Pet Forum / Miscellaneous / Animal Health / June 2006

*snip*

Your poor baby.. I've never personally seen cyclosporin used, but here are
some listed side effects and long term reactions.

*The most common adverse effect of cyclosporine treatment is lack of
appetite. Other adverse effects include vomiting, soft or mucoid stools and
diarrhea.

*Prolonged use of cyclosporine can result in bacterial or fungal infection
related to suppression of the immune system. This allows microorganisms that
would normally be fought off to become disease-forming. It is recommended to
treat all such infections prior to initiating therapy.

*Long-term use can also promote the development of cancers, such as a cancer
of the lymph glands (lymphoma).

HOWEDY cheryl,

Adverse effects and interactions

Treatment may be associated with a number of potentially serious
adverse drug reactions (ADRs) and adverse drug interactions.
Cyclosporine interacts with a wide variety of other
drugs and other substances including grapefruit juice, although there
have been studies
into the use of grapefruit juice to increase the blood level of
cyclosporine.

ADRs can include gum hyperplasia, convulsions, peptic ulcers,
pancreatitis, fever, vomiting, diarrhea, confusion, breathing
difficulties, numbness and tingling, pruritus, high blood
pressure, potassium retention and possibly hyperkalemia, kidney and
liver dysfunction (nephrotoxicity & hepatotoxicity), and obviously an
increased vulnerability to opportunistic
fungal and viral infections.

EXXXCESSIVE self grooming / licking causes hairballs
and is caused by STRESS <{) : ~ ) >

Then it AIN'T a hariball, is it. Still could be stress.

Could be. Could maybe not be right for him.

That cat dander allergy might be due to stress from other kats.
Perahps you'll ask your veterinarian if you can bathe your kats
and rinse them with Downy Fabric Softener to reduce dander.

alt.med.veterinary, alt.animals.dog,
rec.pets.dogs.health,rec.pets.dogs.behavior,rec.pets.cats.health+behav
The Freakin Simply Amazing Puppy Wizard replied to your original
post a month ago. Below you'll find some more in depth information
which may heelp your kat. Please read the following dilligently  <{) :
~ ) >

Human_And_Animal_Behavior_Forensic_Sciences_Research_Laboratory

Subject:     Atopica use in cats?

From:        ThePuppyProp...@AniMail.Net - view profile
Date:        Fri, Dec 30 2005 9:44 pm

HOWEDY Cheryl,

                       A DOG Is A Dog;
                      As A KAT Is A KAT;
                    As A BIRDY Is A BIRDY;
                    As A CHILD IS A CHILD;
                  As A SP-HOWES Is a SP-HOWES;
             As A Mass Murderer Is A Mass Murderer.

Allergies are a SYMPTOM of a compromised auto immune system.

IOW, the allergens are only PART of the PROBLEM.

Simply removing ALL stress from your kat's life will
PROBABLY EXXXTINGUISH his allergy SYMPTOMS.

Here's HOWE to remove STRESS from your kitty kat's life:

                  <{#}: ~ } >8< { ~ :{@}>
           <{#}: ~ } >               < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
   <{#}: ~ } >  http://www.tinyurl.com/7bl5u < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
           <{#}: ~ } >               < { ~ :{@}>
                  <{#}: ~ } >8< { ~ :{@}>

You're welcome.

Lorna kemble wrote:

Cone collars DO NOT make dogs HAPPY, Lorna:

"Hennie van Dalen" <h.vandalen11***

emovethis...@chello.nl> wrote in message:

My dog (a 1 year old Yellow Lab) was biting his tail
at the root (Vet said his anal gland was blocked, and
was causing an itch).

After squeezing it, he still wouldn't stop biting his
tail. The vet advised a neck-funnel (don't know wat
you US-guy's call those) so he couldn't reach his butt.

I hate those things, i think they will drive a dog nuts.

I tried the wits end method. (difficult to read such a long
textfile if English is not your native language) Luckily this
is without all the "HOWE's" etc.so at least it's readable for
somebody like me.

The minute he started to bite i trew my key's
next to him on the floor, and praised him (he
stopped biting and looked up when he heard
the sound) I did this 7 times,

after that the tailbiting completely stopped.
Just give the wits end method a try.

One of the possible downloadlocations
is http://www.doggydoright.com/id3.html

Hennie van Dalen
www.chello.nl/~h.vandalen11

           ---------------

You mean INSTEAD of simply TRAINING the dog not to self mutilate?:

Disciple Paulie and Hennie REPORTED THEY CURED
THE SAME SAME PROBLEM NEARLY INSTANTLY using
EFFECTIVE SCIENTIFIC NON PHYSICAL Pavlovian /
Ericksonian CONDITIONING.

         LIKE THIS:

From: Paul B (a...@clear.net.nz)

Subject: Re: dog chewing he paw raw.
Date: 2004-01-01 22:19:01 PST

Both my dogs at some stage have licked a spot somewhere on
their bodies and I have always managed to train them to stop.
In all cases there was nothing wrong that licking would have
helped (Roz has had cut pads, stitches in her belly and skin
irritations, all tempting her to lick), none of their licking
has been due to any allergies. When I see the dog licking more
than normal I look at the spot to see whats there and decide
if a vet appointment is needed or to wait and see, keeping a
close eye.

To stop the licking I distract the dog and give it
some friendly banter, when it starts licking again I repeat,
usually after about 4 times the dog stops, for the moment at
least, if it starts again then repeat, before long the dog has
no more desire to lick that spot at all.

Paul

          ---------------

From: Hennie van Dalen Hennie van Dalen
www.chello.nl/~h.vandalen11

The same thing worked with my lab licking/chewing problem too.
He had an itch due to blocked anal glands and started chewing
and licking his tail at the root.

After the glands were squeezed, and the itch was gone he still
wouldn't stop. (because the place he chewed raw was itching)
After some training (roughly the same methode as yours) he
stopped.
--
Hennie van Dalen
www.chello.nl/~h.vandalen11
www.chello.nl/~h.vandalen11/fotografie/doggy-pictures/

                ------------

That'll make the dog VERY unhappy.

The use of aversives is an ABOMINATION, Lorna,
and DOES NOT train the dog to refrain from self
mutilation.

Oh. And THAT will endear the dog to his owner and
calm and teach IT not to self-mutilate, Lorna?

Oh. You mean IT DOESN'T WORK. Furthermore, as aversives
go, there's MUCH more EFFECTIVE aversives for occasions
when the use of an aversive for temporary puporses is
necessary to facillitate TRAININ the dog not to indulge
in dangerHOWES behaviors like chewing electric cords etc.

Does THAT train the dog not to self-mutilate, Lorna?

The original poster's PROBLEM is the result of an
EZily PREVENTABLE, opportunistic VIRUS, a stress
induced auto-immune DIS-EASE aka The Puppy Wizard's
Syndrome, a FACT not commonly known to veterinary
malpracticioners.

"Hennie van Dalen" <h.vandalen11***removethis...@chello.nl>
wrote in message news:TlsCb.2895$7U1.7896@amstwist00...

RTFM is age-old computer lingo.... It stands for "Read The
F***ing Manual" ;-) I used the manual and it works very good!

But it is a long text to read (76 pages printed on A4-size
paper) My lab is 1year old now, and teaching him something
new takes about 30minutes  (depending on what to teach
offcourse)

My other dog (a 7year old staffordshire terrier-mix) is a
bit slower in learning, but he is used to me calling him a
"bad dog"whenever he did something i didn't want him to do,
or it might be the age.

Sometimes it looks like Sam (the lab) WANTS to learn
something new: he wants me to bring along the can
filled with washers whenever we go for a walk. It is
a very "humane" way of teaching: the dog is allways
a "good dog", and never a "bad dog"

There is nu punishment or prong-collars involved.

For a fact i tought him to heel in 15min's without
beeing on a leach at-all !!! When he spotted a dog,
he used to run towards it, but now i tought him to
"ask permission" first, and to my surprise it worked!

My dogs never went to puppy-training (lucky for them),
maybe this helped too.

Manual can be found at http://www.doggydoright.com/id3.html

-- Hennie van Dalen www.chello.nl/~h.vandalen11
www.chello.nl/~h.vandalen11/fotografie/doggy-pictures

It's PATHETIC that the veterinary malpractice industry
is unaware / ignorant of EFFECTIVE SCIENTIFIC CONDITIONING
and IGNORES / DENIES the corrolation between STRESS and
CHRONIC DIS-EASE.

HOWEver, it's NOT unexpected, as to do otherWIZE would
EXXXTINGUISH 90% of their veterinary malpractice industry
i.e., the iatrogenic DIS-EASE BUSINESS <{): ~ ( >

Here's a EXXXCERPT from WON of the articles below:

Canine Acral Lick Dermatitis/Granuloma

While acral lick dermatitis (ALD/ALG) may be organic or psychogenic
in origin, this discussion will limit consideration to psychogenic
considerations.

A strong association appears to exist between licking and anxiety
in dogs. Other psychogenic associations include inadequate social
interaction, environmental stimulation, and opportunity for aerobic
activity. As with over-grooming in cats, ALD may also be associated
with displacement grooming in response to social or environmental
stressors.

Compulsive behavior or states of anxiety may contribute to ALD
in some patients. As with feline psychogenic alopecia, the
occurrence and incidence of correlative behaviors to ALD in
feral and wild canines is not known. *(On accHOWENT OF IT DON'T
EXXXIST in REAL LIFE).

Other Presentations

Other behaviors focusing on specific body parts which may be of
psychogenic origin include tail biting, flank sucking, preputial
licking, self-nursing, licking in the anal region, and foot licking.
Based on the evidence to date, these conditions represent the result
of a heterogeneous array of underlying conditions, rather than
specific dermatologic or behavioral diagnoses.

Attention seeking, displacement, self-injurious, compulsive,
and other anxiety-related behaviors may lead to the establishment
of these behaviors.

Seizure activity involving the amygdala and ventro-medial
hypothalamus can result in stereotypic, self-directed,
aggressive behaviors. The physiological sensation of pruritus
may share common biochemical origins with some anxiety states,
which support consideration of neuropsychodermatological etiologies.

                 Death Producing Ulcers:
       "Emotional Influences On Health & Behavior"
                Dr. George Von Hilsheimer

       Illness is directly related to depression and lack of
       adjustment, particularly to a new environment (Parens,
       McConville & Kaplan, 1966).

       A WIDE RANGE of PSYCHOSOMATIC or CORTICOVISCERAL DIS-
       EASES was surveyed by Wittkower (1965) to demonstrate
       the enormous importance of emotional factors in general
       health.

       Interview findings of emotional material (recently
       experienced hopelessness) pryor to biological
       examinations correctly identified 11 out of 19 with
       cervical cancer, and 25 of 32 who were cancer free
       even though psychological tests failed to discriminate
       these groups (Schmale & Iker, 1966)

       150 lung cancer patients showed significantly
       constricted expression of emotions. The had fewer
       childhood behavior problems, and lower neuroticism
       score than their cancer free controls. Heavy cigarette
       smokers who DO NOT INHALE are more apt to have LUNG
       CANCER. They, too, show LOWER neuroticism scores.
       Among heavy cigarette smokers poor emotional
       expression is as highly related to cancer as urban
       residence and is more important than a chronic cough
       or an air polluted environment (Kissen, 1966).

       A ten year observation of all the women who developed
       cancer in an isolated pupulation of 2,550 showed that
       they tended to be unstable or sub stable personalities
       characterized by melancholy and extraversion,
       especially marked with those of an undecided body
       build (Hagll, 1966). Personality dynamics effect both
       the development of cancer and it's SITE. Cancer
       may result from what appears to be a failure to grow--
       somatically, behaviorally and psychologically
       (Grinker, 1966).

       In 109 cases leukemia and lymphoma were associated
       with a number of losses or separations and with
       feelings of sadness, anxiety, anger or hopelessness.
       The PRIMARY FACTOR seems to be the shame and
       hopelessness of running out of psychological resources
       (Green, 1966). Cervical cancer patients are less
       emotionally responsive, more isolative, and less
       frequently diagnosed as having clinical neuroses than
       cancer free patients. There is NO CLEAR DIFFERENCE in
       their FEELINGS and ATTITUDES toward coitus (Rotkin,
       Qunk, & Couchman, 1965).

       Schmidt (1966) surveyed nearly 100 studies of
       behaviorally induced DIS-EASE in animals CONFIRMING
       and EXTENDING the DATA on PEOPLE. Behaviorally
       induced DIS-EASES tend to fall into two groups;
       (1) Hysteriform problems, which INCLUDE HYSTERICAL
       SEIZURES and FORMS of AGGRESSION as well as
       collective panic and epilepsies;
       (2) organic modifications, including functional
       difficulties and lesions affecting gastro intestinal,
       cardio vascular, respiratory, sexual, endocrine, skin,
       urinary, and neuro muscular systems.

       It is INTERESTING, and SLIGHTLY HORRIFYING,
       to note that the ONLY SCIENTIFIC RELEVANCE of
       the standard six hour school day that I have been able
       to detect in research is that Sawrey and Weisz quite
       by accident found that six hours on and six hour off of
       "EXECUTIVE  BEHAVIOR" in monkeys was the ONLY
       TIME STRUCTURE that INDUCED DEATH PRODUCING
       ULCERS.

                        --------------

                      Behavioral Dermatology:
          Acral Lick Dermatitis, Psychogenic Alopecia,
               Hyperesthesia, & Related Conditions
                        Vint Virga, DVM,
             Dipl. ACVB Behavioral Medicine for Animals
                  SM Veterinary Healing Arts, Inc.
                       New York / Newport

HOWEDY People,

Here's The Puppy Wizard's Syndrome. CAVEAT: The Amazing Puppy
Wizard DOES NOT CONDONE or ENDORSE the good Doctor's METHODS
for treating STRESS INDUCED AUTO-IMMUNE DIS-EASE aka The Puppy
Wizard's Syndrome.  He's ONLY a veterinarian and there's ONLY THREE
CURES for it and HE AIN'T GOT 'em.

Here's WON of 'em:

                  <{#}: ~ } >8< { ~ :{@}>
           <{#}: ~ } >               < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
   <{#}: ~ } >  http://www.tinyurl.com/7bl5u < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
   <{#}: ~ } >                               < { ~ :{@}>
           <{#}: ~ } >               < { ~ :{@}>
                  <{#}: ~ } >8< { ~ :{@}>

                     Behavioral Dermatology:
          Acral Lick Dermatitis, Psychogenic Alopecia,
               Hyperesthesia, & Related Conditions
                        Vint Virga, DVM,
             Dipl. ACVB Behavioral Medicine for Animals
                  SM Veterinary Healing Arts, Inc.
                       New York / Newport

Introduction

The practice of behavioral dermatology encompasses the
diagnosis and management of a etiologically diverse set
of disorders which phenotypically manifest with dermatologic
presentations. Not only are primary behavioral etiologies
included, but also primary dermatologic conditions with
secondary or contributory behavioral components.

It is not uncommon, for example, for veterinary or human
patients to experience anxiety, tension, or stress secondary
to chronic or acute dermatologic conditions. Ultimately, it
is the interplay between neurosensory, dermatologic, and
behavioral components which contribute to the manifestation
of clinical signs associated with psychocutaneous syndromes,
including:

Self injurious behaviors

Compulsive disorders

Stereotypic behaviors

Displacement activities

Other anxiety related behaviors

Attention seeking behavior

Sensory Neuropathies

Psychotic Illnesses

A diagnosis of self-injurious behavior in small animals
must meet the criteria of barbering or removal of hair
and/or abrasion, petechiation, or ulceration of any body
part using the teeth, tongue, claws, or an external
substrate (e.g. rubbing against a wall). A condition for
a diagnosis of SIB is that these behaviors must be demonstrated
repeatedly and consistently in the absence of any primary
dermatologic or physiologic condition.

In veterinary behavioral medicine, compulsive behaviors
may be defined as sequences of movements which serve no
obvious purpose or function and which occur repetitively,
out-of-context or at an excessive frequency or duration,
and in a relatively unvaried fashion. In most cases they
are derived from behaviors which are part of the animal's
normal behavioral repertoire.

While such behaviors in animals have been traditionally
referred to as stereotypies, to establish a diagnosis of
a compulsive disorder, the behavior must occur outside
of its normal context or at a frequency or duration which
exceeds that necessary to achieve a real or potential goal
and must interfere with the patient's ability to function
normally in its social environment.

Considering these criteria, it is evident that some patients
presenting to the small animal practitioner may meet the
conditions for both self-injurious behavior and compulsive
disorder.

Compulsive behaviors associated with dermatologic signs are
most commonly classified as grooming compulsive disorders,
although some may be neurotic in origin. In canine patients
these may include acral lick dermatitis/granuloma (ALD/ALG),
flank sucking, tail chewing (which may or may not be associated
with tail chasing), excessive chewing of the feet and/or nails,
and excessive scratching.

Other compulsive behaviors observed in canine patients may
be classified as hallucinatory (e.g. fly/light chasing, prey
searching, staring); locomotor (e.g. circling, tail chasing,
fence running); eating/drinking (e.g. fabric sucking, psychogenic
polydypsia, some picas); vocal (e.g. rhythmic barking, barking at
food or inanimate objects); or neurotic (e.g. vicious self-biting,
spontaneous aggression to humans).

In feline patients compulsive behaviors associated with grooming
include psychogenic dermatitis, feline hyperesthesia syndrome,
and excessive chewing of the feet and/or nails. Other compulsive
behaviors noted in feline patients may be categorized as in canine
patients as hallucinatory (e.g. prey chasing or searching, air
batting), locomotor (e.g. paw shaking, head shaking, pacing),
vocalization (e.g. repetitive howling / crying), or neurotic (e.g.
vicious self-biting, spontaneous aggression to humans).

A diagnosis of self-injurious behavior may be established
independent of compulsive behavior. In the author's experience,
a significant percentage of cases referred for consultation on
potential compulsive grooming behavior do not meet the criteria
for compulsive disorders.

Behavioral conditions presenting with dermatologic signs
exclusive of compulsive disorders include some attention-
seeking behaviors, feline hyperesthesia, and certain anxiety-
related behaviors.

Anxiety may be defined as an apprehensive anticipation of
future danger or misfortune accompanied by a feeling of
dysphoria and/or somatic symptoms of tension.

Anxieties may be internally or externally focused and may
be in response to real or perceived stimuli. Anxiety may
result from motivational states of conflict (the tendency
to simultaneously perform more than one type of activity)
or frustration (engagement in a sequence of behaviors which
cannot be completed because of physical or psychological obstacles).

Because of contributory factors of stress, pain, and pruritus
associated with many lesions, a primary diagnosis of a behavioral
disorder should only be made after thorough dermatologic and
medical evaluation. Even with a presumptive behavioral diagnosis,
after medical causes are ruled out, secondary dermatologic sequelae
may develop as a result of chronic trauma to the skin.

Neurochemistry

Although anxiety, panic, and phobia disorders are related,
different neuroanatomic models have been proposed for each.
Complex neurochemical mechanisms involving dopaminergic,
serotonergic, GABA-ergic, noradrenergic, and opioid systems
may be involved in the manifestation of these disorders.

Numerous clinical studies and case reports have explored
pharmacological manipulation of the above neurotransmitter
systems in patients with anxiety-related conditions with
varying results.

Differences in responses to pharmacotherapy may be reflective
of individual variations in neuroanatomic and neurochemical
function. Therefore, it is important that the clinician
consider the underlying motivational state and possible
neurochemical correlates when assigning behavioral diagnoses
and recommending pharmacologic and behavioral management.

Clinical Presentations

Evaluation of patients presenting for dermatological conditions
with suspected psychogenic components or origins should incorporate
not only a broad-based medical work-up but also a careful review of
the behavioral history and direct observation of the patient.

Table 1 provides a list of important considerations to address
in the behavioral history. A videotape of the patient exhibiting
any relevant problem behaviors recorded by the owner can provide
valuable clues to the practitioner.

Stressful Environmental Conditions

It is not uncommon for both veterinary clients and practitioners
to be concerned about "boredom" as a cause for compulsive, self-
injurious, or anxiety related behaviors. While an assessment of
boredom is anthropomorphic and most likely an oversimplification
of the stresses a patient may be experiencing in relation to its
physical and social environment, it is important and frequently
contributory to the patient's presentation.

Stressors, which may contribute to the manifestation of anxiety-
related, compulsive, and self-injurious behaviors, are noted in
Table 2.

Behaviors that may be elicited in response to stress include
changes in appetite, grooming behaviors, elimination patterns,
social interaction, and activity.

Attention-Seeking Behavior

A significant percentage of cases referred for evaluation of
compulsive or self-injurious behaviors are ultimately diagnosed
as attention-seeking behaviors. Animals can readily learn that
not only disruptive behaviors (e.g. barking, jumping, pawing,
nuzzling), but also less directly demanding behaviors (e.g.
limb/foot/preputial licking, chewing, scratching, sucking,
pawing) often effectively get the client's attention.

The clients may have historically tried a variety of approaches
to discourage such behaviors;

often such attempts include: varying degrees of physical and
verbal corrections, comforting the patient with physical touch
and verbal reassurances, banishment with physical and social
isolation, and ignoring the behavior to varying degrees.

As the animal persists in the behavior, clients typically
report that they eventually provide some form of attention;
in so doing, the behavior can quite effectively be reinforced.

It is important for the client to recognize that any form of
attention, even physical punishment, may serve to reinforce
the problem behavior.

In establishing a diagnosis of attention-seeking behavior, a
careful review of the history should reveal that the patient
will only demonstrate the problem behavior in the immediate
presence or close proximity of the client.

Observation of the patient at the time of consultation should
reveal the behavior is dramatically reduced or non-existent when
the clients (or, in some cases, all parties including the clinician)
are absent.

Feline Psychogenic Alopecia (Over grooming)

Psychogenic alopecia is characterized by excessive self-grooming
that is initiated or intensified by non-organic causes, or which
persists beyond resolution of an organic cause. The predominant
clinical sign is alopecia - particularly in the area of the medial
forelegs, caudal abdomen, inguinal region, tail, and/or dorsal
lumbar areas - in which medical causes have been ruled out.

Because cats may groom reclusively, excessive licking, biting,
scratching, or rubbing may or may not be observed by the client.
Barbering and/or frank alopecia may be the only dermatologic signs.

In other cases, self-mutilation with possible secondary bacterial
infection may be evident. Symmetrical alopecia of the caudomedial
thighs and ventrum may be observed. Lichenification and
hyperpigmentation may develop in chronic cases.

A dermatitic form (atypical neurodermatitis) characterized by
bright red, elongated, oval streaks or plaques may result from
extensive grooming behavior.

Physical examination reveals: (1) short, broken hairs which are
readily palpated by stroking the affected area against the normal
angle of hair growth; (3) remaining hairs do not epilate easily;
(4) microscopic evaluation of hairs reveal broken shafts; (5) hair
re-growth occurs normally and lesions heal with placement of an
Elizabethan collar, (6) significant amounts of hair upon fecal
examination.

Licking of the hair and skin, nibbling, biting, facial rubbing
of the forepaws, and scratching may all be observed in cats
exhibiting normal grooming behavior.

Although they regularly self-groom, specific times and percentages
relative to other behaviors are unknown for household cats. Beyond
such basic purposes as cleansing, removal of parasites, and
thermoregulation, grooming in cats may occur as a displacement
behavior (an activity that is performed out of context as a result
of frustration) in response to social or environmental stressors.

Displacement grooming may be rooted in anxiety and may serve
to lower arousal, deflect aggression from other individuals,
or provide some distraction for the cat.

While the occurrence of such behavior in feral or wildcat species
is not known, incidences of psychogenic alopecia have been noted
in captive wild cats. Psychogenic alopecia is reported to be more
prevalent in strictly indoor cats. A possible common variable in
both captive wild cats and indoor cats predisposing them to
psychogenic alopecia may be limited environmental stimulation.

A seasonal incidence, even in indoor cats, can result as a result
in changes in environmental and social stressors (e.g. accessibility /
visibility of other cats).

Feline Hyperesthesia Syndrome

Feline hyperesthesia syndrome refers to a complex of behaviors
which may include: (1) behaviors similar to those observed in
estrous females (e.g. increased motor activity, rolling, crouching
with elevation of the perineal region, vocalizations); (2) excessive
licking, plucking, biting, and/or chewing, particularly at the tail,
flank, anal, or lumbar areas; (3) rippling of the skin, muscle spasms,
or twitches (especially dorsally), which may be accompanied by
vocalization, running, jumping, possible hallucinations, or self-
directed aggression.

Affected cats tend to be difficult to distract from the behavior,
or, if successfully distracted, remain so for only a short period
of time.

As with feline psychogenic alopecia, environmental and social
stressors have been associated with this disorder. The cues or
changes precipitating the behavior may be endogenous. Cats may
present with clinical signs consistent with hyperesthesia without
evidence of alopecic or other dermatologic lesions.

Review of the behavioral history may further support a lack of
excessive grooming. Such cases support the hypothesis that this
complex of behaviors may represent a number of discretely different
phenomena. While not currently discussed in the veterinary literature,
based on clinical syndromes observed in human patients, it may be
worthwhile to consider hallucinatory, rheumatologic, or neurogenic
origins in future research.

Canine Acral Lick Dermatitis/Granuloma

While acral lick dermatitis (ALD/ALG) may be organic or psychogenic
in origin, this discussion will limit consideration to psychogenic
considerations.

A strong association appears to exist between licking and anxiety
in dogs. Other psychogenic associations include inadequate social
interaction, environmental stimulation, and opportunity for aerobic
activity. As with over-grooming in cats, ALD may also be associated
with displacement grooming in response to social or environmental
stressors.

Compulsive behavior or states of anxiety may contribute to ALD
in some patients. As with feline psychogenic alopecia, the
occurrence and incidence of correlative behaviors to ALD in
feral and wild canines is not known. *(On accHOWENT OF IT DON'T EXXXIST
in REAL LIFE).

Among domestic dogs, certain breeds appear to be over-represented -
Labrador retrievers, Great Danes, Doberman pinchers, German shepherds,
and some northern breeds - with some evidence of familial inheritance.
This may be reflective not only of a genetic component, but also
selection pressures placed on these breeds reflecting their affiliative
work and social relationships with humans.

Other Presentations

Other behaviors focusing on specific body parts which may be of
psychogenic origin include tail biting, flank sucking, preputial
licking, self-nursing, licking in the anal region, and foot licking.
Based on the evidence to date, these conditions represent the result
of a heterogeneous array of underlying conditions, rather than
specific dermatologic or behavioral diagnoses.

Attention seeking, displacement, self-injurious, compulsive,
and other anxiety-related behaviors may lead to the establishment
of these behaviors.

Seizure activity involving the amygdala and ventro-medial
hypothalamus can result in stereotypic, self-directed,
aggressive behaviors. The physiological sensation of pruritus
may share common biochemical origins with some anxiety states,
which support consideration of neuropsychodermatological etiologies.

Clinical Management

Considering the heterogeneous and potentially multifactorial
origins of compulsive, self-injurious, and anxiety-related
behaviors, clinical management should incorporate consideration
of environmental stimuli, social stimuli, the motivational state
of the animal, and underlying neurophysiological mechanisms in
developing a treatment plan.

A hypothesis incorporating the above, which can account for the
patient's dermatological and behavioral manifestations, provides
a rational starting point from which a program of environmental,
behavioral, and pharmacological management can be based.

Environmental Management

Since the patient's environment may frequently contribute to
the establishment of OCD, SIB, and anxiety-related behaviors,
it is important to manipulate the environment so as to eliminate
stressors and conflict-producing stimuli.

If this is not possible, systematic desensitization should
be employed to minimize the effect of the environment. Client
resistance is often encountered and creativity is often needed
when proposing environmental changes.

The client must be committed to proposed changes in the
environment before employing behavioral and pharmacological
management.

Behavior Modification

Counter-conditioning and desensitization provide the framework
of behavior modification. Counter-conditioning consists of
teaching the patient new behaviors which are incompatible with
the problem behavior. Since SIB, compulsive disorders, and
related behaviors are often based in anxiety, it is often most
effective to select for behaviors which encourage relaxation.

Desensitization consists of reinforcing the selected new
behaviors while very gradually introducing provocative
circumstances and environments. Clients commonly wish to
progress more rapidly than the patient can effectively
accept. Patience, consistency, and commitment on the part
of the client are critical for success to effectively
support performance of the new behaviors in the face of
increasingly provocative stimuli. For desensitization to
be effective the patient must accept the direction and
leadership of the client.

Deference to the client can be established through routine
and regular reinforcement of leadership on a daily basis.
This can be effectively and gently achieved through asking
the animal to sit for all routine interactions with the client
(i.e. receiving attention, love, meals and treats; grooming
and petting; interactive play; going outdoors / coming inside).

Withdrawal of attention is an effective, gentle correction for
failure of deference. In all phases of counter-conditioning and
desensitization, appropriate responses are effectively supported
with encouragement and small food rewards as positive reinforcement.
Rewarding the patient at any time when he/she is not exhibiting the
problem behavior and is relaxed can further support counter-
conditioning.

Massage therapy, when the patient is relaxed, can further
facilitate relaxation and encourage appropriate interaction
between the animal and client. The above techniques are not
limited to application in dogs, but can be effectively employed
with cats and other species with appropriate modification.

Client responses to the patient, particularly when they are
performing the problem behavior, can be problematic. Despite
their history and experience of the problem behavior, the
client should never express their frustration in any way in
the presence of the patient.

Doing so may reinforce any anxiety which the animal may be
experiencing. Neither should the client provide any measure
of comfort - verbal, physical, or emotional - to the patient
while performing the problem behaviors. Attention-seeking
behaviors are based on the response of the client or, in some
cases, other people. Attempts to distract the behavior or even
aversive responses may be preferred by some animals and may
reinforce the observed behavior.

Interactive activity and opportunities for aerobic exercise
can be critical components of behavioral modification. Exercise
and mental stimulation in cats can be encouraged with a bit of
creativity. Opportunities for environmental and social enrichment
may include: augmenting accessible three dimensional space;
adding window perches, sisal wrapped scratching posts, and
"kitty condominiums"; varying the location and availability of
limited resources (e.g. resting places); providing an ample
variety of both purchased and homemade toys; scattering food
into small portions throughout the house or employing intermittent
feeding devices; playing with clients utilizing "fishing lure" type
toys, laser pens, and other stimulating games; and training "trick"
behaviors through shaping with a secondary reinforcer (e.g. clicker).

Agility, fly ball, and freestyle provide dogs the opportunity for
interactive, aerobic activity with the clients beyond traditional
activities such as field work, sheep herding, Frisbee tossing, ball
retrieving, and running / jogging.

Interactive exercise can facilitate desensitization to anxiety
producing situations by expose the dog to a variety of potentially
provocative stimuli while providing something else on which to focus.

Interaction with the dog in such activities also provides something
to which he/she can look forward, encourages mental and physical
agility, and serves to enhance the relationship between the dog
and the client.

Pharmacologic Support

Rational use of pharmacologic support can substantially enhance
the effects of behavioral and environmental modification in
patients with anxiety-related behaviors, compulsive disorders,
and SIB. Management of patients diagnosed with attention-seeking
behavior should be limited to behavioral and environmental
modification unless the underlying motivation is based in anxiety.

Pharmacotherapeutic agents should be selected to specifically
address the motivational state of the patient and a proposed
underlying neurophysiological mechanism of action. With few
exceptions, the application of psychotropic medications to
veterinary behavioral medicine constitutes extra-label use.

It is important to note that extra-label use requires compliance
with pre- medication data bases routinely used in human medicine.
Hepatic metabolism and renal clearance of these compounds further
supports pre-medication assessment of serum biochemistry, CBC, and
thyroid function.

Psychotropic medications, as a category, may affect thyroid
hormone concentrations, potentiate cardiac arrhythmias,
potentiate epileptiform seizures, and increase hepatic enzyme
activities (particularly SAP). Practitioners are well advised
to become familiar with the specific indications, contraindications,
side effects and pharmacodynamics of psychotropics which they
wish to employ.

Amitriptyline (Elavil®) and doxepin (Adapin®, Sinequan®) are
tricyclic antidepressants (TCA's) which are utilized in human
and veterinary medicine as an anxiolytics. Both exert their primary
clinical effects by inhibiting the pre-synaptic reuptake of serotonin
and norepinephrine to varying degrees. Both have antihistaminic
properties brought about by their ability to block H1 and H2 receptors.
Amitriptyline equally affects H1 and H2 receptors while doxepin is much
more selective for H1 receptors. These medications, particularly
amitriptyline, also effectively block muscarinic cholinergic receptors
resulting in anticholinergic side effects. Additional reported side
effects include weight gain, transient sedation (particularly in cats),
gastrointestinal disturbances, potential cardiac conduction
disturbances and a suggested role in sick euthyroid syndrome at higher
doses.

Contraindications may include hepatic, renal, or cardiac
disease. This class of drugs should not be administered concurrently
with MAOI's, selegiline (Anipryl®), or L-tryptophan. Amitriptyline
is a first choice medication for anxiolytic therapy because of the
relative cost and rate of clinical response relative to most
psychotropic medications. It has distinct disadvantages of having a
particularly bitter taste and a narrow therapeutic index associated
with a high rate of toxicity with overdose. For patients in which
dermatitis, neuralgia, or pain is associated with an anxiety related
condition, the antihistaminic properties of these compounds combined
with their noradrenergic effects (and the potential role of
norepinephrine in managing neurogenic inflammation) can prove to be
quite effective in managing clinical signs.

Clomipramine (Clomicalm®) is a TCA which is relatively more
serotonergic and less anticholinergic than previously mentioned
medications. Clomicalm® has been approved by the FDA for use in dogs
in the management of separation anxiety and may be an effective aid in
the management of other anxiety-related behaviors. Clomipramine is also
the only TCA which has documented efficacy in the management of
compulsive behaviors in both humans and animals. As a tricyclic
antidepressant, potential side effects and contraindications of
clomipramine are similar to those of other medications in that class.

Fluoxetine (Prozac®) and paroxetine (Paxyl®), as selective serotonin
reuptake inhibitors (SSRI's), share a common mechanism of action of
being serotonergic without substantially affecting the reuptake of
norepinephrine or dopamine. The relatively specific action of SSRI's
is associated with fewer side effects. Adverse effects reported with
SSRI's include increased anxiety, restlessness, insomnia, weight
loss, gastrointestinal disturbances, and alterations in cardiac
conduction. Despite the relative serotonin specificity of SSRI's
compared to clomipramine, they appear to be equally effective in the
management of OCD. As with TCA's, SSRI's should not be administered
concurrently with MAOI's, selegiline, or L-tryptophan.

Contraindications may include hepatic, renal, or cardiac disease.
Paroxetine is the most potent SSRI available, but it does have some
anticholinergic effects. Metabolism of paroxetine is unique in that
almost no active metabolites are produced. This feature may favor the
administration of paroxetine in elderly patients or animals with liver
or kidney disease.

Table 1: Important Considerations in the Behavioral History
Detailed description of the patient's behavior immediately
prior to, during, and after eliciting problem behavior
Chronology, incidence, and progression of problem behavior.

Ease with which problem behavior may be interrupted and
tendency for return to behavior Locations, circumstances,
and potential eliciting stimuli associated with the problem
behavior Review of other problem behaviors Review of home
environment including all persons and animals in household
Presence of the client(s), other people, and other animals
in relation to animal when behavior occurs Responses of the
client(s), other people, and other animals in relation to
the problem behavior Patient's background including adoption
source, familial history, early temperament/behavior of patient,
and history of obedience work.

Interactions with familiar and unfamiliar household guests
Dietary history including consideration of who feeds patient
and review of feeding schedule Daily routine of patient in
relation to other human and animal members of household
Specific types, amount, and frequency of exercise Specific
form, duration, and frequency of interaction with client(s)
and other people Notation of sleeping location and favorite
resting places Review of medical history with notation of
any current medications being administered

Table 2: Potential Environmental & Social Stressors Inadequate
mental stimulation Inadequate aerobic exercise Inadequate
interaction with family or other pets Limited access to
essential resources Social Isolation Overcrowding Status-related
conflicts Territorial-related conflicts  Addition or loss of
family members or pets Changes in health status of family members
or pets Changes in daily routine of family members or pets New
home / environment Changes in physical environment Boarding
Hospitalization