We have a mixed terrier rescue who is about 11 years old. He’s had anxiety since day one.
He’s on amitriptyline, SAM E, and fluoxetine. He’s also on Pepcid, probiotics and Tylan powder.
He has reflux and chronic pancreatitis. His food is low-fat enteric kibble and we give him pumpkin three times a day with his medications. He was recently put on metoclopramide, which is working well, but his anxiety skyrocketed and he’s more clingy than ever.
The vet said there isn’t a good substitute so we either deal with him eating grass and feeling poorly or we deal with the increased anxiety. Do you have any advice?
—Jill, Woodbine
As a general comment, anxiety is a very common challenge for pet owners and we perhaps see it more frequently in rescues as we do not always know what their life was like prior to being rescued and how that may have contributed to their development.
In your instance, I do wonder to what degree, if any, the anxiety contributes to GI issues and pancreatitis. You mentioned that the anxiety has skyrocketed and so I am curious about what signs of anxiety your pet is exhibiting and how have they evolved or progressed in recent months.
Overall, his treatments are appropriate, although I might also consider a medication called sucralfate which can help coat the esophagus and stomach lining, which can become irritated with chronic reflux.
With that being said, I do wonder if the increased anxiety you have noticed could be related to cognitive dysfunction, also known as doggy dementia or sundowner syndrome, rather than solely attributed to his anxiety. In these cases, clients first seem to notice pacing and restlessness particularly in the evening, hence the nickname, sundowner syndrome.
Other potential indicators of cognitive dysfunction might include staring off into space or getting “stuck” in corners as well as a general increase in overall anxiety signs. If you feel like there may be a degree of cognitive dysfunction developing it might be worth touching base with his vet about medical options to manage those clinical signs.
Finally, most veterinarians tend to recommend behavioral modification plans, often through an animal behaviorist, when implementing the use of medications like fluoxetine as we see better management of clinical signs with a multimodal approach.
Ask The Vet is a weekly series by Dr. Devon B. Smith, a Baltimore veterinarian who is an associate at Madonna Veterinary Clinic in White Hall. Send your pet questions or photos via the forms below.
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