Podcast
Daniel Mills, BVSc, ECAWBM(BM), PhD: Pain and Behavior Problems
Nov
[Upbeat music intro]
Jessica Perry Hekman: Welcome to the Functional Breeding Podcast. I’m Jessica Hekman and I’m here interviewing folks about how to breed dogs for function and for health; behavioral and physical. This podcast is brought to you by the Functional Dog Collaborative, an organization founded to support the ethical breeding of healthy behaviorally sound dogs. The FDC’s goals include providing educational, social and technical resources to breeders of both purebred and mixed breed dogs. You can find out more at functionalbreeding.org, or at the Functional Breeding Facebook group, which we work hard to keep friendly and inclusive. I hope you have fun and learn something.
0:47
Jessica Perry Hekman: Hi, friends. This week I’m talking to Daniel Mills, professor of Veterinary Behavioral Medicine at the University of Lincoln, and director of the university Animal Behavior Clinic. Daniel is internationally recognized as an authority on companion animal behavior, cognition and welfare. His laboratory studies, among other things, the association between untreated pain and behavior issues. I asked him to talk about his research and his insights into the challenges of assessing pain in dogs and why it’s so important to do so. Daniel, thank you so much for being on the podcast. I really appreciate it.
Daniel Mills: It’s a pleasure to be here. Thank you for asking me.
JPH: So I always start out by asking people to tell us about the dogs or other animals that they live with, and you can include humans if you feel like it.
DM: Well, I don’t live with any dogs, which surprises a lot of people. I live with a cat, some fish and some tortoises. And one of the reasons why I don’t have a dog, actually though, is because I travel so much and I just don’t think it’s fair on a dog to leave it. So it’s a sacrifice I’ve made, but I have plenty of dogs at work that if I need my dog fix, I can just wander down to the building and find one there. So that works well. Yeah, but the main one in the house probably is the cat. He’s the one who gets most of the attention.
JPH: What’s his name?
DM: Meeka. He came with that name, he’s a rescue. We think he’s probably Maine coon or Norwegian forest. He’s got a lot of it in him. He has the most amazing whiskers, and he more than doubles his length with his tail.
JPH: Sounds like he might be roughly dog-sized as well, so that counts.
DM: Yeah, he probably is. He’s bigger than certainly one of my friend’s dogs.
JPH: So why don’t we start out then by talking about exactly what your job is. You’re a researcher. So where do you work? What do you do? What are your interests?
2:49
DM: Okay, so my official title is professor of Veterinary Behavioral Medicine, which all sounds very grand, but basically my background is, I’m a vet. My first degree, I qualified as a vet. I went into practice, and then after a few years went into academia and just seized an opportunity to follow my interest in behavior. And as a result, we have a very big research group working on companion animal behavior, various behavior problems. I’ve got three PhD students currently working on aggression in dogs. We have some cat work going on looking at scratching behavior – environmental scratching, not scratching themselves. But increasingly, I’m actually getting very interested in sort of some of the social sciences and how people perceive things. So I recently took on – well, recently, it’s a year ago now – took on a PhD student who’s looking very much at why nice people do not so nice things to horses. And I’m just about to take on a new PhD student who’s going to do a similar sort of thing in relation to sort of what’s commonly referred to as pet parenting. You know, people say how much they love their dogs, and you know, they’re fully integrated members of the family, but you wouldn’t leave a child alone for eight hours in the day or put a pinch collar on it to stop it from running off. But these people do, and I’m just fascinated as to why they do. You know what’s going on behind them. We’ve just finished a bit of work looking at short-nosed breeds of dogs, and one of the interesting things there is we were looking at it because there’s been quite a few campaigns to try and raise awareness of the health problems with a view to reducing the tendency for poor breeding. And sort of what we found was that whilst the sort of logical thing is, well if people are aware that these dogs have these health problems, then you know, they wouldn’t want to promote the suffering and so they wouldn’t get one. But actually what happens is if people like these breeds of dog – and you know, I must admit I have a life size pug in my office downstairs, I do see the attraction in them – but when they hear these messages about the health problems, they don’t interpret it as you might think, and say, “Well, this is terrible, you know, we should be doing something about the breeding.” They think, “Well these poor little creatures, they need to be loved and cared for. So I’d better get one.” So the campaigns have the complete opposite effect, potentially. And I find that sort of reframing absolutely fascinating human behavior. So whilst a lot of my fundamental research is much more in emotions and things like that, and have a big interest in pain, as you know, in companion animals, I’m really interested in this whole dynamic of how we all create our own realities, and I find that absolutely fascinating. And as a result, how we process information and how that affects our whole world view and what we do. And, you know, working with problem behavior, it’s absolutely critical to make sure you don’t think that people are going to think like you do. You’ve got to try and they see things from their perspective. And that comes with, you know, their baggage. We’ve all got our baggage of our upbringing, and they may have had a lot of trauma in their childhood, etc. They may be recreating a relationship they had with a parent with their pet or with their partner, and that’s all causing problems. So, you know, there’s so much more to it than just the sort of, well, here’s the solution, implement it. So the human behavior change side of things, I think, is absolutely fascinating.
JPH: Yeah, it’s funny. I did get you on to talk about pain, but I’m completely distracted now by how interesting all of that is.
DM: Well, let’s just talk about whatever.
[laughter]7:12
JPH: Right? We certainly could talk about whatever. So it’s, it’s interesting to me, as you say, I could see where you were going with the flat-faced dogs thing, because I’ve, I’ve read Rowena Packer’s research as well, where there’s been interesting perspectives on why people get them, and it’s not just because people find them cute, right? There’s a lot of other stuff wrapped up in it. And part of what I was thinking when you were saying that, was sometimes I feel like people think that breeds of dogs sort of fall from the sky somehow, that they were, you know, produced by God and that we can’t change them. And there’s almost this perspective of, well if certain types of dogs are very sick, then they need our help. People don’t seem to take the step back to think we can actually prevent them from being created like that. People don’t start from that principle, right?
DM: Yeah, because, it’s often talked about, you know, we have two ways of processing things. And just this week, actually, I gave this example with the students. And I said, “If I tell you that there’s a guy called Steven, and he likes wearing cardigans. He’s quite quiet, he’s quite shy, he likes reading books. And then I ask you, Is he more likely to be a farmer or a librarian? What do you say?”
JPH: I would definitely instinctively say librarian.
DM: Yeah, and that’s because you’ve… but which do you think there is more of in the world, librarians or farmers?
JPH: I would hope farmers, since we all need to eat.
DM: Yeah, that’s the only relevant bit of information. So you know what the correct answer is. All this stuff about his personality was just you creating. I gave you a stereotype, and you just filled it in. And that’s the lazy, easy way that we operate most of the time. But if we stop and think, we can be rational, but we just respond to superficial characteristics and, you know, we drift along most of the time. And, you know, again, I sort of love the idea that most of the time, our brain doesn’t bother to tell us what’s going on. It only brings a small amount of information to our awareness, and it’s just responding to all of this information and that creates our predispositions. And it’s also really important when it comes to behavior, because I think historically, we’ve put far too much emphasis on, you know, the immediate trigger of a behavior as the cause. Well, actually, that trigger has to be processed by the brain, which, as we already said, creates its own reality. And that brain is stacked with all of the animal’s experiences. It’s shaped by the evolution of that species and that breed of dog. And it doesn’t bother to tell anybody any of that information, but that really has a big influence. And so we have to assess those behavioral predispositions in an individual and not just focus on the triggers to really sort people out, because there’s so much more to it than just ‘stimulus, response’.
JPH: Yeah, and it’s so hard for us to recognize too. When our brains are making assumptions and we’re not thinking things through logically, it’s so hard for us to see that. But it’s reasonable, right? Like your brain can’t be completely analytical and careful about every single impulse, every single stimulus that comes through.
10:40
DM: Absolutely I mean, the brain only bothers to create an awareness of this very, very small fraction of all the information that it’s processing. It’s processing billions of bits of information every second. And when we think about what’s going on and how much information, like, we’re having a conversation now, that in itself is probably using up about half our capacity of mental awareness just having the conversation. And if you’re doing something else, then you know… there really isn’t much… everything else is being monitored. You know, the sensations on your skin of the clothes, now that I’ve started to talk about will probably start to feel itchy. The lighting and things like that, adjustments to it, maybe odors that are in the room. And, you know, we just block them out, but it’s still a load on the brain. And this gives me a leverage to talk about pain. You know, this is where chronic pain is really important, because it’s adding to the load that the brain is trying to process the whole time. And so it can’t process as much of everything else in real detail. So it has to take shortcuts. So of course it’s going to be more reactive, because if I haven’t got the resources to attend to everything in the same detail, then I’ve got to err on the side of caution, and the brain will always err on the side of caution to protect itself. So it’s going to be much more jumpy in those situations. We did a fascinating study a number of years ago, actually, where, I don’t know if you’re familiar with the concept of biological motion, but it’s where you sort of see a load of dots on a screen moving relative to each other. And you can look at it and say, well, that’s a person walking across the screen sideways, or that’s a person walking towards me. And what’s fascinating, I think, with this is that in people, they’ll even tell you the gender of the person, because we take in, you know, the ratio of the markers on the shoulders and the hips. And anyone who doesn’t understand this, just Google ‘biological motion’. You’ll find some videos online, I’m sure. So we looked to see if dogs were sensitive to biological motion, not just of humans, but of dogs. And sure enough, they were. But the really interesting thing is we looked at the temperament of the dogs, and what we found was that your typical dog that had a sort of well balanced temperament, it would pay particular attention to the biological motion, the dots that look like a person walking towards you or dog walking towards you. But if the dots were of a dog walking across your visual field, they tended to largely ignore it. They did attend to it, and it was different to the random dots option. But those dogs that were rated as being much more nervous, they watched both with equal intensity, pretty much. So they’re just not switching off. They’re trying to process it because, oh, maybe there’s a threat there. You know, those dogs that are dog reactive, they’re not calming down, so of course they’re worn out. Of course they’re going to react to the slightest provocation, because they’re not going to wait to analyze it in detail. You know, we can stop and use our attention to really look in great detail at something that’s in front of us. But if you’re in a state of urgency and trying to defend yourself, you take this most superficial thing and, you know, you take the evasive action. And you know yourself. If you’re watching a movie, if it’s a scary movie, and you hear somebody with their keys in the door, you might jump. Even if you are expecting your partner home. If it’s a comedy that you’re watching and you hear the keys, then you might, “Oh yeah, it’s just my partner coming home.” You know, our brain is doing all of this stuff without bothering to tell us, and we don’t think about that, that it’s there.
JPH: Yeah, we think of ourselves as this sort of clear, distinct individual with so much cognitive control, and yet we are existing with all this background and then all the hormones.
DM: And I think that’s the thing. I mean, we think of ourselves with all this cognitive control. We are capable of it if we bother to apply it, but most of the time, you know, life works fine without doing it. And I think that’s one of the areas, the more I’ve studied dogs and their behavior, the less I’m convinced that dogs spend a lot of time cogitating, using cognitive skills to analyze stuff, and the more I think they’re very emotionally in tune animals, and they don’t have to analyze it. But because we do that as an integral part, and that’s why we’re really slow, you know, to respond to things generally, because we have so many abstract thoughts and things like. That slows us down by milliseconds. Many years ago I had the opportunity to go to the sky lab at the Primate Research Institute in Kyoto, and that’s where they have those chimps, and they basically show them a screen. And whenever they open the lab, you know, it’s entirely voluntary and the chimps actually love coming in to do the tasks. So they display on a screen, and the task is, they show a sequence of numbers, and then you have to press the screen where the numbers appeared in sequence from lowest to highest. And, you know, so you put numbers one and five, and you have to go ‘one, five’. Well, I had the chance to compete against a chimp, and I was absolutely useless. The chimps were doing about eight numbers, and the numbers were appearing on the screen, and I hadn’t even registered what the eight numbers were, let alone working out which sequence they go in. And I think because they’ve not got so many abstract associations. And that’s a great advantage when it comes to problem solving, but it makes us pretty slow in processing the environment if we bother to think about it the whole time. And you know, people who suffer from things like anxiety, one of the key things is to teach them not to think so much, to live in the moment.
JPH: A lifetime goal of mine is to learn to live in the moment more.
DM: Make sure you’ve got a decent garden, that’s the key thing for me. Take the dogs for long walks.
JPH: Yes, I have 200 acres of forest out back of my house, and we bought the house for that reason.
DM: Good, that’s a very good reason to buy the house.
17:32
JPH: So, wow, as you talk about all this, I can completely see why you ended up thinking about animals and pain, and how pain affects their behavior. How long ago did you start getting into that line of investigation?
DM: I always, as a vet, I’ve had an interest in the sort of medical side of things. And even as a student I started to compile this list of medical conditions that could present as behavior. And my late father, he was a vet as well, and one thing he taught me was, you know, be a good observer and remember your best diagnostic skills are your eyes, your ears and your hands, and watch. And so it dawned on me that people saying, “Oh yeah, no, we don’t get taught about behavior. And behavior is really hard.” I’m thinking, “Well, you know, diarrhea is behavior.” If you get presented with a dog with diarrhea, it’s just behavior of the gut. We know how to analyze behavior as vets. We just don’t think about it perhaps in the right way. So it’s always been there, but just in recent years, I’ve just felt that, well, I’ve looked at these animals and, you know, the gait isn’t right, and what’s going on here. So we’ve put them on trials of analgesia, and we find then that the behavior modification exercises we’ve got to do are so much simpler. And you may, you know, you’ve got a dog with a fear, then actually you may reduce the fear so much that you don’t really have to do a complicated desensitization and counterconditioning program. You just sort of manage it, and the animal can then cope. You bring it back into the realms of being able to cope. And that’s the thing, you know. Kendall Shepherd, I think, introduced me to the idea of, think of a behavior problem like an iceberg. You know, the thing the person’s complaining about is the tip of the iceberg, and it’s everything else underneath. And that fits really nicely with sort of the model of how brains work. And, you know, what underpins behavior. That tip of the iceberg is the trigger and the immediate response, but actually all the behavioral predispositions and everything are underpinning that, and that’s what we’ve got to really get to grips with. Because, going back to what we were saying at the beginning, you know, you’ve got a nervous dog. He sees the world through a lens of, ‘there are lots of dangers out there’, so any uncertainty, and it will be interpreted as danger. And you know, if people say, “Oh yeah, but I was only trying to be friendly.” Yes, you were trying to be friendly, but from the dog’s perspective, you were imposing yourself, and that was really, really scary. In fact, one of the, you know… I’m sure lots of people have heard of Scott and Fuller, who did the classic work on socialization in dogs. And when you read the original papers about socialization, one of the things they say is, and I find it fascinating, because people say, “Oh, you know, they’ve got these critical periods, and if you don’t socialize the dogs, they won’t, because people have tried it.” When you read the papers, what they say is that these dogs who had been in isolation till 12 weeks of age, that they avoided people and they could not be persuaded to approach and interact in a friendly way, regardless of how much they were petted.
[laughter]DM: Yeah! So, you know, we’ve got to look back on this and think, hang on. And this is the basis on which we say, you know, “Socialization periods are this.” And, you know, isolation experiments don’t tell us what’s important for an animal. All an isolation experiment can tell you, that if the animal turns out normal, those things are not important. If the animal turns out fearful, it doesn’t tell you that it needs lots of stimuli, because it could be the whole way that it’s managed coming out of isolation that’s the problem, and as it matures emotionally. So, yeah, you know, I love these things because I didn’t enjoy history at school, but I love reading the old historical texts. Like, “Oh, that’s actually what they said.” People again, they represent things and it gets changed, and what gets accepted as law, and you realize that actually things are so much more complicated, and that makes them fun.
JPH: We depend on a lot of research that was done some number of decades ago, and we’re not willing to redo the research for ethical reasons, which is valid. But then, as you say, what do you do about these studies that perhaps weren’t done in the way that we might have designed them today?
DM: Yeah, and that’s where we have to come up with novel ways of doing it. And, yeah, you know, we can only research what can be financed as well, but there’s so much out there. And, you know, just because something wasn’t done quite as we would like, I’m a great believer that we’ve got to see, what can we take out of this that’s useful and meaningful. But we shouldn’t just sign up to accepting other people’s interpretation, and we need to think maybe there’s other explanations of what is going on. And I think that’s really healthy. So we don’t have to redo everything. We do need to reappraise things, because it’s only… the interpretations are only as good as the science at the time, and science does move on. So we can look back at these things, and “That’s a really smart experiment, but actually I’d have a very different interpretation of that result now.”
JPH: Yeah. Which is… as you’ve been talking too, I’ve been thinking about how most really competent behavior consultants will say, “Go get your dog a pain consult or a general veterinary checkup before we start working on behavior modification.” But that a lot of veterinarians don’t necessarily… they look for large problems, but they don’t necessarily see very mild or chronic pain. Why was I thinking of that? There was something that you had said that made me think that particularly. But that we sort of understand at a general level that pain is important towards behavior problems, but not the details.
23:57
DM: Yeah. And I think one of the things that we’ve done, you know, we started off talking about all sorts of perceptions and whatever. And one of the things that, as we started to sort of get more concerned about pain, we found that we were getting some kickback from some of the vets. Sort of, well, “This animal isn’t in pain. I’ve assessed it.” Um, I’m trying to work out, well, “You know, here’s all the evidence there is.” And so what we’ve done is we tend not to call it ‘pain’, now we call it discomfort. Because I think again, you know, vets are trained in pain in a particular context. They think of pain like post-surgical pain, a fractured femur, those sorts of things. Yes, chronic pain, osteoarthritis. But, you know, a slight irregularity? “Oh, that’s not important.” Well, yes, it is, I think. And as I said, by thinking about it in terms of how much it adds to the load for the animal, then it reduces the animal’s ability to cope with the other stresses of life. So using the term discomfort, I think, is less intimidating to a lot of vets, because nobody gave them a lecture on discomfort in dogs.
JPH: Well, and the owners as well, probably, right? So one of the reasons I wanted to have you come talk about this was that I did an interview with Danika Bannasch about chondrodystrophy, and she asserted that even before they herniate, a lot of chondrodystrophic dogs are probably painful. And there was a lot of discussion about that on the Functional Breeding Facebook group with people saying, “Do you think that the owners don’t recognize that their dogs are painful?” And I said, “Yeah, that is what I think.” And it’s not to say that they’re bad owners, at all, or that they’re not paying attention. It’s that it can be really hard to recognize.
DM: Yeah, I think that there are two things there. And I think I know where she’s coming from, but maybe if we called it discomfort. You know, the sort of chronic back pain that a lot of us get, and if you’ve got an elongated back then, you know, people who are extremely tall often have chronic back problems, and these dachshunds have relatively very long backs. So I think a lot of them are in discomfort. But again, this sort of again, circles back to what we started talking about with the brachycephalic dogs. One of the things we find in the clinic is that when we make the assessment of the owner’s pet and we say, “Well, you know, we think that actually he’s uncomfortable.”, and we may use words like pain to the owners. And it’s great at that moment, because you suddenly, it’s as if fogs being lifted from the owner’s eyes. “God, that makes so much sense.” And so often they also say, “That will also explain why he does this.” We haven’t asked about that, and they’re starting to put the jigsaw together, and that is brilliant. And then, you know, we talk about the assessments and the treatments and they get a report, and typically we do a follow up week or two afterwards. And what’s interesting, a number of the staff that I work with who do the follow up, have started to comment, “You know, when we do the follow up, we get a bit of kickback from the owners.” They’re sort of, “Well, I’ve been thinking about the pain, and I just don’t think my dog is in pain.” And I think what is going on is that in the initial consultation, it all makes sense. And then when they go home, they’re going home with the message that your dog’s been in pain for several years. And they just, like the brachycephalic owner, they don’t want to think, “Well, I’m a bad owner.” So they reframe and say, “Well, in which case, surely that information can’t be right. I’m a loving owner. I care for my animal.” And so they start to push back from that explanation, because it causes cognitive dissonance for them, the thought. And you know, this is where it’s really important, that yeah, we communicate that it doesn’t make you a bad owner. These are very subtle things, which, in many situations may have no relevance whatsoever, but if you’ve got a good relationship with your dog, he’s going to show you much more than a dog that’s trying to avoid you the whole time. So in a way, look at it as a sign that you’ve got potentially a good relationship with your dog, that we can start to pick up on some of these subtle signs. It’s not just that the dog is lame, it’s the fact that, look at the way he goes to lie down. He circles and then stops and then wanders off and does it again, and then on the third time, he drops like a stone. That’s not how you’re supposed to lie down, you know? Look at how he goes to stand up. Look how he sleeps. Yeah? Where he sleeps. Look how he sits. He has one leg tucked underneath him. Why is he doing that? We started to use thermography in the clinic. I’ve got one of my residents, veterinary residents, she’s using thermography in a force plate. And, you know, we’ve had some dogs with hip dysplasia, which has been diagnosed sort of radiographically or whatever, with diagnostic imaging afterwards. And it’s interesting because in the thermography, we can see different patches of heat which indicate different levels of muscle activity. And it seems that different dogs may well use different compensatory strategies. So for some dogs, when they’ve got hip dysplasia, they tend to use their back muscles. And I think what they’re trying to do in that situation, by contracting back muscles on one side, they’re throwing the weight diagonally forward. If you got a sore right hip, and you contract your left lumbar muscles, you know, you’ll put more weight on the left four and therefore take it off the right hind. In others we’re seeing, you know, other groups of muscles, which function may be to actually hold the hip joint together much more. And there seem to be at least two different strategies that might be doing that, that help to stabilize it. And again, you know, it’s all anecdotal at the moment. In fact, we’re going to a conference next week, and she’s going to be presenting a poster with some of these initial observations, and we’re now going to look at it much more systematically. These are very subtle things, you know. And, yeah, I don’t expect an owner to have 50,000 pounds worth of force plate and thermography to pick up on these things. We get a suspicion and then, you know… but it does help to show them that, undoubtedly, to show them that physical element. And it also helps to get the vets on board as well, especially when you phrase it that “Look this dog is uncomfortable.” You can see that the weight isn’t evenly distributed. You can see that, you know, the two sides of the dog are not the same color in the thermography, at least you can see that. They’re having to go into the detail. So clearly, this dog is asymmetric, and it’s actively doing something about it. So these, I think, are really important ways. As I said, it’s so much more than just, perhaps, you know, making the diagnosis. You’ve got to communicate effectively, and you’ve got to work within people’s frame of reference. But I fully understand why owners will kick back, because the idea that they are not aware and attending to their dogs who may be suffering is a really hard thought to live with.
JPH: Yeah, it’s very hard. I have a nearly 15 year old dog and I started her on Librela a few months ago. So she goes into the vet for her shot once a month. And I didn’t, almost. She was slowing down a little bit, she wasn’t limping, she was still able to jump up on things, but maybe a little less likely to jump up on things. And the vet tech who gives the injection, keeps asking me every month, “Is it helping?” Cause Librela is new so they want to know, they’re very curious. And I always say, “Well, it’s hard to say. She wasn’t limping. I don’t know.” And then I was, this week, I was reading your papers, and one of them was talking about increased activity in dogs when pain is managed. And I thought, “Oh, she started playing again.” She had stopped playing with my other dog, and now she’s back to, it’s not full on body wrestling, but she’s doing the bouncing up and down and barking to get him to interact with her.
DM: She’s got energy to do these things.
JPH: Yeah, she has more energy than she had.
DM: Yeah. And that’s because, I mean, she’s more comfortable and she’s got the opportunity to explore things, life becomes more interesting.
JPH: And what’s interesting is that it was easy for me to see that, because the story I was telling myself was, “Look, what a good owner I am. I got my dog on pain meds, aren’t I great?” And if it had been the inverse, right, where someone had come to me and said, “Your dog needs pain meds and you didn’t see it.”, I think that would have been a much harder story for me to tell myself.
DM: Yeah, I’m sure, absolutely. And you know, we put up with a lot, and it’s difficult to know, that whether or not if we’re really insensitive, you know, do we actually encourage the animal to be more sensitive to pain by supporting them? But at the end of the day, our job is to try and improve their well being. So that’s what we do.
34:05
JPH: The best we can. So we talked about… You and I talked ahead of time about four studies that you had done. I had asked you on because of the one study that you did in 2020 which I’ve always found really important. But there were several others that were interesting for us to talk about as well. And I don’t know where it makes sense to start, do you want to sort of go through chronologically?
DM: Um, probably not because I couldn’t tell you which one we did first.
[laughter]JPH: I can tell you, I think I have the citations here. So the earliest one is the 2015 “Clinical indicators of occult musculoskeletal pain in aggressive dogs”.
DM: Ana Maria’s paper, yeah. So that was done by a very keen student from Brazil, a veterinary student who came over to see us, and she ended up doing a Master’s with me and a PhD, and she’s now postdoc working in the UK. She’s very smart, and we got this feeling that these, some of these dogs we’re seeing with discomfort… and so this is, again, where sort of the qualitative work is important. She went through the histories of dogs with aggression, and those where we had got a diagnosis of some musculoskeletal problem, and then those that we were pretty confident didn’t, and she saw a range of different features. We thought, for example, that it would be older dogs, but actually it’s the younger dogs. And that, again, sort of potentially makes sense, because it’s when the dogs start to experience it that they’ll be most expressive, and I suspect that a lot of dogs learn to suppress it, or else end up on a one way trip to the vet, sadly, if they’re aggressive. And so, yeah, we started to look at some of the features, and basically some of the characteristics of the bites. Are they more likely to be just single bites? And the impression overall that we got was those dogs that have got musculoskeletal problems are issuing sort of warning snap bites, just to say, “Back off, I don’t want to move. Can’t you? Can’t you move? Can’t you walk around me?”
JPH: “I can’t cope with you right now.”, right?
DM: Yeah. Or, you know, “You want to come through this doorway, well walk around me, or you go at some other route, you know? I don’t really want to have the effort of getting up.” So that sort of thing. And then we had another Brazilian student over who did a similar study looking at noise fears.
JPH: Yep, that’s 2018, three years later.
DM: Yeah, so Ana Louisa, rather than Ana Maria. And she pulled out something which… we didn’t tell her beforehand, but Helen, one of my colleagues at work, we both just sort of discussed this, that we had this impression that dogs with noise fears, they seem to really over generalize the fear. And that came through. That if you’re walking your dog in this country, we have bird scarers because we don’t have real guns. So basically, what happens is, you walk across a farmer’s field and you hear a bang, and it’s just, you know, it’s something to keep the birds off the crops. It’s not a farmer shooting at you. And so somebody might be walking their dog, and if you’re near one of those bird scarers they’re quite loud. Now, if you’ve got a dog in that situation, it’s perfectly normal for the dog next time to avoid that field. What is not normal, though, is that if that field was a mile away from the car, for the dog the next time you park the car there to refuse to get out of the car. That’s just sort of, you know, yes you can explain it by conditioning, but that’s a big generalization. There’s so many other opportunities. And sure enough, that’s the sort of thing we saw. We saw this big generalization, this overgeneralization to noise events. So we saw, you know, they would just completely avoid the areas as a result. So that was quite nice. And since publishing those papers, so many other people have started to look for it, and they’re reporting the same sort of thing as well.
JPH: Some of what I found interesting in those papers was,I feel like it was the one where you were looking at aggression, where you found that for dogs where their aggression was linked to pain, if the pain was resolved, the aggression became much easier to resolve.
DM: Oh absolutely. And that’s true with all of the cases, as I said. And you know, sometimes when we’re doing trials, we have animals and they’ve got uncontrolled pain, if we’re doing a… I remember one trial we were doing for a drug to reduce anxiety, and the animals had to be in pain-free or pain-managed states. And because they were involved in the trial, we actually scored them in a much more objective way with their pain. And they came in for the initial consultation, and so we put them on pain meds before considering them so we could actually see the differences. And it’s not… you know, these dogs have various anxieties, and some of those anxieties completely disappeared. Others dropped only a little bit. But then you knew what you were dealing with. Rather than having to deal with fear reactions to about five stimuli, we were now dealing with three, and two of those were very, very mild, and one of them really needed some attention. And that’s the difference that you see. So it’s not a blanket effect either, that’s the other interesting thing.
JPH: What do you mean, it’s not a blanket effect?
DM: So when you treat the pain, you don’t find that all fears reduce in a similar way.
JPH: Right. So, and then the next paper that you published after that was in 2020, and that was the one that I found so groundbreaking. And that, I think the number that I remember, and correct me if I’m wrong, but you had found something like 70% of the behavior cases coming through your clinic had some sort of associated pain?
DM: Yeah, and now it’s 80% plus. And the cases that I specifically see, it’s probably about 95% because the professor gets the worst cases. And that came about as a result of a conference. And so yeah, we spoke to people, and we invited everybody in the conference to review 100 cases and tell us. And we looked across and yes, we did have a very high prevalence. Maybe because of the nature of the clinic that we are, maybe because we are leading in this, maybe because we teach our students and so they refer them on to us if they’re not vets more readily. There’s all sorts of reasons why it might be. I’m not saying that 70% of behavior problems have pain. It’s the ones that we see, and we see the tougher cases, but it sort of fits very nicely. That’s why they’ve not resolved. You know, almost all of the cases we see have been to one, two, three behaviorists before they’ve come to us and they’ve instigated what might be very sensible advice, but for the fact the pain isn’t being picked up and so the animals not going to do a sit on command, because actually that hurts.
JPH: Yeah, and I have a follow up about that, which is, you know, what do people do? But I want to make sure we cover your last paper as well, because I think that sort of leads into the question of, how do we assess pain. Where you use network analysis to detect associations between suspected painful health conditions and behavior in dogs. And this one, I feel like was an attempt to try to see what some of the behavioral signs might be.
DM: Well, it was an interesting piece of work, and it used a big sample size. You mentioned the 2020 paper, and I think one of the reasons with the 2020 paper is because we got people, lots of people, to look at their caseloads. And so we really started to say, “Look, this is not just us being nutters, focused on pain. Everybody, lots of people, are seeing this.” And so that started the momentum. This study, very much what we did, is we took a data set that we’d already analyzed for other reasons. And as it happened, we’d got… It was a study looking at arthritis, and we were looking at its relationship with two aspects of temperament. We developed an instrument called PANAS, which stands for Positive and Negative Activation Scale. And basically, what positive and negative activation is, positive activation is sensitive due to rewards, negative activation is sensitive due to aversive. So fearfulness, if you like, for the negative activation. And again, from a clinical point of view, we’ve seen a number of factors. Like dogs in chronic pain, they might score very low on positive activation, which is analogous to depressive states in people, which again, fits very nicely. What Tom did, who’s the first author, and he’s quite a whiz with the stats, is he started to look at the network. So rather than just looking at ‘do individual items predict’, he started to look at the relationship between them in order to try and identify some pathway through, if you like, through the network. And it seemed that the thing that was really important in driving a lot of this relationship with low positive activation was the energy and interest element within it, which goes back to what we were talking about with your own dog.
JPH: This was exactly the paper, as I was reading it, I had the revelation about her.
DM: Energy seems to be a sort of… the items that asked about energy seem to be particularly important. And then there were some other items, but they seem to be acting partly through energy, so things like some of the activity levels and being able to rest, etc. So, as I said, ultimately, if you think your dog looks a little bit depressed, I would say, “Go and get him checked up.” But get him checked up by a pain specialist. Because, again, you know, with the best one in the world, this is not something that your GP vet is well trained in. Personally, I think the risks with analgesics, yes there are risks, but I’d rather err on the side of caution by doing an analgesia trial. And if you can’t afford the imaging, then just go with the analgesia and see if your dog’s behavior improves. You know, it’s a pragmatic way of dealing with it. That’d be my advice.
JPH: It can be really hard. So I had a border collie who had a lot of behavioral issues, and I was pretty sure that he was painful, but never could figure it out. We did agility, and he started… I’m trying to remember exactly what it was. I think he started not wanting to jump. And that was a pretty big sign to me. So I tried to find… I wouldn’t take him to my GP because I didn’t trust them to do the kind of assessment that I wanted. I found a GP in the area who specialized in, sort of sports medicine, sort of the best I could do for a first pass. She thought that he might have herniated a disc. I took him to a neurologist who said he had not and that he had joint pain. And so I took him then to an actual boarded sports specialist who did a CT. It took us a couple years to pay this all off, by the way. Did a CT, and did find that he had arthritic changes. He was six. So definitely, you know, stopped agility, put him on pain meds, and then started noticing that he was vomiting more and more often. And when I realized that was a big problem, took him in for an ultrasound. He had extreme inflammation in his stomach, which probably had been the problem his whole life. And then we euthanized him, and it was just like… it was just… yeah, it just could be really hard.
DM: I find that actually really interesting, because a week before last, our previous cohort of Masters students presented their posters, and just today, actually, they’ve submitted their thesis. And one of the ones I was supervising, she was looking at analgesia medicines in dogs with pain and behavior problems. And I haven’t read her final thesis, so it could all be changed. But in one of the meetings that we had, she said, “There’s an interesting thing here, that when you’re using the non-steroidals, typically, about 1 in 20 dogs in the literature, they say, they’ve got arthritis, have a bit of GI signs.” When I look at the dogs with behavioral problems, we’re seeing it in well over 20% of the cases.
JPH: The GI signs?
DM: Yeah. And she said, “Is that worth commenting on?” I said, “Well, I think it is, because it may well be that because of the stress, they’ve got other things.” And it wasn’t necessarily vomiting and diarrhea, you know. By GI signs, it could be that they started to develop pica, so eating soil and things like that, or plaster off the wall. So, you know, and that is recognized as a GI sign now, increasingly. There’s been a couple of studies by the group in Canada that have looked at that external licking of surfaces. And when they look in more detail, they find that it may well be that with the behavior problems, that then they’re more susceptible to GI stress related issues as well. And so they’re more likely to react to the non-steroidals.
JPH: Well, and what’s cause and what’s effect, right? And in the case of my dog, I didn’t actually think that the non-steroidals had destroyed his GI in such short order. I mean, it was like a month, right? I strongly suspected he’d had GI problems his whole life.
DM: Yeah. And I think what it does is it exacerbates, and I think that’s what’s going on. Because, yeah, she was only looking, I think, in a relatively short time frame, so I don’t think it was that.
JPH: That’s interesting, yeah. But, I mean, I do wonder too. So there’s a talk I give about probiotics for behavioral health, and just talking about how GI upset can be so closely correlated with behavioral issues, and is it cause, or is it an effect, right? Is it that your gut feels not quite right and so you feel not quite right, or is it that your brain is not quite right and it sends signals and puts your gut off? It’s just, it’s really interesting.
DM: Oh, the microbiome is fascinating. You know, when you enjoy that meal, you don’t know whether or not you actually enjoyed that meal or whether the bugs in your gut sent messages to your brain to say, “Yeah, give us more energy like that, that would be really useful.” So again, going back to where we started, you know, with how much of our stuff is free will and of our own thinking, and in the case of the microbiome, how much of it is being influenced by the chemicals they produce and the communities.
JPH: I always start that talk off by explaining, you’re not an individual, you are a planet, and there are a lot of creatures that live on and in you, and that is normal and good.
DM: Well, there’s more microbial cells in and on your body than there are mammal cells. Yeah, so better get used to it. They’ve been hanging around on this planet long before us.
JPH: They are highly adapted.
DM: They may have engineered our creation for their purposes.
50:59
JPH: It’s almost a great place for us to end, but I do wonder, do you have any other advice to people, for how to assess their dog’s pain? Well, let me try to pull together what we’ve talked about. So if you’re seeing behavioral issues, there is a pretty strong correlation between pain and behavioral issues. You can see behavioral issues without pain, but there’s definitely an overlap. If the behavioral issues are somewhat intractable, pain is a good thing to look into. If they’re generalizing quickly, pain is a good thing to look into.
DM: If it’s not responding to a sensible program, think pain. To be honest, well, within our clinic, I tend to assume they’ve got pain unless I can be convinced otherwise. Now, because, as I said, 95% of cases that I’m seeing, that’s probably the situation. For my residents, it’s in the 80s.
JPH: So how do you approach that? Do you just put them on an analgesic trial? Or do you have someone trusted to refer them to?
DM: Well, we take referrals from all over, so we tend to work with the referring vet, so we don’t dispense ourselves. And so we discuss the situation with the client. And you know, if the dog is insured, and they want to know, well, what’s the underlying reason for this because that can affect the prognosis, they may go for imagery. But as I say, sometimes they have to be more pragmatic and say, “Well, we’ll go with this.” And I think one of the important things is, if your dog doesn’t respond to an analgesia trial, that doesn’t mean he’s not in pain, because it can be quite difficult to find the right analgesics. And if you think there’s an improvement or you’re not sure, then stop it, and we’re great believers in measuring the behavior and scoring stuff. And you put them on, take them off, put them on, take them off. And if it fluctuates, then you’ve got pretty good evidence, regardless of anything else.
JPH: And just watch for changes in the behavior, but then also, presumably, watch for changes in energy levels and movement?
DM: Yeah, because the ways that animals compensate with pain is so variable. You know, we’ve got a list of long behaviors that all could be interpreted. One of the conditions, actually, that we still have some trouble with certain veterinarians is subluxating patella, where the kneecap slips out. Quite common in some of the smaller breeds. And there’s still a lot of vets who don’t think that it’s painful, and I think that’s because the dogs don’t yelp. But we find that they improve their behavior when we put them on painkillers. And, you know, I used to play rugby, and when somebody dislocated their kneecap, I don’t remember anybody popping it back in and saying, “Oh, let’s carry on.” I know it’s slightly different, but I do think that we underestimate, you know, these sorts of things. And if conformationally, you know, if you think about it, you pull a muscle and it jars, it hurts! You don’t need to yelp. If you’re yelping then, yeah, there’s definitely something serious on.
JPH: One time after I had had surgery, and I was a couple weeks out, and I was sitting at dinner with my then boyfriend and my roommate, and I was just kind of hunched over and being very quiet. And my roommate, who was a year ahead of me in vet school at the time, looked at me and said, “Is your pain sufficiently managed?” And I feel like that’s… you know, she recognized that I didn’t have to be crying, I didn’t have to be complaining. I was just withdrawn, and she was able to see that. And in veterinary school, we had to be taught because we came in expecting… I remember the first time I did a spay and trying to assess what the dog’s mental status and the comfort level was afterwards, and you sort of come in expecting them to be [JPH making yelping sounds] if they’re painful, and that’s not what they do.
DM: Yeah, absolutely. But by the same measure, you know, I have one of my friends, I remember when I met up with her a few months back, she was saying some of the graduates are using really powerful pain meds, which, in a way, is a good thing. But then they’re saying, “Oh, the dog can’t go home because he’s too, you know, he’s too depressed.” Yeah, and that’s possibly because you’ve overdosed him on the opiates. So, you know, we’ve got to be sensible about this.
JPH: Yes, I almost euthanized an old dog one time because I took her in for pain and she had bad kidneys, so they didn’t want to give her NSAIDs, so they gave her all kinds of other things. Three varieties. I remember amantadine was one. They were just, you know, sort of throwing the kitchen sink at it. And she could hardly stand up. And I was like, “This dog is on death’s door.” And I called my mentor from vet school, who’s an anesthesiologist, and she was like, take her off the pain meds. The dog bounced back. So, yeah, it’s hard, right? It’s hard.
DM: It is difficult. And that’s why, you know, we shouldn’t be criticizing vets. This is a really difficult area to work with. So don’t give your vet a hard time, work with him or her. Tell them what you observe. And I think the key thing, you know, going back to your question, was record the observations. We’ve got smartphones now, show them. Dogs are meant to be symmetrical. If they’re not symmetrical, if they’re crabbing the way they walk, you know, if they walk slightly at a diagonal, that’s not how they’re supposed to walk. They’re supposed to walk, you know, their front feet in front of their back feet in a straight line. Just gather the evidence and bring it together and say, “I’m concerned about this. Please, can you look?” Because I think once they’re primed like that, they’re much more likely to go looking and see it, whereas, if, again we’re circling back to the beginning. Most of the time common things are common, and they’ll be in their autopilot and say, “No, that doesn’t look like he’s painful. Don’t see the obvious signs, he’s fine. Don’t worry about it.” Well, if he’s biting children, do worry about it.
JPH: And I liked your framing of it before that, talking about it as discomfort instead of pain, I think makes it easier for everybody.
DM: I think so.
JPH: All right. Well, thank you so much for this. It’s been fascinating. I wish we had more solid advice for, you know, go push this button and that’ll tell you if the dog’s in pain or not. But, I feel like we’ve given people some stuff to start with.
DM: Yeah. And just balance your interests with your dog’s interests. And there’s so much fun to be had by just watching dogs go on holiday. And when I come back from holiday, usually, I’ve got almost as many pictures of dogs in the park as I have of my wife on holiday. In fact I’ve probably got more of the dogs, actually. But, you know, half of my film is usually just, I’ve just been sitting in a park watching animals and just photographing them. And, yeah, you gain so much. The other thing in relation to that, and I think that this is really important, is that we can be told what body language to look out for, but reading body language is a skill. It’s not a knowledge based thing. Knowing what you’re looking for and being able to see it are completely different things. And by a skill, what I mean is you have to practice, practice, practice before you start to see it. Otherwise, you’re just blind to it. You do not see it. And I’ve done a number of studies where we’ve tried to educate people, and we’ve looked at the effect of the intervention, and it’s not helped at all because they’re not practicing enough. They’ve got the knowledge. They could answer an exam paper that says, “What do you need to look for?” Show them a video? Don’t see it. And again, I think that’s a fascinating point you know, about why we need to understand human brains and how they work.
JPH: Well, watching dogs is fun, so that kind of practice could also be good.
DM: Yep.
JPH: All right. Thank you so much again.
DM: Not at all.
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JPH: Thanks so much for listening. The Functional Breeding Podcast is a product of the Functional Dog Collaborative and was produced by Attila Martin. Come join us at the Functional Breeding Facebook group to talk about this episode, or about responsible breeding practices in general. To learn more about the FDC, check out the functionalbreeding.org website. Enjoy your dogs!
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