The Intersection Between Health and Behavior

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Most people might be surprised to learn how often medical issues influence behavior issues. If you think about it from our perspective, though, it makes sense. When we’re sick or in pain, we might have less energy or, conversely, be more agitated. We don’t perform as well, and tasks that usually come easily to us feel like a slog. We might have less patience or a lower frustration tolerance. Likewise, if we’re anxious or depressed, we’re more likely to cry or shut down or lash out. When thinking about it from a human standpoint, it seems obvious that physical or mental illness changes our behavior. And yet, when it comes to our pets and their behavior issues, we usually jump straight to training without considering potential health factors. But if there is an underlying medical issue influencing the behavior, no amount of training is going to make that go away. Without acknowledging and addressing the root cause, we’ll just be spinning our wheels.

I practically grew up in the veterinary world. As a young girl I thought I wanted to go to vet school, so I was very excited when my 4H club took us on a field trip to tour the local vet school. While on the tour, our tour guide told us, “It’s not enough to get good grades if you want to get into veterinary school. You also have to have a lot of experience with animals.” I took that advice literally, and started volunteering in an animal shelter and a vet clinic when I was 11 years old. That was the beginning of a total of 23 years in veterinary settings in a variety of capacities. One of the reasons I became a behavior consultant was because I saw how deeply physical and mental health influences behavioral health – and vice versa – in seemingly limitless ways. And yet I still, more than three decades after I started, encounter new and surprising cases on a regular basis.


Charlie and his Sneaky Illness

Not too long ago, I worked with a client who had a 3 year old German Shepherd who was reactive to strangers and would sometimes guard food and objects from his owners. The client reported his behavior as unpredictable: sometimes he was reactive and sometimes he wasn’t; sometimes he would guard things from them and sometimes he wouldn’t. Usually, when a client tells me that their pet’s behavior is unpredictable, that means I have the opportunity to teach them how to better read their pet’s body language and how to observe changes in the environment that affect their pet’s behavior. But in Charlie’s case, as we worked together, and the clients honed their body language and observation skills, and Charlie learned some useful life skills, it became apparent that Charlie’s behavior was, in fact, being influenced by something beyond what we were observing.

I suggested that they take Charlie to their vet to rule out any medical issues. The vet did an exam and some basic wellness diagnostics, but didn’t find anything. She sent them home with an anti-anxiety medication, which did improve his behavior somewhat, for a while.

Over time, however, Charlie’s behavior got worse, even on the medication. And what made it even more difficult for the client was that they reported he was less food motivated–which had never been a problem for him before. He was overall more agitated, had difficulty resting, and no longer slept through the night. They tried exercising him more, but that didn’t seem to help at all. In fact, he resisted their attempts to take him out for walks.

Then something occurred to me. Charlie always looked to me like a smooth-coated German Shepherd. I never questioned it; I just assumed he was. So I asked the client if he was single-coated or double-coated? She seemed a little offended by the question, and said that they got Charlie from a reputable breeder who only bred double-coated dogs. I asked her if Charlie’s coat, then, had always been that thin? Her eyes widened, she looked at Charlie carefully, as if seeing him for the first time, then turned back to me, “You know, I never noticed before but… I think you’re right. Now that I’m thinking about it, he used to be really fluffy, and he isn’t anymore.”

There’s a disease called Schmidt’s Syndrome that is a combination of both hypothyroidism and Addison’s disease. It can be difficult to identify because each of those diseases have some opposite symptoms: hypothyroidism typically causes increased appetite; Addison’s typically causes decreased appetite. Hypothyroidism typically causes weight gain; Addison’s typically causes weight loss. But both diseases can cause hair loss and increased agitation and yet, paradoxically, also lethargy.

My dog Brie has Schmidt’s Syndrome. She became symptomatic around Charlie’s age. Hair loss and increased agitation were her first noticeable symptoms as well. I, too, didn’t notice the hair loss until it was significant, because when you look at a dog all day every day, you don’t notice gradual changes. She, also, didn’t gain weight. She, also, lost her appetite. Her vet, also, didn’t find anything significant in the standard wellness diagnostics for a dog her age.

It is both irresponsible and unethical for a non-veterinary behavior professional to give a medical diagnosis to a client, so I didn’t tell Charlie’s owners my suspicions. I did, however, give them a list of very specific symptoms to relay to their vet, along with very specific questions to ask. 

Because the client was able to give their vet more salient information, the vet was able to perform the right diagnostic tests. And sure enough, Charlie had Schmidt’s Syndrome. Within days of getting him on the appropriate medication, Charlie’s behavior started to improve. All the skills his owners had been teaching him suddenly fell into place. He didn’t just know how to do things; he was now able to do them. Life with Charlie became easier and more predictable.


What Did Charlie Teach Us?

Charlie’s journey made it clear to me that, even after three decades in the veterinary profession and over a decade of behavior consulting, some medical issues can still sneak up on us. They aren’t always obvious. Getting a clean bill of health from a vet doesn’t always mean the animal is actually healthy–and that also doesn’t mean that the vet was negligent or incompetent; a lot of illnesses can be tricky to find unless you know what you’re looking for. 


How Do You Know if You Should Be Looking Into a Medical Issue?

There are a lot of factors that lie beyond the scope of this blog, but the four most common signs to look for are:

  • Sudden change in behavior
      • If your pet’s behavior suddenly changes with no obvious inciting incident, it’s probably a medical issue.
  • Sensitivity around a particular body part
      • If your pet’s behavior issue(s) involve a particular part of their body (e.g. if your dog whips around and snaps at you every time you touch their hips), it’s probably a medical issue.
  • Cyclical behavior issues not based on routine changes
      • If the behavior issues crop up at a regular interval not related to your routine, it’s probably a medical issue.
  • Behavior issues that aren’t improving after training
    • If you’ve been working with a knowledgeable, science-based behavior professional who has taught you how to read body language, observe behavior in its environmental context, meet your pet’s needs, and teach them life skills to address their behavior issues, and your pet is still struggling, it’s probably a medical issue.


How Should I Talk To My Vet About My Pet’s Issues?

Obviously it’s difficult for us to tell you exactly what questions you should be asking your vet, since the list of medical issues that impact behavior is seemingly endless. However, as a general guideline it is helpful to be specific about what changes you have observed in your pet’s body and behavior. A vet can’t be as effective if a client comes in and says, “My dog is aggressive and my trainer says it’s probably a medical issue.” But if you can tell them exactly what changes you’re seeing, that will give them some clues as to where to look.

Here is a list of things to think about when talking with your vet:

  • Tell your vet about the specific behavior changes you’re seeing. Instead of making general comments like, “My dog is more aggressive,” or, “My dog is more fearful,” be specific about the behavior changes. For example:
    • My dog used to go on 2-mile hikes with me. Now she lays down and won’t walk again after just a quarter-mile.
    • Last month my dog started barking and growling at anyone who walks by. Before that he always ignored strangers.
    • Over the past year, my dog has been waking up in the middle of the night and pacing and whining. At first it was every so often. Now it happens every night.
  • If there’s a specific body part that seems to be affected, mention that. For example:
    • If your dog growls and snaps when you touch your dog’s ear, mention that.
    • If your dog’s coat quality or thickness changes, mention that.
    • If you notice they carry their tail differently than they used to, mention that.
  • Specify what cyclical changes you’re seeing. For example:
    • Every six weeks, my dog seems to forget everything she’s learned and we have to re-teach all the skills she’s learned. 
    • Every four to six weeks, my dog gets really irritable and will snap at us if we try to rub his belly for a few days. He normally loves belly rubs. 
    • Every summer my dog will bark and lunge at anyone who tries to pet him. The rest of the year anyone can pet him, but in the summer he doesn’t let anyone touch him.

Now What?

  1. Have you noticed any of the signs that there might be a medical issue influencing your dog’s behavior? If so, schedule an appointment with your vet.
  2. Prepare your list of talking points in advance of your appointment so you can be well-prepared and won’t forget any important information. If you’re working with a behavior professional, ask them to help you with this.
  3. If you feel that your vet isn’t taking your concerns seriously, get a second opinion from a different vet.