Firework advice

Re: Firework advice

JonB — Wed, 09 Nov 2011 11:55:12 GMT

[quote user="Emily Herskind Nightingale"]

I put my own collie x on 2.2mg/kg as recommend ( top level dose) Diazepam and he exhibited pretty much every undesirable side effect from polyphagia to excitability and spent the evening pacing, whining, staggering about.

I have had a DAP diffuser on the go since beginning of August (refill replaced monthly) and had him on 450mg Zylkene for 2 weeks prior, with a double dose on 4th + 5th Nov.

He had a dark corner under a blanket draped over a clothes horse under the stairs and we ignored his whining.

Next year am considering Alprazolam- failing that full GA for 72 hours (for me- not the dog =)

Any suggestions welcome.

[/quote]

Adverse effects are reasonably common with diazepam (ataxia, agitation, etc), and in some cases it isn't possible to find a dose that reduces anxiety without producing a level of sedation that is more than we might want.

With alprazolam (Xanax) it is usually easier to get good anxiety reduction without sedation, but alprazolam has strong respiratory depressant effects, (see warnings associated with this in human patients). So, it is important to be cautious when combining it with other drugs. Alprazolam tablets are sometimes marked in microgrammes instead of milligrammes, and this can cause confusion over dosing. Some pharmacies are not at all happy about dispensing this drug for dogs if the dose appears high or involves breaking tablets into <1/2 for smaller dogs (most are OK).

One aspect of BZD drugs that is a nuisance is that they have such inconsistent effects. The speed of onset of action (for noise phobas) is very variable and the dose required to achive a particular effect is also variable. It's always best to get owners to do at least one test dose on a quiet day, to see what effect the drug has. They should aim to find a dose that makes the dog relaxed to the point of being slightly sleepy when there are no noise events (but still able to move around and respond to interaction normally). By observing how long it takes to reach that effect, they can judge how far ahead of an event to give the drug.

You will also see some interesting effects with benzodiazepines:

- Some dogs become very excitable and playful as BZDs wear off. This is usually not a problem. Some owners say their dogs remain in an elevated mood the following day (especially with alprazolam), even though the anxiety reducing effects don't seem to be present when there is a noise event.

- Very low doses (below recommended dose range) can also have the same effect. This is slightly different from the adverse effect of agitation and restlessness, and should not be confused with it. When using a test dose, you do need to avoid giving doses that are too low, because you won't be able to properly assess adverse effects.

Alprazolam is a popular drug of abuse; even more so than diazepam. If you are unlucky, your email inbox may be stuffed with emails offering Xanax as part of a package including Viagra and other exciting, but unnecessary, things! It is good that the BSAVA statement has information about phobias on its website, but I am a bit worried that it draws attention to the apparent "seasonal availability" of this drug. We need to be quite cautious about handing out these drugs to people who only register with us in order to get them.

A few people have talked about using treatments like DAP/Adaptil or Zylkene to keep the dog calmer during the firework season, combined with benzodiazepines for real noise events. That sounds sensible to me (but discuss with manufacturers of Zylkene how to fit dosing of this product around benzodiazepine dosing). Anything that reduces the dog's underlying level of stress will be helpful. Providing a secure base for the dog, where it can go to feel safe, also reduces anxiety, because the dog has a coping strategy.

Re: Firework advice

KMurphy — Tue, 08 Nov 2011 15:52:56 GMT

[quote user="Mark Holmes"]I have used ACp/Diazepam together. ACP to nail them to the floor. Diazepam for the anxiety and so they forget the whole experience.[/quote]

I have used this combination in one very phobic dog for the past couple of years, with the same reasoning behind it. He was hopeless on Diazepam alone, very excitable to the point where he chewed through a door! However, I didn't want to just floor him with ACP, especially after previously explaining at length to the owner why this wasn't ideal.

Dosed him at Diazepam 1mg/kg and ACP 1mg/kg and the owner reported no problems at all. In fact, she was delighted that she was able to take him out to the toilet later at night whereas in previous years he had been far too drowsy to do this.

He also gets Zylkene and we have discussed densensitisation many times but, like most cases, the quick fix wins the day!

Re: Firework advice

Bob Russell — Tue, 08 Nov 2011 15:34:27 GMT

I find the higher doses of diazepam create more problems than lower therapeutic doses. The pacing may have been created by the diazepam! We never go for the higher doses and most owners are happy with the results (or satisfied with the results!). Sadly those that are not happy with the results get the dog 'nailed to the floor' with ACP as someone so eloquently put it!

Not sure about the interaction of ACP and diazepam but it seems to make sense. Anyone tried it on their dogs?

Re: Firework advice

Mark Holmes — Tue, 08 Nov 2011 15:06:43 GMT

I have used ACp/Diazepam together. ACP to nail them to the floor. Diazepam for the anxiety and so they forget the whole experience.

You could give him domitor/torb for the evening. To be honest thats what i do with mine! Edit: I was referring to Emily there clearly that doesn't apply to punterpets

Re: Firework advice

Emily Nightingale — Tue, 08 Nov 2011 14:55:27 GMT

I have had a DAP diffuser on the go since beginning of August (refill replaced monthly) and had him on 450mg Zylkene for 2 weeks prior, with a double dose on 4th + 5th Nov.

He had a dark corner under a blanket draped over a clothes horse under the stairs and we ignored his whining.

Next year am considering Alprazolam- failing that full GA for 72 hours (for me- not the dog =)

Any suggestions welcome.

Re: Firework advice

Jacquin Mitchell — Tue, 08 Nov 2011 12:55:58 GMT

[quote user="Westvet"]My mixed breed rescue is terrified of fireworks but a Thundershirt alone seems to work really well. There is no lead in time and the effect is almost instant.

[/quote]

We've been using a Thundershirt for our 10 year old noise phobic collie cross. It's been helpful; he's gone from pushing up against us, tail between legs, and following us around everywhere while panting to sleeping happily in the same room as us even for the worst few hours on Saturday Night. He will still get up from his sleep and follow us into another room, but he seems a lot calmer and we haven't found him cowering in the shower at like we usually do.

I'm sure they won't work for every dog but they are worth a go.

Re: Firework advice

ann burns — Mon, 07 Nov 2011 21:38:24 GMT

HI Jon B!! Thank you for your informative posts. Are you Jon Bowen that is the behavioural expert from RVC?! I shall keep check on this forum more for your esteemed opinions :)

Ann

Re: Firework advice

JonB — Sat, 05 Nov 2011 12:13:27 GMT

[quote user="Hannah Wynne Richards"]

I certainly wasn't. Should I phone everyone who's had Calmex to recall ?

Wynne

[/quote]

I have no idea how to interpret this situation, does anyone else?

I have put up links to the various documents on the thread about the VMD statement on Calmex (http://www.vetsurgeon.org/forums/p/9771/48870.aspx#48870), and that may be the best place for discussion so that everyone knows where to go.

Right now, I think we are alone with this problem until an official regulatory body comes up with a definitive answer.

Why did VMD send out a statement like this on the Friday before firework night???

Nobody can get hold of them or VetPlus, and there are clients who will be reading Pete's (excellent) blog and wondering what to do.

However, the VMD must be fully aware of our situation and I agree that a recalling the product from clients seems a drastic step.

Re: Firework advice

Bob Russell — Sat, 05 Nov 2011 11:08:52 GMT

My Staffie was freaking out last night when I got home. The first time in her 10 years! Fortunately I was able to see the clear benefits of a single 5mg Diazepam tablet.

Until someone comes up with a better way of dealing with firework phobia my treatment recommendations will continue to be based around the benzodiazepines.

I would avoid a knee jerk reaction to the comments made about Calmex, I would suggest you don't recall it. I suspect it will panic clients over a matter that is far from clear cut.

I have never used Calmex and have a healthy cynicism for these nutraceutical 'drugs'. Get them properly licensed, with proper trials and I will take them a lot more seriously. These are not medicines and should not be treated as such. They may or may not be quackery but until they have been shown to be medicines, whether in man or animals the profession should not just accept the manufacturers colourful brochures at face value.

Re: Firework advice

Hannah Wynne Richards — Sat, 05 Nov 2011 09:54:33 GMT

I certainly wasn't. Should I phone everyone who's had Calmex to recall ?

Wynne

Re: Firework advice

JonB — Fri, 04 Nov 2011 17:37:21 GMT

Here is a piece of interesting news.

Veterinary Medicines Directorate have just issued a statement on the legal status of Calmex.

A longer story will be in Pete Wedderburn's Telegraph blog later today.

A VMD spokesperson said:

‘This product does not have a marketing authorisation as a veterinary
medicinal product and we’re aware of concerns over its use and are
investigating. People should only use authorised veterinary medicines
and the VMD aims to ensure that all vet medical products are safe to
use.’

The VMD’s policy on enforcement can be seen here:

http://www.vmd.defra.gov.uk/pdf/EnforcementStrategy.pdf

Was anyone expecting that???

Re: Firework advice

Arlo Guthrie — Fri, 04 Nov 2011 12:20:48 GMT

Hear, hear.

Re: Firework advice

JonB — Fri, 04 Nov 2011 11:35:54 GMT

David:

Firstly, nobody said that in these examples the animal is only anxious, so I'm not sure where you get that from. It is perfectly normal to talk about one feature of an individual's condition in isolation. We do it all the time. I might say that I am anxious because I am giving a talk, but I don't give you an overview of all other physical parameters at the same time. If anxiety appears to be a component of an animal's distress, then it seems perfectly appropriate to refer to that.

It's fine to use an overall term like "distressed"; but if we want to properly understand or do something about that distress we need a more detailed characterisation. Hence, terms like anxiety and fear; these are not meaningless.

Almost every aspect of what we do in veterinary medicine is based on experimental evidence, so I am not sure why you are so dismissive of laboratory experiment. Experimental testing of models of emotional responses, cognition etc are not confined to lab rats in boxes, and do extend to studies that closely resemble real situations.

You have proposed your own explanation for the anxiety reducing effects of benzodiazepines (and, by implication other anxiety reducing drugs) that is contrary to all existing models, and you refuse to accept any other explanation. That's fine, but when you propose something as radical as this it is your job to provide evidence to support it, and then defend that evidence.

In your postings you treat other people and their opinions with contempt. If they supply a supporting argument or refer you to evidence that might be a challenge to your position, you simply sweep it aside with a dismissive or offensive remark. Your comments are peppered with capitalised words, terms like "claptrap" and "tripe" , accusations that people are wilfully misrepresenting you or making irresponsible statements. Pretty much anything to belittle and demean, and disrupt normal discussion. None of this is appropriate, so please try to restrain yourself.

Re: Firework advice

David Mills — Fri, 04 Nov 2011 08:28:45 GMT

[quote user="JonB"]

So, you accept that animals may experience anxiety, but you don't believe that it is possible to say whether an individual animal is anxious?

[/quote]

No, not what I said. You can say an animal is anxious. Not just anxious alone.

[quote user="JonB"]

With distress of various forms, there are a number of common indicators which we might use to assess an individual's state; blood pressure, heart rate, heart rate variability (this is a good one), cortisol release, behaviour (facial and body postures, avoidance behaviours, vocalisations, etc). Taken individually, a lot of these are not very conclusive, but together they form a pattern which indicates an individual's state. Many of these are shared between people and animals. They provide a basis for identifying the emotional state of an individual we meet, but we don't need to test all of these things when we see an animal (or child, or person) that is displaying a pattern of behavioural signs that is consistent with distress of a particular kind and is in a situation that might be regarded as distressing. I don't blood test my wife's cortisol level and heart rate variability when I detect stress in her voice and identify her as anxious or afraid, even though she has said she is OK.

[/quote]

You have, unwittingly, supported my point. I don't argue that we can't assess mental status from behavioural or even biological cues but that we cannot say, specifically, for animals - this animal is anxious and ONLY anxious because it is showing XYZ. This is in part to do with the lack of verbal communication, individual variable responses, and the fact that an animal will rarely be anxious alone, just like a human wouldn't. Therefore, as you have said, it is far safer to say 'distressed' as this, in animals (and perhaps humans) is as much as it is possible to say. Your assertion that the signs are subtly different between anxiety and fear is a laboratory science delusion (how normal is laboratory behaviour in itself?), artificial, misleading.

[quote user="JonB"]

However, the effect of benzodiazepines on anxiety is not secondary to sedation.

[/quote]

Point me to the evidence that it isn't. I simply do not agree with this.

[quote user="JonB"]

Anxiolytic drugs of various types are tested in lab experiments to see what effect they have on specific behaviours like isolation distress vocalisation, defensive burying, stretched-approach, entry into elevated plus mazes etc. These are models of different aspects of anxiety. Some drugs will profoundly reduce isolation distress vocalisation, but have a limited effect on defensive burying; an example is clomipramine, which is used for "separation anxiety". Others have a much broader effect on all models of anxiety (benzodiazepines seem to work well in all of the tests).

[/quote]

Tests, experiments, laboratory. Meanwhile out in the real world, where dogs/cats are exposed to different levels of training, different personalities etc, anxiolytic is a concept that is useless. Point me to the papers please. Notice 'seem' as well.

[quote user="JonB"]

just more confusion based on ignorance.

[/quote]

Now now.

Re: Firework advice

Lucy Brett — Thu, 03 Nov 2011 16:20:46 GMT

[quote user="SteveOwen"]Happy, and legally able to, I hope. [/quote]

Of course. Nice printed copies!!! xx

Re: Firework advice

SteveOwen — Thu, 03 Nov 2011 16:14:04 GMT

Happy, and legally able to, I hope. Do hope you don't intend to breach copyright.

Re: Firework advice

Lucy Brett — Thu, 03 Nov 2011 15:17:37 GMT

Hello all,

Should any of you be interested in reading any of the papers which support the BSAVA policy statement please drop me a line. My job gives me access to most of the published evidence in this area and I am happy to provide copies.

Kind regards

Lucy

Re: Firework advice

JonB — Thu, 03 Nov 2011 14:39:01 GMT

[quote user="Jillian Hall"]

Going back to the concept of havng to decide between prescription or non-prescription options.

Firework season can last a long time these days. I will tend to suggest DAP (Sorry, Adaptil) or Zylkene to take the edge off over the whole period where kids are letting off bangers as soon as it starts to get dark. For the more severely affected dogs, by which I mean the more concerned owners, I am happy to supply prescription drugs for the Friday/Saturday nights surrounding Halloween and Bonfire night when firework displays are likely.

Based on some of the previous posts I won't be in a hurry to try Calmex on this basis.

[/quote]

For really badly affected dogs that live in an area where they will be exposed to a lot of fireworks, it is OK to give benzodiazepines daily for a couple of weeks.

The response to BZDs is idiosyncratic, so the client will need to trial different doses to find one that works best.

Re: Firework advice

Jillian Hall — Thu, 03 Nov 2011 12:28:00 GMT

Going back to the concept of havng to decide between prescription or non-prescription options.

Based on some of the previous posts I won't be in a hurry to try Calmex on this basis.

Re: Firework advice

JonB — Thu, 03 Nov 2011 11:54:12 GMT

[quote user="bob lehner"]

[quote user="robloxley"]

[quote user="James Laidlaw"]Can't ACP increase the risk of seizures as well?[/quote]

I thought this had been debunked?

[/quote]

I was told by an anaesthesia diplomate that the old myth that ACP should never be given to epileptic dogs was based on a very old and flawed paper, which has long been discredited.

Unfortunately it somehow got into veterinary folk-lore and has been passed down to generations of students.

[/quote]

There are two recent papers on this:

McConnell J, Kirby R, Rudloff E (2007). "A retrospective study on the use of acepromazine maleate in dogs with seizures". Journal of Veterinary Emergency and Critical Care 17 (3): 262–7

Tobias KM, Marioni-Henry K, Wagner R (2006). "A retrospective study on the use of acepromazine maleate in dogs with seizures". Journal of the American Animal Hospital Association 42 (4): 283–9

Both show no link between epilepsy and ACP.

Re: Firework advice

bob lehner — Thu, 03 Nov 2011 11:46:12 GMT

[quote user="robloxley"]

[quote user="James Laidlaw"]Can't ACP increase the risk of seizures as well?[/quote]

I thought this had been debunked?

[/quote]

I was told by an anaesthesia diplomate that the old myth that ACP should never be given to epileptic dogs was based on a very old and flawed paper, which has long been discredited.

Unfortunately it somehow got into veterinary folk-lore and has been passed down to generations of students.

Re: Firework advice

toby travis — Thu, 03 Nov 2011 10:55:32 GMT

Excellent tip from a client last night for Bonfire Night ..... they're taking the dog to Ireland for the weekend!

Re: Firework advice

JonB — Thu, 03 Nov 2011 09:09:48 GMT

Many years ago, ACP + Atropine was the standard premed.

David is very dismissive of the idea that ACP treated dogs still show emotional reactions, but I can remember how reactive dogs under ACP alone could be.

Dogs that were immobile and apparently fast asleep would suddenly try to leap off the table if something roused them.

An incident I clearly remember was when I accidentally dropped a pair of scissors into the metal sink under a dental table upon which the dog was awaiting induction; the noise wasn't very loud but the dog went potty! That dog was apparently well sedated.

Such dogs were distressed, agitated, ataxic and sometimes a real problem to deal with. Usually this subsided reasonably quickly if the dog was treated gently, but it showed that these dogs were able to respond to their environment.

Did anyone else have experiences like that?

I think that this kind of experience is where the caveats about ACP for fireworks stemmed from; anecdotal evidence only, mind you!

However, the recommendation against using ACP for acute management of noise phobic dogs is not based on the idea that even a fully sedated dog is still able to be anxious or fearful, because clearly there must be a point at which sedation induces insensibility.

The recommendation is based on the concern that avoidance behaviour (being able to move away from the source of fear and toward a place of safety) is a key aspect of coping, and successful coping is an important element of learning not to remain afraid of something. Depending on the dose, ACP can make a dog ataxic, disorientated or generally incapacitated enough that it is unable to move around and cope, despite being alert enough to respond to fearful stimuli.

Lots of the dogs we see are only mildly afraid of loud noises, and their owners just want something to take the edge off.

These are dogs that would probably respond quite well to most of the drugs that have anxiolytic effects, so they don't need to be sedated.

Some of them don't even need drugs at all, they just need the owner to leave the door to the cupboard under the stairs open and stop reinforcing the fearful behaviour!

We have so many options available now, that a one size fits all approach of sedating all noise-fearful dogs with ACP is probably not justifiable.

Re: Firework advice

JonB — Wed, 02 Nov 2011 19:18:50 GMT

Disinhibitory: tending to overcome psychological inhibition. A drug is described as disinhibitory if it is disposed produce such an effect, but there is no implied level of disinhibition. So I still don't see why you argue around the word "binary". What scientific evidence do you have that ACP produces less disinhibition at conventional dose rates than diazepam? Just asking, because I don't know of any. Don't ask me what evidence I have that they are exactly the same, because I am not making that claim.

So, you accept that animals may experience anxiety, but you don't believe that it is possible to say whether an individual animal is anxious?

This is because you don't accept that patterns of behaviour are specifically indicative of emotional states.

OK, I see what you are trying to say.

Unfortunately, plenty of human patients are unable to communicate for one reason or another, so they cannot communicate meaningfully about their emotions.

Likewise, people also lie and use terms incorrectly, so they may say they are anxious when they are not.

The capacity to describe oneself as anxious/in pain/afraid using any method of communication is not entirely reliable.

so, we subconsciously use behavioural indicators of emotional state when dealing with members of our own species all the time.

Whever you ask someone whether they are alright, you do so because you have observed some aspect of their behaviour.

The behavioural signs of anxiety and fear are, for example, subtly different and we all look out for this difference without even being aware of it.

Anxiolytic: the ability of a substance to alleviate emotional anxiety and stress. A drug that relieves emotional anxiety or stress is also called an anxiolytic. It's just a term to describe one characteristic of a drug (amongst many).

However, the effect of benzodiazepines on anxiety is not secondary to sedation.

There is absolutely no evidence that it is.

Likewise, there is no evidence at all that there is a dose of ACP that impairs cognition to such an extent that the animal has no ability to experience stress/anxiety etc. (other than when the dog is unconscious)

OK, you may not accept these as models of anxiety, but the point is that the animal's behaviour changes selectively without sedation.

In fact, some of the drugs that are used for emotional problems also enhance, rather than suppress, cognition (fluoxetine, selegiline).

The essence of using drugs to treat acute fear/phobia of noises should to reduce the emotional impact of the event whilst leaving the animal able to move around and function normally. It is not necessary to produce any sedation. If we can achieve a result without sedation, isn't that better?

Back to the curare example.

You say that titration to the point that the animal is "visibly settled" is the right approach because it produces the correct level of sedation. This assumes that your sedation=secondary anxiolysis idea is correct.

If it were possible to add a small amount of a curare like drug to your ACP, before you unknowingly wen on to dose the animal to what you call "effect", you might look at the animal's behaviour and incorrectly assume that it was less anxious because you think that you have obliterated its cognitive faculties. In fact, it is partially paralysed.

There is no perfect way to identify emotional state in any species, including man, but I don't think you are offering a solution; just more confusion based on ignorance.

Re: Firework advice

David Mills — Wed, 02 Nov 2011 18:27:36 GMT

I cannot decide if you are being deliberately obtuse or not, but here goes.

[quote user="JonB"]

Don't quite know what you mean about disinhibition being binary. I was just saying that ACP is also disinhibitory (i.e. it has the potential to disinhibit to a similar degree as a benzodiazepine)..

[/quote]

Binary is 1 or 0, yes? Your throwaway comment at the end of your last post, suggested because you put a label of disinhibitory on a drug then its either disinhibitory or its not, which is obviously claptrap because there are levels of disinhibtion, just like there are anaesthesia, drunkeness or being stoned. Many things including the animals physiological state explain this. ACP may well be disinhibitory but doing at the recommended rates is far far far more likely to give you sedative effects that disinhibition compared to benzos.

[quote user="JonB"]

I still don't find your argument about anxiolysis is convincing.

Do you believe that animals don't experience anxiety?
Do you believe that medication cannot reduce anxiety in animals?
Do you believe that behaviour is not evidence of underlying emotion?

[/quote]

No, no, no. Re read my post. Of course they have anxiety, feelings, emotions, a whole range, but to say a drug is specifically anxiolytic is preposterous (and yes, I'm aware I've used the term above but only for ease) because, simply, the animal cannot say "I am anxious". You can measure behaviours of animals but the most you can say is 'stressed' which encompasses a whole host of emotions, not just anxiety. It will be anxiolytic but with a whole host of other effects. The anxiolysis may well be to do with reduced, sedated, mentation. It's fundamentally inaccurate to argue whether a drug in anxiolytic or not (e.g. acp vs benzo) because when does an animal become non-anxious.

[quote user="JonB"]

Your "secondary anxiolysis" is a difficult concept to make sense of.

[/quote]

Evidently. Essentially, benzos do not JUST target anxiety. They are mild sedatives (sometimes) and this is their primary function - you are sedating the dog. AS A RESULT reduced neural processing reduces emotion. They therefore become less anxious and stressful stimuli produce reduced extremes of emotion i.e. anxiolysis is SECONDARY to SEDATION.

[quote user="JonB"]

At what point does a sedative reduce mental faculties to the level that the individual is incapable of perceiving its circumstances and experiencing emotion, and how far is this from complete unconsciousness?

Who knows? It certainly has no practical application.

[/quote]

Of course it does, because when outcomes reduce sufficiently that the animal is visibly settled, then you ahve the correct level of sedation. This is the whole essence of the idea of giving products to reduce firework phobias/fears.