Illness-related anxiety 2

Illness-Related Anxiety 2

(Geriatric Separation Anxiety)

What's Covered in Part 2
• "Be with me, I'm hurting"
• Not just for older dogs
• Drugs that ease the pain
• What else can I do?
• Where to find help

"Be with me, I'm hurting."
In his book, Dr. Dodman characterizes Geriatric Separation Anxiety as a condition in which a dog, usually older, suddenly starts "showing intense anxiety, particularly at night, keeping its owners awake by pacing, panting and pawing at them, constantly demanding attention."
     He notes that these dogs often act relatively normal during the day, although some become anxious even during daylight, especially when they are separated from their owners. I remember that JoJo's condition progressed to the point where he had to have me not only with him, but looking at him, nearly all the time. While he would once lie quietly on my lap as I worked on the computer, he now stood on the floor in a state of agitation, staring at me and stomping his front feet. He would also make a strange, high pitched, cooing whine that I sometimes referred to as, "hooting".
     The noise seemed familiar, in a way. After awhile, I recognized it as a sort of adult version of the whining cry a puppy makes when it is separated from its mother.
     But why was it always so much worse at night? Dr. Dodman believes that "Dogs with Geriatric Separation Anxiety appear to view their owner's sleep as a form of separation, and the consequences are very similar to those observed in other fear-based conditions, such as thunderstorm phobia. "
     He relates that in many instances, dogs begin to display Geriatric Separation Anxiety before they begin to show noticeable signs of disease. Dr. Dodman explains it this way, "This discomfort, I reasoned, would make the dog insecure and more needy of attention. After all, kids never like to be left alone when they are ill, and even adults need extra nurturing when confronted with an overwhelming medical problem."
     Also, many of us can relate to the fact that pain often seems more noticeable at night. When the sun is down, and the world is quiet, there is less to distract us from our pains and anxieties. This only makes them seem to grow in proportion. It's not difficult to imagine that our dogs might have this experience too.

Not just for older dogs.
Though the condition was initially described by Dr. Dodman as a geriatric disorder, I became aware through my correspondence with other owners of sick dogs, that sometimes younger dogs suffered similar symptoms. As Dr. Dodman observed, these cases were usually connected with an underlying disease condition which may or may not have been formally diagnosed.
     I wrote to Dr. Dodman about this and he responded that the name, Geriatric Separation Anxiety, reflects the fact that most dogs who suffer from serious illnesses and from this anxiety are older, and so were the first cases to be identified with the disorder.
     ;Based on the fact that it is possible for younger dogs to suffer from this condition, he is now considering revising the name to Distress Activated Separation Anxiety Syndrome (DASAS).

Drugs that ease the pain.
By whatever name, illness-related anxiety in dogs can be extremely troubling to both the dog and the people who care for it.
     Fortunately, Dr. Dodman has developed a pharmacological approach to treatment that you may want to discuss with your veterinarian. These recommendations were based on the assumption that most dogs suffering from brain tumors will also be taking drugs (quite possibly heavy maximum doses) that include seizure control drugs like phenobarbitol and potassium bromide, as well as steroids like prednosolone.
     According to Dr. Dodman, Buspirone (brand named BUSPAR) is a drug that is helpful in easing anxiety in dogs. This can be combined with Butorphanol (brand name TORBUGESIC) which he says is a good analgesic (pain killer).
     He states that "the combination of an opioid analgesic (butorphanol) plus a non-steroidal anti-inflamatory drug (NSAID) has synergistic analgesic properties." This means that when the two drugs are taken together, the combined effect in easing pain and anxiety is greater than if either of the drugs are taken alone.
     He advises that "one has to be careful about dosing NSAIDs in dogs and cats because they are sensitive to them." But he adds, "it can be done."
     Dr. Dodman shared a personal note that his own sister died of a brain tumor (malignant glioma). He says that she was on medications similar to those commonly prescribed to support the treatment of brain tumors in cats and dogs. Along with these, she also took analgesics and anti-anxiety medication.
     In the case of brain tumors in dogs or humans, surgical and radiation treatments may not be performed for many reasons. Not all tumors are operable, due to the location of the tumor, for example. Whether the decision is made to operate or not, or to pursue other methods of treatment, it is my opinion that it is an act of human kindness to also treat the pain and mental suffering that our animals experience during our attempts to prolong their lives.

What else can I do?
Aside from pharmacological support, there are other things you can do at home to help make your dog more comfortable.
     Dr. Dodman writes that independence training as described in his book, " The Dog Who Loved Too Much " may be of some help to some dogs with illness-related separation disorders.
     Daytime activity that that keeps the dog's mind occupied can also help prepare him to sleep when bedtime comes. A short walk in the fresh air might be helpful. Other dogs might like to participate in a moderated version of an activity they have always enjoyed.
     On his good days, JoJo still enjoyed doing simple obedience exercises in the back yard. We also carried him in his blue carry bag to art fairs and festivals. Until his last days with us, he seemed to enjoy getting out, and his nose would work double time savoring the smells around him.
     I found that rocking JoJo on the porch swing sometimes settled him down. Luckily, he was a small dog. I can only imagine trying to do this with a 90-pound retreiver!
     In addition, it often seemed as if stomach irritation from medications added to JoJo's discomforts. We remedied this by serving a dollop of plain yogurt after his nightly medications. That yogurt was one of the things he really lived for near the end.
     Beyond this, the only thing I can suggest is to simplify your life as much as possible, and try to get to bed early as you can. You may have to give up primetime television, but you'll feel much better prepared if the night terrors strike.

Where to find additional help.
Dr. Dodman has informed me that Tufts University where he is in practice now offers a remote consulting service called Petfax. He says people can use it to find answers to behavioral questions on a wide variety of issues. You may also call 508-839-8PET for phone consultation.
     Dr. Dodman will soon also be consulting on expertcentral.com. Your veterinarian or veterinary neurologist may also be able to put you in contact with additional resources.
     If this information has helped you, please consider contributing to the JoJo Meningioma Research Fund at the University of Illinois. It is a fund to support study into new ways to treat brain tumors in dogs and cats. The fund is administered by the University of Illinois. Contributions are tax deductible.

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