Beyond Training: The Medical Side of Aggression with Dr. Maggie O'Brian

Episode Transcript
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Speaker 1 (00:02):
In this episode I sit down with Dr Maggie O'Brien,
who is one of North Carolina'sfew board-certified veterinary
behaviorists, to explore whatday-to-day looks like in a
clinical behavior practice.
From navigating complexmedication cases to supporting
overwhelmed caregivers, maggiebrings a wealth of insight into
the evolving field of veterinarybehavior.

(00:23):
Maggie brings a wealth ofinsight into the evolving field
of veterinary behavior.
We dive into emergingtreatments, the growing
recognition of pain as a rootcause in behavior cases and the
nuanced conversations that comewith helping both pets and their
people.
If you've ever wondered what acomprehensive, medically
informed approach to behaviorlooks like, this conversation

(00:43):
offers an inside look into theheart of that work.
And before we jump into today'sepisode, a quick heads up If
you're looking to learn moreabout helping dogs with
aggression issues, head on overto aggressivedogcom, because
we've got something for everyone.
For pet pros, there's theAggression and Dogs Master
Course, which is the mostcomprehensive course available
on aggression anywhere in theworld, and it's packed with

(01:05):
expert insights and CEUs.
For dog guardians, check outReal Life Solutions, a practical
course for everyday challengeslike leash reactivity, resource
guarding and dog-to-dogaggression.
And if you want full access toexpert webinars, live mentor
sessions and exclusive discounts, the Ultimate Access Membership
is just $29.95 a month.

(01:26):
You'll also find info on the2025 Aggression and Dogs
Conference happening inCharlotte this September.
That's all at aggressivedogcom.
Check it out after the show.
Hey everyone, welcome back tothe Bitey End of the Dog.
This week, we have a veterinarybehaviorist with us, and you

(01:48):
know how we love our veterinarybehaviorists.
On this show, dr Maggie O'Brienis joining us and we're going
to be diving into a lot ofdifferent topics.
When I was talking to Maggiebefore the show, I was like I
have a wishlist of questions andtopics I want to dive into and
she's like, yeah, sure, noproblem, so I'm excited to have
Maggie here.
Welcome to the show.

Speaker 2 (02:08):
Yes, thank you so much for having me.

Speaker 1 (02:10):
So just to give the listeners a little bit about
what you do on Daily Retune,I've given everybody your
background in terms of youracademic degrees and all the
letters after your name, buttell us a little bit more about
like a day in the life of yourpractice and what you're
focusing on now.

Speaker 2 (02:26):
Yes, so I am primarily in the clinical world,
meaning I work with patients ona day-to-day basis.
So we have a standalonepractice in Charlotte, North
Carolina, where we see dogs andcats for behavioral concerns.
So it's myself and I have awonderful resident and we have a
wonderful team including sometrainers and support staff and

(02:46):
things like that.
So on a day to day we just seedogs and cats for their behavior
concerns and then we also havea virtual branch so we work with
a lot of patients all over thecountry through video calls and
things like that, so we're alsoable to help, again, dogs and
cats with behavior concerns allover.

Speaker 1 (03:05):
Amazing and the difference here between you and
some of my other veterinarybehavior guests is that you are
just straight on all clinically.
You're working with patients,because I know a lot of
veterinary behaviors are alsodoing research.
They're teaching atuniversities, seeing some
caseload, but your caseload mustbe massive because that's what

(03:26):
you're focusing on strictlycorrect.

Speaker 2 (03:29):
Yes, so we see.
I mean it depends on kind ofhow many rechecks we see in a
day versus new appointments, buttypically we'll see anywhere
from like three new appointmentsand then three rechecks a day,
or sometimes the ratio isdifferent from that, but it is
just all patients all day, whichis very fun.
That's why I got into this.
I just like working with peopleand helping individual animals.

Speaker 1 (03:50):
Yeah, that's interesting because that was a
question I was going to ask you.
So what made you lean in thatdirection?
So you were like I just don'twant to do any research, I want
to stay out of the universitiesand I just want to be in there
with the patients, or was theresomething else?

Speaker 2 (04:07):
I think some people really thrive and love academia.
I was never wildly drawn to theacademic world or academia
world, I should say Veryobviously drawn to the academic
world, but I just always gotinto this to help specific dogs
and cats and their families, andso that's just what I find most
rewarding.
So that's what I've honed in on.

Speaker 1 (04:27):
That's fantastic, and you know I'm going to pick your
brain about so many differentaspects of cases.
So, but first, is thereanything kind of new and
exciting?
In the veterinary behaviorworld?
We always get lots of reallygreat insights, especially again
from the academics, but alsothose in practice and finding
new insights with meds ordifferent protocols.
What's top of mind for you?

(04:47):
Anything kind of new andexciting that might be coming
across the trainers' desks atsome point?

Speaker 2 (04:53):
I think there's always a lot of things that
people are thinking about or arecoming up more and more
commonly.
Certainly they've been aroundforever.
But things like being concernedabout pain as a component in
the cases we see and kind ofwhat pain options we have for
dogs how much does that playinto their behavior or in cats'
behavior?
There's a lot more I would sayinventiveness with how we can

(05:18):
sedate certain dogs in aveterinary setting if they are
very fractious, fearful in thatsetting.
So that's been really fun morerecently to work very hands-on
with trainers and get planstogether to get these dogs seen
in a vet clinic that maybehaven't been seen in years.
So that's been exciting.
Recently there's some coolresearch coming out about
caregiver burden, specificallypertaining to behavior cases.

(05:41):
So how stressful is it to havea dog with behavior concerns or
have a cat with behaviorconcerns for the owner, for the
people working with the owners?
So there's always lots of newstuff and exciting things.

Speaker 1 (05:53):
You're speaking my language, because actually I've
kind of seen the same phenomenonin the behavior, consulting,
training side of things withregard to pain, as well as the
caregiver side of things.
But the many more people,including dog guardians, pet
guardians, are becoming aware ofpain, I don't know kind of
where that really like.
We started to see that shift.

(06:14):
I think it's been a little bitof a concerted effort from lots
of different organizations fromthe veterinary side, the
fear-free community, the trainerside, social media and some
trainers pushing things outthere.
Canine arthritis management outin the UK.
There's a lot of greatresources helping educate the
masses and a lot of peoplereference Dr Danny Mills' study
on the pain and underlyingmedical issues, the high

(06:36):
prevalence of it, right.
So yeah, I'm very excited tosee that and, on that note, we
could talk about some of thepain meds, maybe as especially
as of late, so Labrella beingone of them as being
controversial and something wecould talk about.
But let's dive into that sideof things for a second.
It's just pain meds, what youwould typically recommend, pain

(06:58):
trials like.
There's a lot of new stuff tokind of wrap our heads around.

Speaker 2 (07:02):
Yeah, and it's such a prevalent problem that we'll
see in our patient populationand whether they come in, the
owners are very aware that theirpet is painful but more often
there's not an awareness thatthe dog might be in pain or the
cat might be in pain and thatcontributes to a lot of behavior
problems.
Just not as directly as the catis limping, the dog is limping.

(07:24):
It's more.
The dog is touch sensitive orthey're having out of character
behavior at an age we wouldn'tanticipate or they're having
aggressive behavior at a youngerage than we would anticipate.
So whenever dogs don't quitefollow the rules, we want to be
specifically concerned aboutpain and obviously it should
always be on our radar.
But as far as treatment optionsand kind of what we do when we

(07:46):
suspect that a dog might bepainful, we always try to get
them to consult with or kind ofgo back to primary care and
consider working dogs up to thebest of our ability for physical
issues or cats up.
I keep leaving our cats out buttrying to work them up
physically.
A lot of times it's superhelpful to even if we're really

(08:07):
suspicious of pain or if theydid initial things that indicate
that the pet might be painful,we really try to onboard another
specialist, such as a rehabveterinarian or neuro or ortho,
depending on what the problemsare, but really trying to have a
team approach.
And then really nice, now thatthere's so many treatment
options for pain, just kind ofan ever-expanding pool for us

(08:31):
too.

Speaker 1 (08:32):
Could you talk about the prevalence of any particular
issues, pain issues, are youseeing an increase in anything
arthritis or any other trendswhen it comes to that,
especially in the US with thedogs, and maybe you could talk
about breeds in that regard?

Speaker 2 (08:47):
Yeah.
So I don't know if there's anincrease in prevalence, but
there's certainly an increase inawareness, I would say, of dogs
that are painful.
So NC State had a study where Ithink it was 25, 20 to 25% of
dogs under four have arthritis.
So we're just learning to notfocus on.

(09:08):
This dog is 10, we should thinkabout arthritis If a dog is two
.
It should be at least on ourradar of.
Is there possibly a medicalcomponent, such as pain, playing
a role in this dog's behavior?

Speaker 1 (09:22):
I wonder how much of that has to do with breeding and
structural characteristics.
Do you know if this study waslooking at that by any chance?

Speaker 2 (09:30):
That one was a mix of breeds.
I don't think they pulled outany specific one and that was, I
believe, more like people thatwork at NC State or are
associated with it and volunteertheir animals for it.
But there's certainly you know,certain breeds that were going
to be automatically.
Oh, do there's?
Certainly you know certainbreeds that we're going to be
automatically.
Oh, do you have this?
You know you're a GermanShepherd.
Do you have back pain?
You're a golden retriever.

(09:52):
Do you have hip issues?
So we certainly have more breedpredispositions towards certain
issues that we want to be awareof, but we also don't want to.
Oh, you're not a golden, soyour hips are fine.
You know.
We don't want to be approachingthings that way either.

Speaker 1 (10:05):
Yeah, yeah.
So talk to us about Labrellanow.
That's made the rounds onsocial media lately and people
are concerned and what is yourinsight there?

Speaker 2 (10:14):
Yeah, so Labrella is still fairly new.
It came out in 2023, I believeand so it is an anti-nerve
growth factor.
So nerve growth factor plays arole with arthritis and
inflammation and then, obviously, further down the line, pain
awareness.
So it's been in the UK for alittle bit longer than in the US

(10:35):
.
It has shown to be very, veryhelpful for dogs.
Certainly, clinically, we havemany cases that have a
significant difference, I wouldsay, in outcome based on being
treated with labrella.
There are side effects that arebeing reported.
So increased drinking,increased urination is now, I

(10:55):
believe, officially on the labelfor it.
And then there's some kind ofmounting concerns about
neurologic issues.
It's just very difficult to sayat this point if it is a kind
of a causative issue.
You know, do they get reallycomfy and active and then they
do something to their back,that's, you know, because they

(11:15):
were so much more comfortableand they were more active than
they had been in a really longtime or is there kind of a more
concerning connection there?
And it's just so early thatit's hard to say.
And I think it's tough becausethe population that's being
treated are primarily seniorpets.
Senior pets are going to have ahigher likelihood of developing

(11:36):
scarier things.
So how much is that associated?
So I think it's an excitingaddition to our ability to help.
So I think it's an excitingaddition to our ability to help.
Ironically, in the behaviorworld, it's an injection once a
month.
So we see these dogs where it'slike man, we'd love to try
Labrella on you.
But realistically, withoutonboarding a team to help, how

(11:58):
do we get monthly injectionsinto this dog in a realistic way
?

Speaker 1 (12:00):
So yeah, yeah, how do you navigate conversations with
your patients, your patients,caregivers, in terms of let's
use LaBella as an example, ormaybe when the benzo dies?
I mean, they read something andthey're like, oh no, that's
like terrible.
And it's especially somethinglike this, where we don't the
data is getting there, but wedon't have anything robust or

(12:20):
anything that's definitive.
There's concerns about it,right, and so maybe that
caregiver is concerned.
At the end they say well, drO'Brien, I don't know, I heard
about this and then, and youknow that that particular med,
whether it's for behavior orpain or anything, is going to be
probably the best option forthat dog.
How do you convince that typeof concern?

Speaker 2 (12:41):
So we try to never talk someone necessarily into a
treatment that they are veryhesitant to pursue, whether it's
an anti-anxiety medication orif it's something that's
strictly pain management.
So if there's true like I'mreally scared of this, I don't
want to do it, then it's kind ofa full stop.
We'll explore other options.

(13:02):
Of a full stop, we'll exploreother options.
If it's more just that theyhave questions about it, then
we'll kind of talk more aboutprevalence.
You know, with behavior medsthe incidence of side effects
would be typically insanely low.
So is your dog going to be this?
You know one out of how manythat has a weird side effect,
potentially, but it's just solow that typically the main

(13:23):
focus is pros versus cons and inthe majority of cases the
potential pros are going tovastly outweigh the potential
cons.
And that's true of anymedication that any of us ever
take.
You know when they whisper theside effects at the end of your
ads, you know, and really fast.

Speaker 1 (13:39):
Yes, five times speed , yes.
So, speaking of the caregiverside, you know we have caregiver
burden and I imagine so many ofyour conversations are
considering that side of theequation.
So we're talking about, youknow, a person navigating.
Do I give my dog this med andpossibly they could be impacted

(14:02):
by this particular side effector this issue or this
disinhibition or something I'mreading about or something
somebody told me about, and then, at the same time, if it's a
profound aggression issue with alongstanding history, there's
also obviously the ramificationsfor that.
So talk us through some of thethings you've learned over the
years when it comes to difficultconversations like that with

(14:24):
patients, and you know some tipsand tricks that may be helpful
for the rest of the listeners ingeneral, but also the trainers
and consultants listening in.

Speaker 2 (14:33):
In terms of them being concerned about meds or
just their stress level overbehavior problems.

Speaker 1 (14:39):
It's kind of a broad question.
I didn't give you any specificsthere, but.
I'm kind of looking for yourinsights in the human side of
your consulting.
What has been some of yourbiggest takeaways over the years
?
Like wow, I used to have thisproblem with convincing a person
to do this or having thatdifficult conversation about
potential outcomes or how a medcan be important.

(15:00):
So it's a general sort of broadquestion about, like anything
that, any insights you mighthave that you've learned when it
comes to talking to the humans.

Speaker 2 (15:09):
Yes.
So we do put our kind oftherapy hat on every, you know,
fairly frequently and some weeksfeel like that's, you know, a
heavier part of our job than anyother part of our job.
But I would say that I try tooutline our overall goals for
patient care.
So we want the dog to be happyenough with the plan we're
laying out, or the cat to behappy enough with the plan we're

(15:32):
laying out.
We want the plan to be feasiblefor the owner.
So I tell people, you know, ifthis plan takes over two hours
of every single one of your days, it's not an appropriate plan.
So we need to figure outsomething that works for that
individual.
And then the biggest thing,because we deal with so much
aggression, is that we need theowner to feel safe enough with

(15:54):
the situation that we're livingwith.
So they need to feel safeenough for themselves, for the
pets around them, for thecommunity around that pet.
So I tell people, on any ofthose three things, if we're not
feeling like we're hitting youknow where we need to then we do
need to have a biggerdiscussion about does this
obviously?
Does it mean we change the plan?

(16:14):
Does this bring up biggerquestions for you about?
Are we going to be able to keepthis pet in the home?
If we can't keep the pet in thehome, what are our options
there?
Because that's a whole notherconversation.
So I try to just lay out thosemain goals and then emphasize
hey, if we're not hitting thesethings, you need to let me know
so we can kind of regroup.

Speaker 1 (16:33):
I love that.
You've kind of, in a way,you've learned like a system of
navigating conversations, right?
So you get to a certain stagein a conversation, you kind of
know where it might go.
And that's tough because youhave limited time in a consult,
right, you're not going to spendeight hours getting to know
every single detail about thisperson as well as their case, so

(16:53):
you have to be really efficientin that time.

Speaker 2 (16:56):
Yes, and luckily we do have people fill out a lot of
paperwork ahead of time.
And then it does includequestions like have you
considered rehoming?
Have you considered euthanasiafor this behavior problem?
So having that helps navigatethe conversation because
sometimes on paper I'll think,well, this might be a behavior
euthanasia discussion case, andthey put no.
Think, well, this might be abehavior euthanasia discussion

(17:17):
case, and they put no, no, noteven interested.
So I know, hey, we're goinginto this with a plan of how to
make things better.
Sometimes you'll see cases whereit's like, yeah, we're really
at the end of the road here andwe know, okay, we need to talk
about that on a bigger pictureduring the appointment.
I think the trickiestappointments are the ones where

(17:37):
we see a case that feels morepotentially dangerous or more
serious than the owner is reallyaware, particularly like in a
young dog with you know, if yousee a nine month old that's
starting to growl at everybody,or if you see if we're starting
to see things where it's likethis is going to be a really
challenging case.
These are people that are goingto have a young kid in the next

(17:58):
couple of years.
Those conversations are alittle more challenging because
you just know you're going tobum them out.
It's not the right word, but itis.

Speaker 1 (18:05):
You're going to kind of you know.

Speaker 2 (18:06):
Give them news that they maybe aren't anticipating
about how difficult things canbe with some of those guys.

Speaker 1 (18:18):
That's got to be really difficult too is having a
.
It's inevitable, right?
We're going to have someperiods of our career.
We're going to have a higherpercentage of those kinds of
conversations.
So what do you do in thosetimes when it's like, oh gosh,
it's one bad I'm not going tosay bad, I'm going to say
difficult conversation, oneright after the other, where
you're having to help the clientsee the reality of their
situation.
What do you do to kind of helpyourself with that reality?

Speaker 2 (18:38):
of their situation.
What do you do to kind of helpyourself with that?
I generally don't mind I mean Idon't obviously don't enjoy
making people feel kind ofbringing up issues that they may
not have been aware of.
But I enjoy the aspect of, youknow, being able to be
empathetic and say, hey, I knowthis is not what you anticipated
when you acquired this dog youhad, this was going to be your
brewery dog, you were going togo on group hikes, you know, and

(19:00):
we need to adjust what ourgoals are overall with this pet.
So I think I enjoy helpingpeople in that regard, even
though they're tougherconversations.
So I don't necessarily feellike they you know I carry them
home or things like that Cause Ido genuinely enjoy helping
people with those conversations.
That might just be my own weird, unique thing, but so yeah,

(19:23):
yeah, no it's.

Speaker 1 (19:24):
It's definitely not for the faint of heart when you
have to have that many it's, itcan make for a tough week or a
tough month sometimes, rightyeah, and luckily the you know,
the really heavy ones are notnot wildly common.

Speaker 2 (19:37):
and I try to tell people like we're not doomsday
prepping here, we just want tobe aware.
You know, as your dog getsolder, if you notice new things,
if you see escalation, we needto be aware of that and this is
what we're here to do to help.
And so I think always endingwith you know, this is these are
all the things we're going todo to try to improve the
situation and get things in abetter spot.

(19:58):
So I try to always have a levelof optimism, you know, as much
as it allows.

Speaker 1 (20:04):
Yeah, yeah.
So just to back up a second.
So you have this.
Really, this sounds like a niceintake form or a way of getting
some information.
Does that contain elements of,like, a caregiver burden score?
I think it's a CBI or thatparticular tool.
I'm seeing that used more inthe veterinary field.
Is that something that you findcould be helpful or is that

(20:24):
something you use?

Speaker 2 (20:26):
So we do not, and there's been conversations about
whether we should includethings like that.
Obviously, we are not humanmental health professionals, so
I never want to dip my toe in anarea where it doesn't belong,
and so I think just personallypart of my potential concern
there is okay.
Well, if they come back withthis form that says they're

(20:47):
really struggling, I'm not theright person to talk to you
about if you have serious mentalhealth concerns.
So I think that's been a littlebit on the mind is are we
opening the door for people tofeel like we're the appropriate
person to reach out for, forcare?

Speaker 1 (21:06):
Interesting point.
Yeah, it's almost like you needto add another disclaimer there
with a little checkbox.

Speaker 2 (21:11):
You know yeah like if you're struggling.
And the nice thing is, socialwork and veterinary care has
definitely expanded and justresources for people that are
living with pets with behaviorproblems have wildly expanded.
So we have resources now wherewe can say, hey, this is really
hard, this situation is reallyhard.
Here are all these excellentresources that can provide help
and we're here to help too, butthere's people that that's their

(21:34):
main is to support the humanside of things.

Speaker 1 (21:38):
Yes, I'm really happy to see that aspect of it coming
into the field for not onlyveterinary social workers but
also for professionals to helppet parents know kind of how to
navigate the after or even theduring of a difficult situation.
So I'm really happy to see thatof a difficult situation.
So I'm really happy to see that.

(21:59):
I know Valerie Bogey as well asMarlene LeBurge are a couple
that I've brought in for variousaspects of the aggression space
to talk about their expertisein that and it's good to see
that because it's so badlyneeded right.
For both sides, for both thepatients as well as us as
professionals.
So, yeah, Okay, I know whatkind of this is what happens to
me.
I have so many questions thatcome up as we're talking that I

(22:19):
tend to jump around a little bit.
But I want to jump back alittle bit on the meds topic and
get your opinion on, sincewe're talking about questions
from caregivers and you knowwhich meds should I use and what
is all this informationswirling around on social media?
But let's talk aboutover-the-counter or things that
people can get without aprescription.
So CBDs or pheromones, thosekind of products.

(22:41):
What are your thoughts andopinions on those type of
recommendations?

Speaker 2 (22:45):
Yeah, so there's a fairly big nutraceutical world
in veterinary behavior, justbehavior in general.
So nutraceuticals would be yourpheromones, your supplements
like zilkene and all of thoseoptions that are available over
the counter for people.
Cbd is certainly one of thoseoptions that people will reach
for.
The jury is still a little bitout in terms of the dosing for

(23:09):
CBD and can you find a safe doseto help with behavior.
There's more informationavailable with CBD in the pain
world, in the seizure world.
So clinically I would say, whenwe have patients that are taking
CBD, it's typically becausetheir rehab veterinarian
recommended it, for pain is theprimary reason we ever have pets

(23:32):
on it.
I do think I have a slightlyunfair view of the nutraceutical
world because usually by thetime that we see cases it's like
I've tried that, I've tried,we've done that, so they've
usually failed.
A lot of those things that arelikely very, you know, could be
very useful in a certainpopulation, I just don't find it
as applicable to the majorityof the population that we see.

(23:56):
We certainly reach for them,not infrequently, but more often
we're discussing prescriptionmedications.

Speaker 1 (24:04):
I'm gonna answer, or respond to this one carefully.
So I get the same question alot as a trainer or consultant
and of course the right answeris ask your veterinarian or a
vet behaviorist.
But in terms of anecdotalexperience, similar.
They've tried, but when they,by the time they come to me,
they've tried all theseover-the-counter things and
these different products orgadgets or whatever, and of

(24:24):
course they haven't worked withus.
They wouldn't be coming to seeeither one of us.
So you know you tend to get adifferent opinion of those
products when you're in aparticular seat, so totally
understandable.
In a particular seat, sototally understandable.
Well, in that regard, do yousee any of those particularly
being effective for aggressioncases or having sort of a higher
percentage of efficacy withaggression cases?

(24:45):
Anything exciting you?

Speaker 2 (24:47):
For the nutraceutical world, or just the?

Speaker 1 (24:49):
Just nutraceuticals.
We can get into the other medsdefinitely.

Speaker 2 (24:52):
I would say none of the nutraceuticals wildly excite
me for aggression at this pointand maybe that again is an
unfair opinion of them.
When you talk aboutnon-prescription, non-behavior
prescription, the most excitingoutcomes could be management of
pain and how much that improvestheir behavior.

(25:13):
So how much of this problem isnot a baseline anxiety problem,
how much this is pain, and so Iget very excited about that
aspect because it's reallyrewarding and almost sad in
hindsight like, oh my gosh, thiswhole, you know this whole
thing was pain.

Speaker 1 (25:28):
um, yeah, yeah, yeah, yeah.
And some odd cases too yessometimes you get like that
placebo effect where they plugsomething in or it's like a
spray type of product, theolfactory factor involved and
the client actually, forwhatever reason, they think it's
working, so they tend to calmthemselves.

(25:49):
So with the dog, the precursorcues that a person would give
with their own anxiety or theirconcerns or tension start to
dissipate, which then the dog'slike well, okay, things are good
now.
So it looks like it's working,sometimes when it's actually not
, which is totally fine though.

Speaker 2 (26:05):
Yes, yeah, yeah, placebo effect is very, very
real, obviously in humans, thenabsolutely in humans' perception
of their pets, because that's awhole nother layer of kind of
making judgment calls.
But all those kind of fallunder.
For me they're not going tohurt, they may help, and so
there are certainly things thatare absolutely worth trying, and

(26:25):
you'll get people that feellike they're game changers, and
that's a wonderful thing.

Speaker 1 (26:30):
Absolutely.
Now, there are a few that youalways want.
Well, with any of them, we wantto inform our veterinarian or
vet behaviorists what they'retaking, but there are some that
can interact with other meds,correct?

Speaker 2 (26:41):
Yes, so CBD in particular can interact with
some of the anti-anxietymedications.
So it has some overlap, forinstance, with how it's
metabolized, with how fluoxetineis metabolized.
Fluoxetine's a very commonmedication in the behavior realm
, and then CBD tends to be avery common one that people will

(27:01):
do over the counter.
So it is very, very importantto let your vet know what your
dog is taking so they can kindof screen.
For, oh, do we have anythinghere where we may not want to
have both those things going atthe same time?

Speaker 1 (27:13):
What's a potential side effect or outcome?

Speaker 2 (27:17):
So theoretically you can increase the levels of one
because of the way that it'smetabolized through the liver,
so it can change the level ofthe drug.
Clinically we don't know howmuch that actually is a risk for
that pet, but we just know thatthey use similar pathways to
kind of get through.

Speaker 1 (27:36):
Is serotonin syndrome a risk with over-the-counter or
nutraceuticals in combinationwith one of those, or is that
more when we're looking atprescribed meds?

Speaker 2 (27:44):
In theory it could be , because some of the
supplements are precursors forserotonin.
Clinically, I would say we havevery small levels of concern
with combining those things, butit is always good to be fully
aware of, because if we'regetting creative with
medications and we're startingto play with multiple things
that increase serotonin thatmight make us well, it's just to

(28:08):
be overly cautious.
Let's get that supplement offthe table if we're getting more
creative on our end as well.
So we definitely like to knoweverything that people are
giving their pet.

Speaker 1 (28:17):
Yes.
So on the topic of meds, sincewe're there, let's talk about
prescribed meds and what Maggielikes to use or what's common,
because and it's a question Iask every vet and every
babysitter comes on the showbecause I'm always curious
what's the latest?
But the standard answer thereis no latest.
Like we have what we're using,and there's been tweaks.
But one of the things that thetrainers will say well, like,

(28:40):
what about trazodone andgabapentin?
It's like they're being used sooften in the cases they see,
usually in the combination withfluoxetine or one of the TCAs.
But so give us your overallpitch on meds first and then we
can get into the individual ones, maybe a little bit more.

Speaker 2 (28:58):
Yeah, so elevator pitch on meds first and then we
can get into the individual ones, maybe a little bit more.
Yeah, so elevator pitch on medsis broadly for behavior.
There's two big categories.
You've got your fast acting asneeded medications.
So classically those get usedprior to stressful events.
So we tell people, just likesome people don't like to public
speak or some people are veryterrified of getting on an
airplane, there's medicationsthat you can give dogs in

(29:20):
anticipation of something thatyou know is going to stress them
out.
Those drugs tend to have big,wide dose ranges.
The lower the dose usually theless side effects, but also the
less efficacy potentially.
And then the higher the dose,the potential more side effects,
but also potentially they'remore helpful.
So if you have a once in a bluemoon stressor and the dog is

(29:41):
totally zonked out on that,those as needed meds.
If it's rare and it gets usthrough it, then we'll deal with
the sedation side of things.
Those medications would includethings like trazodone and
gabapentin and clonidine andkind of all the benzos, all of
those categories.
They can be used daily, kind ofin contrast to using them just
as needed.
The only issue potentially withusing them daily for anxiety

(30:06):
alone is that you get this dogor cat that feels better, then
they feel worse, then they feelbetter and then they feel worse.
So you get a lot of seesawing.
And then you also get like thisride or die if they're really
helpful on when the doses aredue.
So people will be like, oh mygosh, it's six o'clock, can I
please give Clonidine?
Like they're just desperate forthe next dose of it.
So the other categories arelong-lasting daily.

(30:29):
So those are typically pulledfrom antidepressants in people
and you are trying to get thebaseline level of anxiety,
reactivity, you know, poorimpulse control, whatever it is.
You're trying to target to alower baseline every day, but
not change their personality andtheir goofiness and their joy,
because those are all things wewant, obviously.

Speaker 1 (30:49):
Absolutely.
So let's do this.
Let's take a quick break tohear a word from our sponsors,
and then I want to dive muchdeeper into the bedside of
things.
So we'll be right back.
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All right, we've been talkingwith Dr Maggie O'Brien and we've
been talking about a lot ofdifferent things, but I'm gonna
do the deep dive into meds nowand talk about types of

(32:37):
aggression cases and which medswould potentially be the most
appropriate.
Now, of course, each case isunique.
Each case is individual.
So I'm asking you to kind ofspeak generally, which I know is
not the easiest thing when itcomes to meds.
But with your classicfear-based aggression, you know
you have dogs that are justfearful of particular stimuli.
They go out in the world andthey're having a tough time.

(32:57):
So you could do the situationalmeds, where it's just like
you're going to hike today andwe got to get you out, but we
also want to take the edge off.
So that might be a situationalmed.
And then you're looking at theantidepressant class.
Those are the SSRIs or.
TCA class drug in which to helptreat the fear.
So we're talking more, not justa dog that's afraid of garbage

(33:20):
cans.
Once in a while it's.
We're thinking of dogs thatjust have a tough time outside,
not completely learnedhelplessness, but just you know.
Picture that kind of dog.
What are you looking at therefor meds typically?

Speaker 2 (33:31):
There's a lot of individual variations, so I tell
people we do have certain medsthat we might reach for with
certain presentations, and thiscan vary too amongst veterinary

(34:00):
behaviors in terms of what yourfirst choices are for things.
Typically if we are seeing anaggressive case where the pet
may have poor impulse control,like the owners can't see the
problem coming until it'shappening, so it's like I didn't
even know they were upset andthey bit somebody.
Where we really want impulsecontrol, fluoxetine still tends

(34:20):
to be my first choice for thatwhen you're strictly trying to
treat an impulsive or aggressivedog or cat.
Potentially there are otherthings, like if the pet has we
call them like Eeyore dogs, soif they're just like I just
don't know if today's going tobe any good Right, and the lamp
moved four inches to the right,so the living room's probably

(34:42):
off for the day, and you knowjust.
If they're more fearful andwithdrawn, I typically lean
towards something likeSertraline or Zoloft, which has
slightly more effect on dopamineand dopamine can be involved
with motivation and rewards, sosometimes that'll bring them out
of their shell more.
If we have a dog that hascomplete ants in their pants,

(35:04):
like I'm in the room for 90minutes and I'm just exhausted,
having watched this dog beactive, like they're on the
table, and then they're overthere and what's in the window?
And I heard a small sound overthere.
If they're very, very busybodied, that might make us lean
towards Clomacom or Clomipramine, which is a tricyclic
antidepressant.
There's more impact onnorepinephrine, which plays a
role in that hyper arousalvigilance.

(35:27):
You know, on the go, on, the go, on the go.
So there are certain things thatyou know.
I joke with the assistant.
I can say like I heard the dogasking for Clomacom through the
hall because you can just heartheir tippy taps for 90 minutes
straight.
So there are certain thingsthat might lean us towards one
or the other.
But I tell people like your dogmight look perfect on paper for
something like Zoloft and thenwe're going to find out two

(35:49):
months from now that Venlafaxinewas the ticket all along.
So we have guidance and it cancertainly help, but we're always
ready to shift gears ifclinically we're not getting the
outcome we want.

Speaker 1 (35:59):
So it sounds like when deciding on the appropriate
med, what you feel is the bestfor the case.
You're looking more like apersonality profile versus a
contextual type of aggression orbehavior issue.

Speaker 2 (36:12):
Yes, yes, I would agree with that.
So it's more just what's youroverall like?
Are you more timid?
Are you more fearful?
Are you zero to 60?
Are you constantly on the go,as opposed to conflict?
Aggression gets this problem,or you know.
So it's more based onpersonality than specific
diagnosis.

Speaker 1 (36:31):
I would say the dogs that are, if I was to describe
the personality profile here,just a dog that is not showing
signs of fear, what they mighthave labeled like conflict
control aggression years ago oreven dominance aggression years
and years before that, but thedog that is proactively,
sometimes using teeth to gainaccess to resources or to

(36:53):
control the people in theirenvironment.
So we're not seeing the fearsignatures.
We're seeing hard stares,agonistic puckers, high flagging
tail, straight spine alignment.
So just, I'm going to come overhere and make you get off the
couch to the other dog or to theperson, and so they're not
responding to necessarilythwarting off a threat.
They might be competing forresources, but they might be
saying, okay, I'm going toproactively say you need to go

(37:15):
there, you need to go there,which is not a common case, but
would you be looking at meds forthat kind of case?

Speaker 2 (37:21):
Yes, and typically and again, it would depend on
the whole pet, but I typicallyon what you just described,
fluoxetine would still be top ofmind for that.
Interesting, Interesting, anddo you see a lot of those kinds

(37:51):
of cases, or is that much forour few between and monitor
everything?
When we see dogs for resourceissues within the house with
another dog, it's more oftenthat they are more insecure and
oh, the couch is over there andthe dog's near my mom and they
do present in a more anxious,concerned manner than a cool,

(38:13):
calm, collected everythingaround.
This is mine.

Speaker 1 (38:16):
Yeah, kind of speaking of that personality.
Let's talk about maladaptivebehaviors and let's just use a
Border Collie, since we're justtalking about a dog that wants
everything to be in its place.
What do you typically go to ifyou have a dog that's presenting
maladaptive, hurting or chasingthe people out of the well,
trying to keep the people in thehome?
They're just trying to leave orget up to go to the bathroom.

(38:37):
They're biting at their calvesbecause it's a lack of
enrichment.
So we determine okay, thisdog's just not getting its needs
met.
Do you kind of look at, let'stry to meet the needs first, or
do you say this dog has gottento the stage of well, we should
probably separate this out alittle bit.
We can get into compulsivestuff, where the dog's starting
to chase shadows and lights, orwe're just seeing it manifest in

(38:58):
a different way.
The dog's just hurting peoplein the home, but it's hurting
people.
It's like putting teeth on skinnow and it's getting very
common, happens on a daily basis.
What would you think of the medprofile there?

Speaker 2 (39:10):
Generally we would.
Still, I don't necessarilyapproach things wildly stepwise,
so I tell people if it's, yes,this dog is under enriched, they
have GI issues.
They likely do have some levelof anxiety or impulse control or
meds could help.
I like to be in a positionwhere six weeks after we've met

(39:34):
with them we're like we're doingbetter.
I don't know exactly which oneof these is helping, but we're
doing better.
I am so much more excited to bein that position than super
stepwise.
And then it's you know, eightweeks later we're like well, we
kind of talked about the GIstuff.
Let's start treatment for thator start looking into that.
And two, I think the potentialproblem with being very stepwise

(39:55):
is that a lot of these guysmight need they need more
enrichment, they need trainingor behavior modification, they
need meds.
So if you do it super stepwise,it could look like, well, the
training's failing.
Well, the training would havegone great if they were on
medication and could focus for asecond.
So I don't know that I actuallyanswered your question.

Speaker 1 (40:13):
No, it totally does, because it makes me think about
the juggling of all of thesepotential balls of what could
work.
So why hold off one especially?
And we could talk about thedynamic of how some people feel
it takes forever to get aveterinary behavior appointment
and all those dynamics like andthe interest of time.
So that's one additional layerof these cases is the client

(40:35):
time, their commitment level,their patience level and
something we have to considerand we say, okay, yeah, we could
just do no meds for eight weeks, but then what?
Now we've just spent eightweeks.
Now we have another six weeksfor the meds to take hold.
So you bring up a lot of reallysalient points for this
conversation.
It's not just that.
Let's just try one thing at atime, so it's incremental, right

(40:57):
.

Speaker 2 (40:58):
Yeah, yeah.
And, like you said, the we havethis beautiful plan in mind.
Well, it doesn't mean anythingif the client can't
realistically implement it.
So that is definitely a reallybig factor we have to consider
and try to encourage honestyfrom the.
I was talking to Dr Nick Dodmanand Vivian Zatola on another
episode the other day and we'dgone as a topic of partial

(41:33):
seizures, and dogs that are theclassic.

Speaker 1 (41:35):
you know, I'm just sitting there, I'm going to
attack you or the blanket nextto me, or I'm going to staring
off.
My pupils get dilated and Ijust start biting whatever's
nearby.
So not full-blown seizures, butpartial seizures, that one of
the things that can happen isaggression, so high levels of
aggression sometimes.
So in that regard, of course,you might be working with a

(41:55):
veterinary, neurologist, or andthose are the cases where we're
saying, okay, we've got a lot ofballs, we're juggling here,
right, so can you talk usthrough a little bit in another
day in the life of Dr O'Brienworking with other professionals
?
So let's say, you see a patientlike that.
You're gonna be like okay, weneed to refer to this person,
and so how is that done and isthat easy for you, or is it hard

(42:16):
to get the clients to commit?

Speaker 2 (42:18):
to that, that we see that are not purely behavioral.
Where we do feel like there'ssomething else you know again,
pain being the most likely casethere but pain, neurologic
issues, gastrointestinal issues,allergies where it just feels

(42:40):
like, okay, this medical issueis not being fully met, we
either need to talk with primarycare about addressing this or,
if it feels like it needs aspecialist, then kind of
onboarding the specialist.
That would be indicated in thatcase, because if dogs don't
feel good, it absolutely affectsthe way they perceive the world
, it affects their behavior.
So it's.
It can be really challenging tomake improvements in a dog that
does not physically feel well.

(43:00):
So it's emphasizing theimportance of that and, I think,
trying to appeal to the owner'sempathy side of it's.
We just want your dog or cat tofeel better, and it can be
really challenging because a lotof this is expensive If they
don't have pet insurance.
They came to see us and I'mtelling them they got to see
another specialist too, and soit.
It is difficult and luckilyprimary care veterinarians are

(43:23):
phenomenal and wear 10,000different hats.
So if they can't see aspecialist, you know it's well,
we'll talk to your primary careabout what they can do to help,
and so it's just kind ofonboarding to the level that the
owner is able, and thenobviously trainers and things
are hugely important and part ofwhat we always try to onboard
and involve as part of the team.

(43:44):
And that's just anotherconversation about emphasizing
how important that is and tryingto relay that.

Speaker 1 (43:49):
Yeah, and that's just like the human medical field.
How often there is a lot ofquestions and confusion who to
talk to, what's going to getcovered?
So, in regards to your practice, now, each you know I've
chatted with a lot of differentveterinary behaviors and that
the system or the flow of how apatient moves through that
process can be differentdepending on whether it's
through university or throughprivate practice or through just

(44:11):
somebody in a satellite office.
So for you, the patient we'vealready learned fills out this
lovely intake form.
You get to learn about them andlearn about their wishes.
And it sounds like we werechatting before the show.
You only have about a two-weekwait list, which is fantastic in
the veterinary behavior world,and it's a misconception I like
to clear up on the show too,because the general theme is

(44:32):
like oh, it's going to take sixmonths on average for any
veterinary behaviors, and that'snot true.
Some, yes, but there's plentyof availability depending on
which practice you reach out to,and yours being one of them.
So they fill out this form.
They wait the two weeks theyget horse being one of them.
So they fill out this form.
They wait the two weeks.
They get in to see you.
You meet with them.
So what is the next step in theprocess?
Maybe we can use that partialseizure disorder dog as an
example.

(44:52):
Like you see the dog, you hearthe history.
What's next for them?

Speaker 2 (44:55):
So in that case it would obviously be trying to get
them to go see a neurologist.
Those cases, at least in myexperience or not, those are
pretty rare presentations andwe'll get more often people
saying like I think this dog ishaving seizures or you know REM
sleep disorders and things, andthen, because there's no
identifiable trigger, and thenyou ask, when do you see ground?

(45:18):
It's like it's when I pet himwhen he's sleeping or when I
pull him off the furniture andyou're like well, those are
identifiable triggersidentifiable triggers.
So but if that case were topresent, it would be, yes,
trying to onboard neurologypotentially if, like, let's say
what, they're not willing to seeneurology, you know, do you
speak with their primary care?
Do we start doinganti-convulsant trials and
things like that.
We always encourage a lot offollow-up.

(45:40):
So I try to get people to emailme at least once a week with
how things are going for ourfollow-up window until we see
them for a recheck appointment.
I tell people like it'd begreat if we could meet for one
hour.
Your dog or cat goes home andyou never have another problem a
day in your life.
That is just not how behaviorcases go typically.
So we're going to need tozigzag somewhere along the way.
So I try to make that clearfrom the jump, that part of this

(46:03):
plan we're going to need toadjust based on your dog's
response or your cat's response.
So we try to encourage a lot offollow-up and then we'll also
try to get the ball rolling ifwe do feel like other people are
indicated to kind of hop alongthe team.
So if I think neurology isindicated, then we'll submit a
referral for them.
That means that neurologydepartment is going to reach out
to that client.
So trying to provide, you know,as few roadblocks as possible

(46:27):
and get them the help they needwithout putting all of the work
on the owner, can be, I think,helpful as well.

Speaker 1 (46:33):
And the outside professionals that you refer to.
Do you have like a localpractice or a veterinary
hospital nearby or attached toso I'm not attached.

Speaker 2 (46:43):
We're standalone behavior building but we
definitely have a relationshipwith, you know, the ortho people
in the area and the internistsand the opto people.
So it's a small enoughcommunity where you kind of know
, you know, and we've got theneurologist that will let us
send them videos of gates andrehab people who will give me
opinions on whether thingsshould be referred and to what

(47:05):
department, and so having thatcommunity is really very helpful
.
With the virtual world it's alittle more of kind of just
researching okay, this is theirzip code, let's see who's in the
area that would be best forthem or talking to their primary
care about hey, who's yourgo-to ortho person?
Because I'd like this patientto go see that person.

Speaker 1 (47:29):
Yes, and something earlier you said too, really
just shows the insight you haveonto the human side of
consulting, which is making sureyou tell the patients we're
going to be doing somezigzagging, possibly here, and
just so you're prepared for that.
I find that that's whatexperienced consultants learn to
say.
They start to answer questionsbefore they're asked right so

(47:50):
they sense what the questionsmight be coming and they kind of
help the clients understand.
I think it's so important,especially in aggression cases,
that the clients are made awarethat, hey, we're going to try
our best, but we're probablygoing to have to change course
maybe a few times, because it'srare for those cases to go
perfectly and everything we trythe first time is going to go
well.
So, in that regard, fortrainers and consultants that

(48:11):
might have the sameconversations, you have a couple
trainers on staff that you haveto help with the cases.
Do you also have a network oftrainers you refer to in the
area?

Speaker 2 (48:21):
Yes.
So we have all the people thatwe really like and I do tell
people like we have a list and Isay I'm sure there's excellent
trainers who, for whateverreason, I'm just not aware of
and aren't on the list.
If they're not on this list andyou're really interested in
working with them, please let meknow who they are so we can do
a little bit of vetting.
But if people come in alreadyworking with a professional that

(48:44):
we like and uses themethodology is the primary thing
we're obviously concerned aboutthen that's really helpful
because it's oh, they come inwith a B-Mod plan, they come in
with environmental adjustments,and so it makes our lives
significantly easier becausethey have that really good
background.
So then it's you know, we talkto the pet parent and then send

(49:05):
all the info typically to themand then the trainer behavior
consultant just gets CC'd on allof our communication.
So it's usually like a hey teamfluffy email that goes on
between everybody, so everyonecan kind of be on the same page.
And then regionally wedefinitely have, since our
trainers don't obviously travelhours to get to people we see a

(49:27):
ton of people from the Trianglearea.
So I have trainers I really,really love in the Triangle area
in North Carolina, so it's niceto get to know specific people
and be able to vouch and be like, oh no, this person's
incredible, go work with them.

Speaker 1 (49:38):
What's the furthest?
Somebody's come to see you.

Speaker 2 (49:40):
Four hours, I believe is the furthest.
Yeah, we had someone fromGeorgia come at some point.
Yeah, okay.

Speaker 1 (49:45):
Maybe we'll get somebody to fly in now that
they're listening to the podcast.

Speaker 2 (49:50):
Now, when people call and they're like, oh, it's four
hours, we say we have a virtualoption and people are like, yes
, I will do that instead.
So.

Speaker 1 (49:57):
Is that in-state only , or can you do anywhere in the
US for the virtual option?

Speaker 2 (50:00):
That is national so.

Speaker 1 (50:02):
Wonderful, Wonderful that was.
Was that also changed duringthe pandemic?
I know that was a kind of aweird thing for veterinarians
before that.

Speaker 2 (50:11):
So more research came out about virtual behavior
consulting, I believe secondaryto the pandemic.
I was in residency for thepandemic so we didn't open until
obviously there's ongoingthings.
But we didn't open until kindof the worst of it was through
and we could do in-personappointments.
Our side of the virtual stuffreally just came from being

(50:32):
aware that there's largeportions of the US that do not
have a veterinary behavioristand so just trying to increase
access to care for those people.

Speaker 1 (50:42):
Yeah, when I heard about virtual consults with VBs,
I was like the best thing everjust happened.
So needed.
And I'm so happy that thathappened.
It's such a great resource forpeople that don't have that
access in their area.
So so just to back up a littlebit on the trainer consultant
role so you have your trainersand staff, you have trainers
that you work with.
So the role of the trainer andthe vet behaviors do you

(51:05):
typically write the plans andthen the trainer helps to
implement them, or is it sort ofyou see what the trainer
consultant's doing and you saythis is good, or do you give
advice or what's the strategythere?

Speaker 2 (51:28):
kind of lay out.
These are the main goals, and Iwould say as a veterinary
behaviorist, I'm typically goingto lean more on like these are
the environmental changes.
This is management.
So I don't get into detailsnecessarily of like these are
the nuts and bolts of how youteach a dog to go to a place.
If they're on the couch andthey don't want to move, I do
throw a cheerio on the ground toget your dog to move and that's
kind of you know.
Those are more the managementtools, because we're really
trying to like put out the firein certain situations and just

(51:49):
quickly get to a betterrelationship.
But then I say, hey, there's alot of great ways we can
navigate.
Yes, your dog can get anexcellent recall, your dog can
run to a spot on cue.
We can teach pattern games andall this stuff that we can do
with your pet.
But it is going to go muchbetter if you are under the
guidance of a wonderful trainerthat's in person, helping you in

(52:11):
real time.
And so then it is sending themlike, hey, these are our main
goals, but we're, because theysee a unique side, right, they
go to the house, they absolutelyzigzag based on what they're
seeing, and so it's not like.
You must follow this guidance.

Speaker 1 (52:25):
Yeah, I think those roles are confusing sometimes
for some guardians.
They're not sure oh wait, isthat behavior?
So it's going to be coming tomy home to teach my dog to sit
in the kitchen, or is it?
Is it a trainer?
And it can get a little muddysometimes.
I think even trainers have somenot knowing which path to go.
And I've heard this commentlike I'm just I'm afraid to talk

(52:45):
to them, like just reach out tothem.
They all talk, right, they justyou know, and it's like this
sometimes strange, like I don'tknow, like there's a wall up
between the veterinary behaviorcommunity and the training
community.
But it shouldn't be like that.
Right, it's just we're allworking together to help the
dogs and cats in our care, andso do you have any insights
there as far as you kind of laidout what you do?

(53:07):
But do you think what can we doas a community to help each
other, like connect more?

Speaker 2 (53:11):
Yeah, I would just say we're love when people come
in with trainers on board.
We love when people reach outabout cases that they think
might be warranting referral.
Or if people come in with areally good trainer, then we're
like, oh heck, yeah, again, thismakes our life easier.
So, yes, I would never wantsomeone to feel like I can't
reach out because we I mean,it's so much better when they

(53:34):
are working with someone likethat, and it's very uncommon to
get referred by someone that wewould then look and say, oh, we
got to change a lot about whatwe're doing with this pet from a
training perspective.
Those styles of training andthings just don't.
We don't get a lot of referralsfrom, you know, shot collar
camp trainers.
It's just that's not the stylethat ends up on our door

(53:56):
typically.

Speaker 1 (53:58):
Sure, yeah, which is yeah, it kind of works out for
you in some ways?

Speaker 2 (54:02):
Yeah, cause that might be a little more awkward.

Speaker 1 (54:09):
Yes, yeah, yeah.
It's always hard.
I'm sure you having it, andsame thing for trainers if their
client's seeing a veterinarianthat might be giving advice that
is not part of their plan.
That's a tough side of thingsto navigate, but if you guys get
a chance, go listen to theepisode with Dr Chris Pockel and
we you know how to mend thoseissues or those relationships as
well.
Okay, so in the last five or 10minutes here I'd love to hear

(54:31):
maybe about an advanced case now.
So we have a lot of dog prosand veterinarians and people
that are working behavior casesin the listenership here.
So walk us through maybe a caseor two, something just top of
mind, some advanced case, someunique insight or discovery or
something that went really wellfor you and your practice.

Speaker 2 (54:49):
We had a very recent one that I think from a team
perspective was fun, where thepet came in for fear aggression
of unfamiliar people, but alsoone of the big issues was really
challenging to see at the vetand had kind of been either
pulled through a door for rabiesinjections or put in a squeeze
cage, so really like last resorthandling techniques.

(55:11):
So we had I've worked with thisfamily for a long time and we've
gotten so much better on leashreactivity and people coming in
the house but the vet visitswere still not going well and
despite medications and thingslike that.
But we finally were able toconvince the pet parent to
onboard a trainer in their areabecause they were not local to

(55:33):
Charlotte and work on injectiontraining, which I think is such
a cool area.
So we call it the squish andboop, which is from Ohio State
where I did my training, butjust training a dog to be, you
know, cooperative care world,being very willing, participant
in not sneak attacking and sobeing very in on the game of how

(55:53):
to do injections.
And so still, you know, again,it's expectations, but the goal
was not, yeah, let's get thisdog examined and vaccinated wide
awake, but it was like we'vegot to make injections doable
for this pet.
So we worked they worked reallyhard with the trainer and then
the trainer was able to go withbecause the primary care was
like heck, yeah, whoever wantsto help.

(56:13):
So the trainer came day of thevisit and we were able to get
her a much less stressfulsedated exam earlier this week,
which is super exciting.

Speaker 1 (56:22):
Yes, such a big hurdle for some of my clients
too is just getting to that.
But to get the basics done, youknow the dog can't be handled
Sometimes.
That and the game changingaspect of it when it finally
gets done and seeing like therelief on the person's face and
you know, and if it's done inthe most efficient way and most
caring way for the dog, the kindof relief the dog gets to like

(56:45):
oh that wasn't so bad.
most caring way for the dog, thekind of relief the dog gets to
like.
Oh, that wasn't so bad.
I had Tabitha Kusara, who's aLVT and does a lot in the
handling side of things, justgave a wonderful webinar on
handling cats and dogs that canexperience these issues.
And it's one of themisconceptions I think,
especially on the trainer side,that I've seen is we have lots
of lovely cooperative caretechniques and when we're doing

(57:07):
it on video it looks perfect athome.
So we get these lovely chinrests, the dog's all happy
food's involved, but we have toremember that's not going to
look perfect in the veterinaryenvironment, especially if you
haven't practiced there andpracticing there as much as you
need to.
To have a completely visitthat's showing no signs of
stress at all is next to nearimpossible most of the time.
So it's just something I liketo mention because we have, we

(57:30):
see again, social mediainfluencing us like the perfect
situations all the time, but itdoesn't look like that.
The goal is decreasing theintensity and frequency of
distress for the dog and makingsure they feel safe as possible,
but still getting what we needto get done as caretakers Right.

Speaker 2 (57:47):
And I think part of like that case was they put an
immense amount of work into it.
So this was not like theyworked on it for two weeks and
then we started working on thismonths ago.
So yes, with cooperative careand veterinary handling, if you
want to go down this path, it isgoing to be time intensive
typically, so trying to setexpectations for that.

Speaker 1 (58:07):
Can you tell us about another case where maybe you've
had a high degree of aggressioneither high bite level,
multiple bite injuries,something unpredictable, sort of
a difficult aggression casewhere you've seen success, and
what'd you do to make thathappen?

Speaker 2 (58:22):
So we see just so many aggressive cases.
That could be most relevant.

Speaker 1 (58:28):
Something that surprised you, maybe that, like
I wasn't expecting that tohappen, because this dog is like
really you didn't think it wasa good prognosis, but it turned
out.
Maybe.

Speaker 2 (58:38):
I would say one of the more surprising ones and I
hate to keep bringing thingsback to physical issues, but one
of the, I would say, quick fix,surprising cases that I've had
in recent memory.
I saw a golden retriever.
That was about two, no obviousgait abnormalities, but I saw
her for resource guarding, butkind of abnormal resource

(59:00):
guarding.
These people weren't trying totake rawhides from the dog, they
were trying to pick up piecesof fluff from across a room but
would traverse a room, bite theowner very severe aggression for
triggers that we would considerbenign.
So that dog came in but whenshe was in the appointment she
was just very dull and she was agolden retriever.
She was a very dull dog.

(59:21):
She just like she didn't wagher tail, she just laid in the
corner, she wasn't frenetic, shewas just very dull and her gait
looked okay.
But we had them do videos ofgoing up and down a flight of
stairs and you know, walking upand down a hallway at home where
she's in her normal environment, getting up from laying down,

(59:41):
and then you could see in thatshe had intermittent bunny
hopping.
You could just see she had moreof a hard time than she should
have.
And again.
I'm aware there's differentfeelings about Labrella, but we
recommended let's try Labrellafor a couple months.
We at the same time didfluoxetine and did a lot of
management things for theresource guarding and she had
other aggression things towardsthe owners.
And then, long story short, sheis strictly on Labrella.

(01:00:03):
She is not on any anti-anxietymedications she has.
They sent me a video of herhaving.
They said we didn't know shehad a personality.
They're not usually that easyof fixes where it's pain only,
but that was a cool.
I was like, oh my gosh, thatpoor dog, you know, but it was
so.
Its whole problem was just itwas so painful and Labrella
ended up being the ticket forthat dog, which was really cool

(01:00:27):
full and labrella ended up beingthe ticket for that dog, which
is really cool.

Speaker 1 (01:00:29):
It's kind of bittersweet in a way when you,
when the pain meds kick in andas you see such profound changes
, but at the same time you'relike the poor dog was suffering
from that for so long and thenjust trying to express to the
world you know, hey, I don'tfeel well here and finally
something's done.
That's definitely seen a fairshare of cases and the
interesting thing too I don'tknow if you had a case like this
is sometimes the context inwhich the pain events have

(01:00:52):
happened that have been beenexacerbated by something.
So I've had some.
A case shared with me.
There's dog had spine issues inthe neck area and was, um, the
previous trainer.
I tried to address resourceguarding of the food ball using
a knee collar and and it wasaround the food bowl.
So guess where the dog startedattacking the people?
And it wasn't the classicguarding case of I approach your

(01:01:13):
food bowl, it's you'reapproaching with a food bowl,
which doesn't make a lot ofsense to people, like wait a
minute, I have the resource, I'mbringing you something good,
and then you're attacking me.
And it's hard sometimes forpeople to put their mind around
as well.
It sounds like resourceguarding.
It seems like it's the food,but it's really not.
It's the context of I could bein pain when you bring that food
bowl out and then, once thepain is resolved, the behavior

(01:01:34):
completely changes anddissipates.
So it's actually not a resourceguarding thing.
In the general sense it mightstart out, but the major
exacerbating factor was pain,yeah, and it's kind of whenever
they don't follow patterns thatwe anticipate.

Speaker 2 (01:01:48):
There is this question of like, what are we
missing here?
You know why it's just whenit's a weird presentation, it
automatically rings like eithersomething off in the environment
or something is off with thedog, and just what piece are we
missing?
Cause it's not a normal, youknow normal presentation.

Speaker 1 (01:02:03):
I love those kinds of cases.
I don't like seeing the dogstonight, but I love problem
solving those kind of yeah,they're very interesting, yeah,
yeah.
So, in this regard, if you haveone takeaway message for
everybody, as a vet behaviorist,what would it be?
Just your like thing.
I wish everybody out there knewthis.
When it comes to helping dogs,what would it be?

Speaker 2 (01:02:47):
I think in general we would love to see pets as soon
as possible if they are startingto notice issues.
So I would love if peoplebrought it up to their
veterinarians that they hadconcerns about behavior and then
they could kind of get pointedin the right direction, either
from a training perspective or aveterinary behavior perspective
.
But we tend to select for verylast resort scenarios where it
can be sad.
I guess is the right word tokind of look at a history and
say, man, if we could have seenyou three years ago we really
could have had a differentoutcome than what we're dealing
with now.
So we always wish we can seecases as soon as they're
starting to see issues, becauseyou can have such a different

(01:03:07):
outcome and just helping themget the right resources as soon
as possible, as opposed to youknow, potentially doing things
that may accidentally, by nofault of the owner they're just
they're trying their best butyou know potentially do things
that might push us in the otherdirection for a couple of years
and then we kind of get on board.

Speaker 1 (01:03:24):
So yes, I 100% concur with that thought.
I wish people would come to seethe professionals much earlier
than letting it escalate orspiral out of control, or the
emotions and so many otherthings that can happen if you
wait.
So, maggie, this has beenwonderful.
Where can people find you orlearn more about you and
anything you're up to, and wheredo you want to send people to

(01:03:45):
if you have anything going on?

Speaker 2 (01:03:50):
Yeah, so I am in Charlotte, north Carolina, so we
have Southeast Animal Behaviorand Training for anyone in the
North Carolina-esque area andthen we also have virtual
veterinary behavior medicine.
So that's our virtual optionfor folks that may not have a
veterinary behaviorist availableto them locally.
We have that for anyone in thecountry.
On that service, we dotypically monthly race approved

(01:04:12):
CEs for anyone.
The credit for CE is availablefor, you know, rvts and DVMs,
but anyone's able to join thoseand we just go over a behavior
topic every month.
So I think we already didJanuary, but February's will be
inappropriate elimination incats.
So those are obviously virtualand then, yeah, that's kind of
what we're up to and then justlive in a clinical life, you

(01:04:35):
know.

Speaker 1 (01:04:36):
Wonderful.
Maggie, thanks so much forcoming on the show.
I learned so much.
I wish I could have you on forthe rest of the day, but I wish
you well in the future and Ihope to see you again.

Speaker 2 (01:04:46):
Yeah, thank you so much for having me.
This is very fun.

Speaker 1 (01:04:50):
What an absolute pleasure it was chatting with
Maggie and hearing how she'shelping dogs and their people
navigate even the most complexbehavior cases with empathy,
science and a trulycollaborative spirit.
Her insights into medication,pain and the emotional toll on
caregivers offer a valuableperspective for anyone working

(01:05:11):
in this field.
And if you're ready to godeeper into understanding and
helping dogs with aggression,visit aggressivedogcom.
Whether you're a professionalor a dedicated dog guardian,
you'll find everything from theAggression in Dogs Master Course
, which is the mostcomprehensive program of its
kind, to expert-led webinars,informative articles and the

(01:05:32):
Aggression and Dogs Conferencehappening from September 26th to
the 28th 2025 in Charlotte,north Carolina, with both
in-person and virtual options.
And don't forget to check outour Help for Dogs with
Aggression bonus episodes, whichare solo shows where I walk you
through real world strategiesfor issues like resource
guarding, fear-based aggression,territorial behavior and more.
Just hit, subscribe or head tothe show notes for more info.

(01:05:55):
Thanks for listening in and, asalways, stay well, my friends,
friends, friends world.

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Beyond Training: The Medical Side of Aggression with Dr. Maggie O'Brian

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