour in animals have not always been made clear. Vets should be aware of the ways in which pain may manifest as behaviour problems. Behaviour consultants should be aware of the way behaviour problems may indicate underlying pain.

Although some parts of the paper has been sometimes been misread and sensationalised, its claims are valid. In one of the six clinics studied, 53% of the animals investigated for behaviour problems had confirmations of underlying health problems impacting their behaviour.

The paper’s statistics are a little hard to read. To start, the paper does not specify how many animals were included. It only includes a percentage. Then there is a smaller percentage of animals for whom a diagnosis was confirmed. The centres were also university hospital clinics on the whole, where animals had been referred by other specialists. These factors mean that we have to be careful about sensationalising numbers.

Avoiding sensationalisation of medical factors

Taking the often-quoted headline figure of 80% of aggressive animals experience pain gives us a clear indication of why this is troublesome.

First, it puts us in conflict with our vets if they rule out pain. If our dog who is reactive in public is given a clean bill of health, knowing that such a large percentage of animals were diagnosed with underlying medical issues may make us doubt our vet’s capabilities.

One former client ran up over 3500€ in referrals because she was so convinced her vet had not investigated her animal’s health properly. She created a problem in that her dog became very resistant to handling as well. This caused a lot of problems because of all the manipulation.

It is important we trust our veterinarians, and we can’t do that if the internet has told us that most (80% is most) dogs are aggressive because of medical issues.

The wording of the study is also unhelpful. In a Barcelona clinic, for example, undiagnosed medical issues were suspected in 28% of cases. However, the next line of the report says ‘percentage of these cases with some form of confirmation of diagnosis’ (italics my own). Now if we take that clinic to have had 100 dogs, they found diagnoses for 16%. But that is unclear whether that is 16% of 28% (around 4 or 5 dogs) or 16% of 100 (around 16 dogs). Either way, as caregivers, if we understood that around 16% of dogs had medical issues underpinning behaviour, if our primary veterinarian ruled out health issues, we’d be more satisfied that they’d done a thorough job.

Considering medical problems

Even so, whether it is 4 dogs in 100 or 80 dogs in 100, knowing that medical issues might be implicated in behaviour may help us understand that a trip to the vet to rule out common problems might be very helpful.

Again, the reporting of 80% of cases of aggression being underpinned by health issues is also unhelpful. It’s much more than aggression.

It is certainly more complex, however, than pain causes behaviour.

The authors found several ways that medical issues could affect behaviour.

Where health directly impacts behaviour

The first was that medical issues such as gastrointestinal problems or neurological problems directly caused behaviour. Perhaps our dog has a dicky tummy. This might lead to him barking and lunging at dogs who come near him in the park. Maybe our dog is struggling with arthritis and they resent strangers coming in with their hands to pet them. Both of these could be examples of a dog whose behaviour was directly caused by their health.

In cases like these, we could expect that if the medical cause can be treated, then the behaviour would stop.

When a health issue directly affects behaviour, we also might see the dog being less tolerant with anybody who attempts to manipulate them. Irritable aggression, caused by dogs whose growling, snapping or biting is a direct response to being handled, is one such thing we might see. Thus, if our dog struggles with the groomer or with the vet, ruling out health problems is vital.

It may also affect social behaviour. A formerly playful dog may feel less comfortable in play. This can be especially true if the dog is playing with less familiar dogs. A dog who previously enjoyed meeting other dogs might then become reluctant to engage with others.

Pain also affects cognition, learning and memory. I’m sure we can all remember times when a headache made it hard to concentrate or made it difficult to remember things. Pain directs attentional focus, affecting working memory.

This is not just about acute pain. It also relates to chronic or ongoing pain. In animal models, chronic pain affects connectivity in the hippocampus and the prefrontal cortex, meaning it can be harder to inhibit behaviours and our dogs may seem more impulsive as a consequence.

Pain affects learning, performance and memory

Hesitation or reluctance to perform learned behaviours can also be a result of underlying health issues. It’s easy to think of a ‘stubborn’ dog who is reluctant to sit when we ask actually having problems with hip dysplasia and finding it difficult to do so.

Whenever we notice dogs are slower to respond to requests or if they sometimes don’t do the requested behaviour at all, then underlying medical problems can sometimes be the cause of that. For instance, a spaniel I worked with was very reluctant to approach their guardian to have their harness put on. The harness was one that slipped over the head. Because the dog had chronic ear problems, his fears made him slow to respond to his guardian’s requests to approach to have his harness put on. Switching harness brands made a lot of difference.

This reminds us of a critical and often overlooked fact: pain teaches. It modifies how we move and it modifies the choices we make in our actions.

Two years ago, I slipped on the steps outside my house and fell down onto my thankfully well-cushioned behind. After a few days of rest and taking it easy, the pain disappeared. However, even though the pain has long since gone, its memory is still very powerful and I avoid walking down the steps quickly. Because it was icy, I’m also much more cautious on icy days and go down one step at a time with both feet.

Pain teaches. It modifies how we move even when the pain has long since gone.

This can be hard for guardians to understand sometimes. It may even send them on a search for a vet who will confirm their concerns if their primary vet rules out current pain as a problem.

Pain affects existing behaviour concerns

Sometimes medical issues are not the direct cause of behaviour. It may alter behaviour by increasing aspects of it, or decreasing aspects of it.

Say for instance we have a dog who doesn’t much like being handled and never has. Perhaps they tear a ligament and this affects their behaviour. It can change the behaviour itself. Instead of their usual growls, they may snap or even bite if someone attempts to manipulate them.

In other words, we may see different behaviour as a result of health concerns.

This can affect the intensity of the behaviour too. We may see more or less of the behaviour. For instance, our dog may be more growly than usual. Sometimes, pain reduces behavioural intensity or choices as well. Perhaps our shy dog is even more shy than normal.

The type of behaviour we see and its intensity are not the only changes we may see to existing behaviour problems. We may also see an increase or decrease in the frequency of behaviour. Perhaps they growl more or they engage with us less than usual. Duration is another way that behaviour changes. Perhaps our dog used to bark for thirty seconds or so if someone passed the house with a dog, only for pain to affect this. We may find them barking for two or three minutes, or even barely barking at all.

Latency of behaviour means how quickly our dogs respond to a trigger that causes behaviour. We may see that they are quicker to respond to dogs they see if they’re usually reactive. We could also find that they are slower to respond as well.

Here, the dog will have already had existing problems such as barking and lunging at other dogs, but health issues will alter those problems.

Veterinary investigation

For this reason it is important to get a veterinary investigation before you start working on a behaviour modification programme with a dog who barks and lunges.

It’s also helpful to give your vet an idea about the behaviour you are seeing. Keeping a diary for a few days can be helpful and making a note of what it is you have seen. This is where a behaviour consultant can help you in observation. Sometimes, when people take their dog to the vet with non-specific behavioural symptoms and say they want a general check-up, the vet may not be sure exactly what it is they’re supposed to be looking for.

It’s easy in those circumstances for the vet to miss things or even to run so many tests that your bills are in the thousands.

Helping vets narrow down can be really useful in getting an accurate and speedy diagnosis.

A case study

Just as one example, a former client’s dog seemed very stiff around the neck. He’d had a large number of tests including an x-ray and full body MRI scan, but two things helped in particular. First, we noted that even though he could stretch his neck, he did not.

We set up a silicone food toy fixed about a head height higher than his normal head posture and put an obstacle in the way so he had to elongate and elevate his neck. Although he could do this, from his posture and gait, it was clear he was having some issues. He also had an unusual gait on walks and would sometimes stumble. He rarely ran or walked and he seemed to put an unusual effort into movement.

Armed with these observations, we were then able to clarify things for the primary vet who sent him for very specific blood tests at the university hospital. He had inflamed lymph nodes and blood tests revealed a highly unusual parasitic infection. The dog had a course of antibiotics.

Although this did not cure his reactive behaviour around other dogs, it certainly reduced it to a tolerable level so that we could start a behaviour modification programme.

Pain trials?

It’s become a trend in the dog training community to demand ‘pain trials’. What this usually means is a short course of anti-inflammatories to see if anything changes. Partly, this very influential paper has been responsible for this. Pain trials can be very useful.

However, we often overlook the single most useful diagnostic tool in the study: manipulation. A physical examination was the most popular method of identifying problems, not a pain trial.

Vets can perform all manner of manipulations to identify soft-tissue injuries where x-rays or body scans might not. These can often rule specific problems in or out. Instead of having to subject our dogs to anaesthetic – which is not always an option with every dog – and invasive or frightening imaging tests, physical tests can reveal a lot.

Many of these need not necessarily involve manipulation. For the dog in the case study, he was very wary of manipulation. This was perhaps why his swollen lymph nodes had been missed in the first case, although even the university team who carried out a full body MRI under sedation did not identify this at first. Knowing the normal range of motion for the limbs and spine can be very helpful.

There are also other manipulations vets can carry out, like knuckling tests and other reflex tests. These can sometimes identify neurological problems and start to narrow down the potential problem.

The importance of vet tests

If our dogs are reluctant to go to the vet, we may hold off on consultation. It’s easy to feel overwhelmed if your dog is anxious, fearful or panics at the vet. Sometimes, this leads us to seek out less veterinary support than we would otherwise.

Planning ahead can be very helpful. No vet (well, none you should want to see!) wants to cause a dog to panic. Explaining your problem and asking for support is the first way forward.

Many vets go out of their way to be flexible, providing you with appointments at quiet times, engaging in video consultations or asking you to participate in the sessions. Again, if they are very rigid and unsympathetic, it might be time to find a different vet.

Feeling embarrassed over your dog’s behaviour at the vet or feeling afraid that they will panic are never good reasons to avoid taking your dog for investigation. Unfortunatelty, this is surprisingly common with dogs who are anxious, fearful or aggressive.

Being able to give clear descriptions of what you see will also reduce the time you will need to spend with your vet. It can help them know what to look for. Going in and saying, ‘My behaviour consultant insisted you rule out health problems’ is often unhelpful. Being able to say the behaviour you see and how frequently can help your vet enormously.

It’s also helpful to say what you don’t see, if there are things that your dog used to do and seems hesitant to do any more. It was helpful in the case study to say that the dog never ran, even if chasing a ball. Even in the house, they seemed to trot rather than walk.

In summary

Your vet is often your best ally alongside a behaviour consultant in resolving behaviour problems. Helping them help you is an essential skill in determining the factors that affect behaviour.

Together, the vet-caregiver-behaviourist team is a mighty one. This in itself means having a realistic understanding of the influence of pain. It also means trusting your vet! Finally, we also need to help our vet understand the behaviour. Being clear about this rather than vague and general can help us help our dog.

Understanding where this fits within the 10 common reasons for reactive behaviour can help.

If you work regularly with dogs who are struggling with anxiety, fear and panic in the vet, you may find this 4-hour webinar useful. Safety cues can make an enormous difference.