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Calming Isaac's Rage

Figure 1: Sir Isaac Newton

This is the story of how we first incorporated  a comprehensive holistic approach to behavioral health.

NOTE: This paper is the sole intellectual property of Marie Seelmeyer! Any reference to or quotation from the doucment MUST reflect appropraite credit.  The document may not be reproduced in any form, in part of in whole without express written permission from Marie Seelmeyer. 

                         

Calming Isaac’s Rage

 Signalment

Figure 1. Isaac, Saint Bernard mix. 15 months after beginning treatment.

            Isaac presented, in January 2008, as an approximately one year old neutered male Saint Bernard and Great Pyrenees mix, weighing 92 pounds (Fig. 1).

History/Observations

            Isaac was acquired by Freedom Service Dogs from a local animal shelter, three months after being found as a stray. He began training as an assistance dog at 10 months of age. He was isolated in a kennel for 20-22 hours a day, due to a severe case of kennel cough. Isaac exhibited signs of dominance aggression by  jumping on and muzzle-punching (slammed his muzzle into the trainers face and nose) two separate trainers. He growled whenever he was approached from the front , stood over or stared at.  (Landsberg, Hunthausen, and Ackerman, 2003). I began behavior modification while Isaac was in service dog training, and adopted him at age 11 months.

Figure 1: Sir Isacc Newton

                                                           Figure 1. Isaac, Saint Bernard mix. 15 months after beginning treatment.

                                                                                                        
            Upon adoption, Isaac immediately showed signs of severe aggression. During his first night in my custody, he lunged without warning at my elderly husky. Isaac grabbed the husky by the head and back of the neck. He had to be physically pulled off of the husky. (The husky was not seriously injured.)
Figure !: 

            Over a 3 month period of time, Isaac lunged at several dogs’ faces and throats, without warning. He bit the target dogs’ heads, faces and/or necks.  I observed Isaac’s jaws lock in a closed position, and was unable to force his mouth his open even with a metal bar.  Isaac would attack unpredictably, and not always to known stimuli or triggers. The muscle spasms causing clamped jaws would last 5-8 minutes, at which time, Isaac would release his hold, and back away apparently disoriented.

Seconds before an attack, and during the “lock-jaw” episodes, Isaac experienced horizontal nystagnus, and his eyes appeared “clouded”. The nystagnus stopped 2-5 seconds before the mandibular muscle spasm relaxed.  Also for 12-24 hours prior to a rage Isaac exhibited “fly catching” (snapping at things that neither other dogs nor humans saw).

Through daily journaling of his behavior, I noted a pattern of aggression when Isaac was placed in high stimulation situations, and at 17-23 day intervals. Isaac exhibited shadow chasing, nervous pacing and apparent disorientation 12- 24 hours prior to an “attack”. 

A physical exam noted tenderness and painful response in the lumbar area. Isaac exhibited a stiff, lumbering gait, with uneven weight-bearing in hind limbs. Radiographs revealed collapsed or non-existent intervertebral disc spaces between L1 and L2, and L2 and L3. All other physical parameters were within normal limits.

Hematology, blood chemistry, T4, and urinalysis were all within normal limits. No parasites were noted in a fecal analysis.

 Diagnosis

            Based on radiographic evidence, Isaac suffered from collapsed vertebral discs resulting in spinal inflammation, and impaired mobility.

            Based on the behavioral history, observed neurological  signs (shadow chasing, nystagnus, muscular spasms and disorientation) and the consistent 3 week pattern to the aggressive episodes; a neurological defect, disease process, or disorder was suspected.  Rule outs were, brain tumor, frontal lobe damage or frontal lobe epilepsy, impulse control disorder,  or episodic dyscontrol (commonly referred as “rage syndrome” or idiopathic aggression), neurological damage due to puppyhood distemper infection. (Personal communication with Stephen Lane, 2009) (Dodman and Shuster, 1998).  Due to the prohibitive cost of a MRI, a definitive diagnosis could not be made.  Dr Lane, a veterinary neurologist, recommended a treatment plan consistent with managing rage syndrome.

Rage syndrome

            Rage syndrome is characterized by sudden, unprovoked aggressive attacks. A dog suffering from rage syndrome will lunge without growling or giving other warning signals. While in a rage, the affected dog bites any human or other animal in its path. The dog bites down and facial muscles often spasm, preventing the dog from opening its mouth until the spasm relaxes. Some neurologists believe that this “lock jaw” is in fact a localized petit mal seizure. (Personal communication with Stephen Lane 2009) Observers may report that the dog’s eyes appear “glassy” or “cloudy” and the dog may exhibit other neurological signs such as “fly catching” and “shadow chasing” within minutes to hours prior to a “rage.” ((Dodman, N and Shuster, L, 1998). 

            The exact etiology of these rages is unknown, hence the name idiopathic aggression.  One theory holds that the rages are a form of temporal lobe epilepsy (or TLE).  “ [Human] patients [with TLE] may lash out with hands, feet or other objects. This aggression appears to be random and undirected.”  (Dodman and Schuster, 1998. P 69). Johnson (2001) suggests that the “rages” may be related to abnormally low levels of serotonin in the brain.

            Some researchers and observers have noted a predictable time cycle to the “rages”, often approximately 1 month.  Because of possible cyclic nature of the rage episodes, this disorder may be referred to as episodic dyscontrol or temporal dysfunction.  (Dodman and Schuster, 1998)

            In dogs, this unprovoked or idiopathic aggression appears first at puberty and increases in intensity with age. The disorder is common in springer spaniels, cocker spaniels and bull terriers, and is referred to by breeders as springer rage (Dodman and Schuster, 1998). A form of aggression with similar signs was also noted in Saint Bernards in the early 20th century. (Heim. 1966). Although this rage was believed be to “bred out” of Saint Bernards; the breed is still prone to epilepsy and other seizure disorders.

            Recommended treatments vary from the use of anticonvulsants (Dodman and Schuster, 1998), to medications which increase serotonin levels (Johnson, 2001) to euthanasia, due to the safety concerns presented by a dog with unprovoked aggression.

 

Our Team

            Due to the lack of consensus and documented research with treatment of this disorder, and the availability of various modalities, I choose a combination of conventional pharmaceuticals and alternative therapies for Isaac’s case.

I consulted my valued team of veterinary consultants in order to determine the best treatment plan for Isaac. Dr Metzger provided primary veterinary care, and laboratory testing to monitor organ damage from the anti-seizure and anti-inflammatory pharmaceuticals. Dr. Overman, who has a master degree in organic chemistry, provided consultation regarding brain chemistry, modes of action and possible interactions for the pharmaceuticals and herbals prescribed. Dr Lane provided neurological consultation. Dr Miller provided acupuncture and consultations regarding acupressure points and Chinese food therapy.

            As Isaac’s owner, behavior specialist and a certified veterinary technician, I played a multi-facetted role in Isaac’s care. I documented all treatments, examinations, laboratory analysis, and behavioral observations. I determined and executed the behavior modification techniques utilized. I also, explained to my husband and student trainers Isaac’s possible diagnosis, and medical, complimentary and behavioral treatments. Because of concern for safety, I did not allow other veterinary technicians or staff to assist with Isaac’s care.

            Treatment

            The veterinary team recommended treatment with conventional anti-seizure medication; combined with Western herbal therapy, acupuncture, acupressure and nutritional therapy.  To these therapies, I added behavioral modification and aromatherapy.

Due to the lack of a known cure for idiopathic aggression, our treatment goal was to control Isaac’s aggression and improve his quality of life. To support the quality of life goal, we used non-steroidal anti-inflammatory agents, acupuncture and nutraceuticals to reduce Isaac’s back pain.  I documented all treatments, observations and interactions with Isaac for future reference.

Conventional Treatment.  Isaac received 90 mg of Phenobarbital orally twice daily to suppress his aggression and help control the neurological/seizure aspects of his disorder. He received an additional dose of 60mg when he exhibited neurological signs, such as shadow chasing, disorientation or a rage.  (Dodman and Schuster, 1998). He also received 100 mg of Rimadyl orally twice daily for pain control. In determining dosages for these medications, we assessed the risks of hepatic and/or renal damage, from long term use of this combination of medications, against my goal of improving Isaac’s quality of life.

Herbal Therapy.  Isaac received daily oral doses of 600mg Valerian root. Valerian root has shown anti-anxiety and anti-seizure properties. (Schwartz, 2005). Although Kava-kava is also an excellent anti-seizure and anti-anxiety herbal remedy, Dr Overman (Personal conversation January 2008) advised against its use in Isaac due to a possible side effect of reducing impulse control.

Neutraceuticals.  Chondrotin, Fish Oils, and Vitamin A & D, to help control inflammation and support joint health.  (Personal communication with Deanna Miller). I mixed Nutrigest, a probiotic mixture, (Rx Vitamins) into each of Isaac’s meals to eliminate the diarrhea he experienced as a side effect of the Valerian and Rimadyl interaction. (Personal conversation with Dr Monica Overman, March 2008).

            Acupuncture.   Dr Miller performed acupuncture every 4 to 6 weeks. She performed dry needling along several meridians.(Figure 2) She targeted the Liver meridian, to increase moisture in the nervous system and help control the seizures and other neurological symptoms. She utilized points along the Heart and Pericardium meridians to calm the “mind” or spirit.  She also targeted the Gall Bladder meridian to decrease stiffness and pain in Isaac’s back. After Isaac experienced a seizure or rage, Dr Miller injected Vitamin B12 at PeriCardium 6 (Figure 3)  to reduce anxiety  and at Heart 7 (Figure 4) and Gall Bladder 20 to decrease the probability of another seizure. (Schwartz,1996)

Figure 2. Heidi demonstrating acupuncture

Photo taken June 24, 2010

PC6-trigger point for  anxiety

Figure 3. Heidi demonstrating acupuncture at Pericardium 6.

Photo taken July 9, 2010

HT7-trigger point for  seizures


Figure 4. Heidi demonstrating acupuncture at Heart 7.

Photo taken June 24, 2010

 

Acupressure Massage.  I performed light pressure and circular massage along the liver and heart meridians. I concentrated my massage at PC 6 and HT7. (Schwartz, 1996).  Although medical massage was attempted along Isaac’s lumbar spine, he reacted aggressively each time, so this technique was stopped.

Isaac wore an anxiety wrap (Figure 5) (Sharpe) during times when other dogs were present or times of stress. The anxiety wrap creates a calming session through light pressure across the body.

Figure 5. Anxiety Warp.

Photo Courtesy of Susan Sharpe

http://anxietywrap.com/about/H...

Nutritional Therapy.  Isaac experienced severe ear inflammation when eating beef and lamb, so I eliminated these protein sources from his diet. I fed him both dry and canned dog food with turkey as the main ingredient. Turkey contains L-tryptophan, which acts as neurologic depressant. (Reich, 2003)

Houpt (2003) found that high amounts of long chain proteins may aggravate dominance aggression. To reduce Isaac’s aggression, and to help support his kidney and liver function (in response to the increased burden to these organs from the high doses of Rimadyl and Phenobarbital, I changed Isaac’s diet to a lower protein senior diet.(Hills, 2005)

Aromatherapy.  Dog Appeasing Pheromone (Crosby),(Figure 6)  can help reduce stress and inter-dog aggression. The Dog Appeasing Pheromone eliminates the smell of distress and anxiety in the air, and replaces it with the scent of relaxed female dog. I had DAP diffusers running in the main area of our home and in the room with Isaac’s kennel.

Figure . Dog Appeasing Pheromone

                            Photo courtesy of Pet USA.

http://www.4petsusa.com/index....

During times of intense activity, or when Isaac acted nervously or disorientated, I burned small amounts of lavender incense in the room with his kennel. Lavender can help calm and reduce seizures. (Schwartz, 2005).

Behavior Modification.  

My first goal, in behavior modification was the safety of my other dogs, any dogs that Isaac came into contact with, and the safety of any and all humans who interacted with him.

While Isaac was away from home, or when unknown humans or other dogs were present, I kept Isaac on a leash with a Halti head collar. The Halti permitted complete control of Isaac’s head. In the event of an aggression.  (Figure 7)

Figure 7

Halti headcollar

Photo courtesy of Shelby Marlo

http://store.shelbymarlo.com/h...

 

When Isaac displayed disorientation, shadow chasing or other neurological signs, I immediately placed him in a secure kennel. I kept the kennel in a separate room, which could be darkened and was away from away from outside stimuli because intense stimuli can precipitate a seizure in epileptic animals (Personal communication with Dr Lane, January, 2008), and often precipitated a rage in Isaac. Isaac often went into his kennel without being told, when he appeared to me over-stimulated.

My second goal was to reduce and eliminate as many aggressive triggers as I could identify. To accomplish this goal, I practiced having Isaac “share” food and toys, to reduce his possession aggression. I gradually desensitized him from his known triggers, such as other dogs approaching him from the front, loud noises, and being leaned over. I, with the help of my student trainers, exposed him to the above triggers in short time frames, treated and praised him when he did not react. When Isaac did react to the trigger, he was placed in “Sit” and held until he stopped reacting. I often used acupressure massage to calm him and reduce his reaction to these stimuli.

 

Outcome

            During the first 14 months of treatment, Isaac’s rage episodes decreased in frequency from every 18-24 days to every 100-120 days (4 months), duration (from 30-45 minutes to 15-20 minutes) and intensity. His pre-seizure behavior became predictable. Often when Isaac began “shadow-chasing”, with acupressure and increased dosage of Phenobarbital, no subsequent seizure/rage occurred.

            Isaac’s mobility increased and he became less reactive to having his hind quarters handled. He played with my other dogs more, in an appropriate manner. He participated in training classes, family activities and even began therapy dog training.

            Twenty-two months after treatment began; Isaac suffered a severe seizure/rage, resulting in him severely biting my husband’s hand. After having to be physically forced into his kennel, Isaac continued to attack the kennel bars for nearly 4 hours! Due to the severity of the bite that he inflicted and the prolonged duration of his rage despite repeatedly administration of Phenobarbital; the entire veterinary and behavioral team decided that euthanasia was the only remaining option.

            Despite the final need to euthanize Isaac, I believe that the integrative approach to his treatment and management provided Isaac with two years of a high quality life, that most rage syndrome dogs do not experience.  The information that we acquired from documenting his treatment and progress has positively affected the treatment of several other dogs with related panic disorders and aggression issues.

References

Crosby, J. Canine Behavior Spotlight. About.com: Veterinary Medicine. Retrieved July 3, 2010 from:

            http://vetmedicine.about.com/c...

Dodson, N. and Shuster, L. (1998). Psychopharmacology of Animal Behavior Disorders.

 Blackwell Sciences. Malden, Massachusetts.

Heim, A. (1966). The New Complete Saint Bernard. Howell Book House, New York, New York.

Hills Pet Nutrition, (2005). 2005 Hill’s Key to Clinical Nutrition.

Houpt, K. (2003).  Effect of Diet on Behavior AVMA 2003 Convention Notes.

Johnson, L. ( 2001). Springer Rage Syndrome. English Springer Spaniel Field Trial Association

Retrieved from: http://essfta.org/Health_Resea...

Landsberg, G. (2010). Drugs and Natural Products as Adjuncts in the Treatment of Aggression.

NAVC 2010 Conference Notes.

Landsberg, G, Hunthausen, W and Ackerman, L.(2003). Handbook of Behavior Problems of the Dog

            and Cat. Saunders, New York, New York

Retrieved from: http://www.iknowledgenow.com/a...

Lane, S. DVM Diplomate ACVIM. Personal Conversations. January, 2008 to October, 2009

Metzger, K DVM. Personal Conversations. January, 2008 to October, 2009

Miller, D, DVM, IVACS. Personal Conversations. January, 2008 to October, 2009

Overman, M DVM, MS. Personal Conversations. January, 2008 to October, 2009

Reich, M. (2003). Medical Considerations for Behavioral Drugs: Drug Interactions and Medical

            Contraindications. AVMA 2003 Convention Notes.

Schwartz, C, (1996). Four Paws, Five Directions A Guide to Chinese Medicine for Cats and Dogs.  

            Celestial Arts. Berkley California.

Schwartz, S, (2005). Psychoactive Herbs in Veterinary Behavior Medicine. Blackwell Publishing.

 Ames, Iowa

Sharpe, S, How it Works. The Anxiety Wrap. Retrieved on July 1, 2010 from:              http://anxietywrap.com/about/H...



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