Behavioral answers for general practitioners questions

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Behavior issues are one of many significant concerns veterinary professionals and clients have regarding patients. Because of this, veterinary professionals are going to be faced with questions regarding behavioral issues regularly, and some may not be confident in answering behavioral questions, leading them to reach out to a behaviorist for help.

During her day 2 keynote address at Fetch Kansas City, Lisa Radosta, DVM, DACVB, shared multiple questions that she has received from general practitioners, ranging from shock collars to combining medication, to help general practitioners be better prepared to answer these questions if they come their way.¹

Question #1: I don’t ever recommend shock collar training for my patients. Am I wrong to take this stand?

In the presentation of this question, Radosta shared the ‘texts’ from a general practitioner who had a client tell her the patient had just finished a shock collar training course for her dog and did not consult the veterinarian about it. To Radosta, she said that the general practitioner is really asking if she should be recommending shock collars for her canine patients. Like any other potential treatment, the sciences need to be listened to and followed to solidify the standard of care.

“The consensus of [the] experts...is based on scientific literature that shock should not be used in training. It's not based on my opinion...it is science. So, if you ignore the science, welcome to the state board and someone testifying against you. That is the bottom line; follow the standard of care,” explained Radosta.

Radosta added that there is a lot of literature stating to avoid shock as a training tool for dogs due to adverse effects including increased fear, anxiety, injury, and aggression in dogs. These effects will then persist long after the trainings are completed and within different environments.

IRadosta tells those who ask her about shock collars not to recommend they use them and to follow the science. Instead of shock collars, positive reinforcement is a more effective and humane way to train pets. According to Radosta, veterinary teams should educate clients on the harmful effects of shock collars and that the American College of Veterinary Behavior recommends against using them.

Question #2: Can I safely combine trazodone with NSAIDs, without increasing the risk of gastrointestinal bleeding?

Radosta said that, in reality, the question the practitioners are actually asking is whether or not there is a higher risk of gastrointestinal (GI) bleeds when combining

Radosta explained that the combination of NSAIDs may increase the risk of gastric ulcerations and trazodone, a serotonin inhibitor/antagonist may alter platelet function. The patient has neurons sensitive to serotine in many areas of the body and the blood serotonin is mainly stored in platelet aggregation during clot formation. Because of this, Radosta explained that by inhibiting serotonin reuptake, which happens with any trazodone or serotine reuptake inhibitor, platelet serotonin levels can be reduced by up to 80%. This can potentially then impair clot formation, increasing the risk of a GI bleed.

Radosta mentioned to attendees a recent study that evaluated the effect of trazodone in dogs on hemostatic factors.² The researchers evaluated buccal mucosal bleeding time, platelet count, platelet aggression, and platelet function testing. They found within the study that there were no significant changes in the buccal mucosal bleeding time, platelet count, or PFA-10 closure time. They did note however that there was a significant decrease in platelet aggression. It is not known at this time if this would cause clinical signs to worsen in a dog with GI ulceration, but the evidence does suggest that there is a risk, but it is small.

To answer this text, according to Radosta, general practitioners can combine them, but they must monitor the patient and warn the client of the risks.

In conclusion

Within her lecture, Radosta provided attendees with real-life scenarios as a way to provide insights educate attendees on practical solutions and provide answers to help those who need it. To close the lecture, Radosta told the crowd she hoped that her lecture gave me a sense of feeling empowered to go out and tackle the behavioral issues at their clinics, and not stop reaching out for help.

Reference

1. Radosta L. Tick Tidbits: Novel Insights & Protection Updates on These Tiny Troublemakers. Presented at: Fetch dvm360 Conference; August 23-25, 2024; Kansas City, MO.
2. Benjamin EJ, Nelson OL, Baumwart R, Haines J. Adverse effects of trazodone in dogs on primary hemostasis and electrocardiogram: A single-blinded placebo-controlled crossover study. J Vet Intern Med. 2023;37(6):2131-2136. doi:10.1111/jvim.16841