We had a follow-up appointment with our VB recently.
I don’t know whether it’s lingering fallout from the Christmas period and road trip challenges, or just bad luck with triggers, but it feels like George’s medication has been less effective lately.
He had been doing better with people at a distance, although dogs were still a struggle. Recently, his tolerance of people, even at a distance, has decreased again.
He’d also been doing better at home, but that’s become more challenging too.
Daycare drop-off and pick-up remain very difficult, as does running the neighbour gauntlet.
I’ll admit my own mental state has been suffering a bit as well. I know these things are closely linked.
I got a bit teary explaining our current situation to the VB, particularly the feeling of being stuck in “management mode”.
It’s very difficult to make progress with behaviour modification when George is over threshold as soon as we step outside (and sometimes even when we’re inside).
Not being able to work on behaviour modification really limits hope.
George was accommodating during the appointment by displaying a lot of anxiety. He did remember the VB and the trainer—and that they give the good treats—and produced some very sharp demand barks I’ve never heard before. Thankfully.
The VB was understanding, as usual, and suggested making some changes to his medication. I’m grateful that she doesn’t tell you what to do, but instead offers guidance and talks through the pros and cons of the various options.
We’re increasing the Sertraline to twice a day and adding Lorazepam. We’ll review this in a month. If there’s no improvement, we’ll look at weaning him off Sertraline and trialling Clomicalm (a type of antidepressant).
This is in addition to daily Clonidine and Gabapentin, and Sileo for grooms and vet appointments.
The VB explained that some dogs can be resistant to SSRIs, and as we’ve trialled both Fluoxetine (Prozac) and Sertraline (Zoloft) with little effect, it would be worth trying a different class of medication.
We were described as one of the more challenging cases—likely in terms of finding the right medication combination—although George has been described as having extremely high anxiety on many occasions.
I’m always scared when starting George on a new medication. There always seem to be side effects to work through. The guilt is real, even though I know he struggles more without support. I’m just trying to work out what helps, and because he can’t tell me, I have to observe him very closely.
I waited until we could have a few days together at home before starting. I was particularly nervous about Lorazepam. Even though I don’t know a lot about it, I’d heard it’s more “heavy duty” and can be addictive. George’s dosage range is 1–4 tablets, up to twice a day, which feels like a lot.
George is off his food at the moment, which makes giving medication challenging. The VB explained that Lorazepam can increase appetite, which might actually be helpful right now.
I started with one tablet in the morning on the first day. He was quite drowsy, but not stumbly (there is a more medical term for that!). I didn’t want to increase the dose yet.
He did have some reactions to the neighbours, but they were definitely muted. I was able to do some counter-conditioning and desensitisation, which hasn’t been possible recently.
Unfortunately, the increased appetite hasn’t happened yet. If anything, it’s decreased further, which is making medication time more stressful.
Once we left the house, there was no noticeable difference in his anxiety levels or reactions. It was as if he hadn’t taken anything at all.
I’m not sure how to navigate this. I definitely don’t want him to be over-medicated at home, but I also want him to be supported out in the world. It’s so difficult.
It’s early days—we’re only three days in—and he’s still on one Lorazepam in the morning. I’ll continue to monitor closely.
I’m so jealous of people with anxious dogs for whom Fluoxetine (Prozac) is a “game changer”. I think this is our tenth medication, plus many more combinations and dosage tweaks.
Each new medication change brings a little hope that this might be the right combination to support George.
We live in hope.