WSU’s Behavior Service: Treating the Whole Patient
Story by Marcia Hill Gossard '99, '04 | Photo by Henry Moore Jr.
Ann Patten was inside her home when she heard the ear-piercing sound of a cat howling. She thought one of her cats was in a fight, so she ran out onto the deck. She looked around, and there was Cleo, the newest member of their cat family, all by himself. “It was only Cleo chasing his own tail,” says Patten.
A slender, long-legged, gray tabby, Cleo had followed Ann and her husband Michael’s cat, Maggie, home some months earlier. They tried to find his owner, but no one claimed him. “He looked like a sphynx, so we named him Cleopatra,” says Patten. They later found out that Cleopatra was really Cleopatrick.
Playful and affectionate, Cleo often seemed like any other young cat. He liked to put his paws around Ann’s neck and nuzzle her hair. But if the doorbell rang, he would hide outside for days. Other times his ears would flatten, his eyes would get wide with dilated pupils, his breathing became labored, and he would start chasing his tail, pulling violently at the fur. Ann says they could distract him and he would stop, so they didn’t think too much of it. He was also marking around the house spraying urine many times a day.
When Cleo started having trouble urinating they took him to their local veterinarian. He received medical treatment to unblock his urinary tract and was put on a special diet to help prevent it from reoccurring. But six months later, Cleo was taken to the WSU Veterinary Teaching Hospital. This time, because it was New Year’s Eve, he went to the emergency room. “Many veterinary clinics were closed, so we were grateful for WSU’s emergency service,” says Patten. At WSU, he was diagnosed with feline idiopathic cystitis, or inflammation of the bladder with no underlying cause such as stones or crystals in the urine.
Stress can contribute to a cat developing feline idiopathic cystitis. So, emergency care veterinarian, Dr. Angela Nguyen, started asking questions about Cleo’s home life. “If there is more than one cat in the home we will ask if there are multiple litter boxes and multiple water bowls. We will also ask if there are toys and things for the cat to do,” says Nguyen.
At Cleo’s home, there were not only multiple litter boxes, but ramps for the cats, places to hide, and plenty of toys to play with. “There was a lot of enrichment in the home,” says Nguyen. “Everything sounded perfect.”
But as Dr. Nguyen started asking more questions about Cleo’s behavior at home, she began getting the sense that his behavior was not typical. “When she told me about the screaming and self-mutilating while chasing his tail and marking 10 to 15 times per day, I knew it was beyond normal behavior,” says Nguyen. “But it was very normal to them that he acted that way. As veterinarians, we need to ask for details because although it may be normal for them, it isn’t normal behavior.” Ann also realized just how different Cleo’s behavior was when she saw how her other cats behaved when Cleo was in the hospital for five days. “They all seemed more relaxed,” she says.
Dr. Nguyen believed stress from a general anxiety disorder contributed to the inflammation in Cleo’s bladder. Although she could help him in the short term by unblocking his urinary tract, once cats have urinary blockage, Dr. Nguyen says it usually happens again. Surgery is an option, but it comes with its own risks, and if stress is causing the inflammation then other parts of the urinary tract can become blocked even after surgery. So, Dr. Nguyen referred Cleo to WSU veterinary behaviorist, Dr. Leticia Fanucchi. “Addressing the stress is the long-term solution and we recommend it for all cats who have urinary blockages,” says Nguyen.
Dr. Fanucchi came to WSU in 2010 for graduate school to study animal behavior. While earning her veterinary degree in her native Brazil, she had thought she would become a neurologist, but it was her Lhasa Apso named Betty Boop that helped her find her career path. “She had severe separation anxiety from day one,” says Fanucchi. “And I made the mistakes with her that everyone makes, so her behavior got worse, not better.” By 2015 she had earned her doctorate, and the day after she graduated, she started the behavior program at the WSU veterinary hospital. Currently WSU has one of only eight animal behavior programs in the country.
Dr. Fanucchi sees dog patients at the WSU veterinary hospital, but for cats, like Cleo, she makes house calls. “When cats are outside their environment, they don’t show their normal behaviors,” she says. “They shut down and go into survival mode so they are more likely to want to hide or go into their kennel.”
After visiting Cleo in his home, Dr. Fanucchi prescribed him fluoxetine, a medication to help reduce his anxiety. Usually a month or more is needed to get the medication to effective levels, but in Cleo’s case, his owners saw changes within days. “The spraying decreased by more than 50 percent after the first week on the medication,” says Patten.
Dr. Fanucchi also put Cleo on a protocol to desensitize him to the noises that were causing him anxiety such as the doorbell or other loud noises. “When exposed to a stimulus that creates anxiety, I had them give Cleo a treat or play with him so he would have a positive association with the stimulus,” says Fanucchi. She also used counter conditioning to help Cleo stop the undesired behavior of chasing his tail and replace it with a desired one. Whenever he would start to chase his tail, she had Ann and Michael distract him with a toy. “Play is more goal oriented, so he wouldn’t think so much about his tail,” Fanucchi says.
“A good environment combined with fluoxetine has really changed his life,” says Patten. “He has more normal responses to loud noises and more control over himself. And he is happier now, too. It turned out to be the best option for him.”
“It is not one thing that you do, it is a combination of many things— chemical, nutritional, and behavioral therapy,” says Fanucchi. “If the brain is not balanced, no amount of training will solve the problem.”
But by the time a patient comes to Dr. Fanucchi, their unwanted behaviors are often severe. “When I see a patient, the animal usually has a combination of behaviors, and they are coming to me as a last resort,” says Fanucchi. “It has usually been bad for a long time so the behavior has been reinforced.”
For dogs, the most common behaviors she sees are separation anxiety and aggression. Anxiety, she says, can show itself as aggression. Many dogs who are anxious have what is called fear aggression. They are afraid, so they act out aggressively towards people or other animals. But animals can also have obsessive compulsive behaviors where they lick a certain spot or even begin pulling out their own hair. Some animals develop these issues over time, but many are born with anxiety or fears, which can become reinforced unknowingly by owners until it becomes a serious problem.
“It is a misconception that it is the owners fault,” says Fanucchi. “But as owners, we can make it worse.” For example, a dog who is nervous when looked in the eye, may try to look away to avoid eye contact, which is a signal to the owner that the dog is afraid. If the owner doesn’t recognize it as fear and continues to try to get eye contact with the dog, the dog’s anxiety could turn to aggression. “The dog is giving signals,” says Fanucchi. “But as humans we may miss those signals, so when the animal becomes aggressive we are surprised.” She believes it is important to try behavioral options as soon as possible, before the behavior gets severe.
Although Fanucchi says treatment for behavior problems is a lifelong commitment, behaviors can change so radically that the pet can seem like a completely different animal, which was the case for Cleo. Not only is he calmer and happier, but he has not had a urinary blockage for more than a year.
“What truly helped Cleo was getting his generalized anxiety under control,” says Nguyen. “Although he may block again, behavior modification, in addition to medication, has really reduced the risk of his urinary tract reblocking. We feel very lucky to have someone like Dr. Fanucchi at WSU.”
For more information about the behavior program at WSU visit go.vetmed.wsu.edu/Behavior.