Vito's Behavioral Recheck- New Plan
Big changes will be coming soon for Vito. He had his recheck appointment this week with his behaviorist. A long overdue appointment since we had a hard time getting in on the schedule. We talked about his 3 core issues and how for the most part he is worse in all areas:
- Separation Anxiety
- Car anxiety
- Reactivity to people/ generalized anxiety
Vito likes to stick to his habit of great improvement with each new drug or dosage we try, and then a slow shrinking back to normal.
SA- We continue our habit of not really ever leaving him alone. If he does have to be left, it better be in the morning when he has the best chance of just deciding to crawl back into bed and sleep. Otherwise he's anxious after 5 minutes and has restarted his panting and has even gone back to some howling.
Car- Vito has been slowly getting worse for awhile now. I was hoping that when we were gifted a minivan earlier last month that it would make him happy. Vito seemed to enjoy the Honda Fit we've sometimes borrowed and I thought maybe he liked the flat surface vs being on a seat. But the van is apparently out to eat him. Vito has taken to stalling about getting inside as it takes him forever to cross our miniature yard space and of course he then has to stretch. About half of the car rides now are panic attacks. The other half range from light panting to a few nice ones.
Reactivity to people is the lowest of his anxieties. He's reacting quite a bit at work to sounds of people coming by. Even to me. Vito was nice enough to demonstrate his increased anxiety by totally flipping out when the exam room door opened. But overall not bad.
By all accounts, we're pretty close to where we were last May. I guess there's one good change since then as I've mostly fixed/managed the issues we were having with redirecting onto the dogs at work. Vito was rushing and snarking at the labs with the excitement of being let out into the big yard. Just leashing him and waiting a little bit wasn't helping as Vito is proud of his ability to obsess and explode. So I went to requiring Vito to take, and swallow, treats. I've already taught him this requirement for past problems so it didn't take Vito too long to get the rules. I love that the simple act of eating helps to calm dogs down. Even though Vito really doesn't want to the treats it's remarkable how much he demands them now, he likes routines you know, and then how much this calms him. We're not at 100% success, but most days this problem is conquered.
The new plan:
1. Scrapping Diazepam which has just too short of an effect and is creating lots of spikes throughout Vito's day.
2. Replacing Diazepam with a longer acting drug. A very, very expensive longer acting drug :( We will start Clorazepate.
(3. Sticking with Clonidine to keep helping him during all the transitions. I definitely notice a difference when it's wearing off.)
Because of the big move, the rest of the plan will be delayed some more. But hopefully Vito will settle into the new house quickly and we can start.
4. Good bye Fluoxetine. The daily dose of 40mg is very high and clearly not helping. Weaning process will take awhile. This will be rough.
5. Hello Amitriptyline. She was reluctant to do another SSRI due to the Fluoxetine dose and effect on Vito. This new drug is in the same family as the very first drug Vito tried. At that time we stopped after 4wks because Vito was becoming more reactive and anxious in places. In hindsight I'm now not sure if we weren't giving the drug enough time to work and the anxiety shown was the new Vito just starting to emerge.
