Today was the straw on the camels back.
Anyone who has read here more than a few minutes knows I loved my old vet Dr. K. She was absolutely the best vet ever, bar none. Hence I've been doing the 2 hour trip while trying to find another since moving here! If I could have convinced her to pack up and move here too I would've. (I did ask... lol) Up to date on the latest information (I would kill for a vet here who has even passing awareness of Dr. Dodd's work...) but also recognized she had limitations (deferring to specialists when appropriate) and wasn't afraid to say, "I'm not sure but let me find out..." or acknowledge that some dog owners are actually quite well informed, will want to be involved and can pretty accurately assess a situation.
At any rate, I needed to get refills on Veri's meds and tried out a vets we'd decided to trial. Should be no trouble, it's a medication she's been on for awhile, both under the specialist and Dr. K and we're quite happy with so all he needs to do is write out the refill form. For those who don't know, Veri is on fluoxetine. This fellow started by telling me he wasn't familiar with fluoxetine (which, wow...) and wanting me to put her on clomipramine, as all SSRI's are the same or else he uses benzos.
Now for those who don't immediately see the problems...
- First I believe that there is value in a specialists opinion who has studied additional to their veterinary degree on the subject and have extensive experience in working with a particular problem over a general practitioner. Besides, why change medications from something that is working so well!
- Second SSRI's are not all the same - different ones affect different serotonin receptors to varying degrees making some more suited to particular expressions of anxiety than others. Likewise because all dogs are individuals they each differ in how the receptor types are distributed, how they will metabolise medications and which their particular chemistry will be most receptive to. In short, one size does not fit all.
- Second - clomipramine, the medication he was telling me I should use instead as all SSRI's are the same, while sometimes mis-termed a SSRI is actually a TCA. TCAs work differently than SSRIs, affect norepinephrine, are less selective in their effects on the receptors and can have unpleasant side effects. "Isn't that a tricylic?" was met with, "Um, yes, actually, ah..."
- Third I can't imagine why you'd use benzos unless both SSRIs and TCAs weren't doing the trick, certainly not as a long term daily med.
Okay, now everyone who has met Verity, me or seen me with dogs in general take a moment to pick yourselves up off the floor when you're done rolling around laughing at the absurdity, it gets better...
His recommendation is that I need to send her away to an alpha trainer for "bootcamp" (the name rather explains the mentality doesn't it...) where they will train the anxiety out of her over a few weeks before sending her back. Hn. Well that explains why he was grumping over the veterinary behaviourists choice of medications (never mind the countless studies, double-blinds, peer reviewed articles, etc by Dr Karen Overall, Dr Dodman and other leading specialists internationally) - she's also Delta accredited, so obviously using positive reinforcement, operant conditioning, and applied behaviour analysis means her veterinary and behaviour credentials are invalid. :rolls eyes:
Anyhow, managing to quell my internal devils advocate (who would love to debate the whole benefits of sending a dog to an outside trainer to solve the problem that by their own theory is with the owner...) I query how they address cases where the issue is a genetic predisposition (have yet to meet a training technique that alters DNA) and what methods they use to address remedial socialization. Oh he knows there is such a thing as genetic predisposition but in his opinion it's not really a big thing that has much effect, didn't seem to think much of the fact that for some dogs while training improves on genetic predisposition there will always be a tendency to drift-back and a degree of management. It's mostly just the owner failing to make the dog understand they're the alpha. Riiiigggghhhtttt. Okay, well - in for a penny... I query about the methods. Unshockingly the alpha way involves corrections. Mind you they can't tell me if that's in the form of neg reinforcement, pos punishment, neg punishment... that would assume they actually knew what they were talking about you see....
*SIGH* Have I mentioned I really, really, really miss Dr. K???????? Who besides being all over wonderful had learned about training sometime more recently than when dinosaurs roamed the earth and happily acknowledged it wasn't her area of expertise? At any rate, I got the script, took the papers with the suggestion to just look at them as he thought I'd find the program excellent (yeah right) and crossed another vet off my list of potential replacements for Dr. K