Let me first start this post with my standard disclaimer: I AM NOT A VET. As a trainer who specializes in fear, aggression, reactivity and separation anxiety, I always ask clients about their dog’s medical history and I’m always scanning for red flags that may require a vet check. Why? Because we know there is a strong connection between physical health and behavior and open communication between the trainer, client and vet benefits the dog’s long term success. I’ve written in the past about the link between physical pain and behavior and given examples of clients where I suspected the dog was in pain based on my behavior consult and recommended the client have a vet check, which confirmed the dog indeed did have pain or something physical going on.
A recent study, The prevalence of behavior problems in dogs in the United States, grabbed my attention with the summary circulating on social media being “there’s no such things as a well-behaved dog,” which sort of surprised me. This recent study included data from over 43,000 dogs enrolled in the Dog Aging Project, which BooBoo was part of and now Gertie is part of. This study concluded that over 99% of dogs (based in the US) had moderate to severe behavior issues with separation-related issues being the most moderate-severe. After separation issues, poop eating, aggression and fear-anxiety rounded out the top behavioral issues.
These are all issues I’ve helped clients with in my behavior practice and while veterinarians often do not ask for or discuss behavioral information consistently in appointments, some veterinary behaviorists say that around 80% of dogs referred to them have an undiagnosed physical issue. And in cats presenting for issues like litter box issues, nearly 40% had a physical problem. There is a growing body of research on the connection to medical conditions and behavioral health, in humans and dogs. It can be a challenge to get answers. Behavioral problems and medical conditions are often treated or diagnosed independently but behavior depends directly on an animal’s physical health, and vice versa. Some behavioral problems are caused by or made worse by an underlying medical condition. I tell clients behavior is often the canary in the coalmine. Clients will often notice a behavior change before the pet is demonstrating clear signs of physical pain or discomfort.
It is not my job to diagnose pain but I can encourage clients to talk to their vet, coach them on how to get good videos for vet review (because animals will not move or behave the same way in a clinic as they do at home) and can help them distill what information to communicate to their vet, so their vet has all the information they need to make a diagnosis.
Pain could be coming from any number of things – joints, GI system, ears, teeth, anal glands, eyes, nails/pads or skin. Discomfort from ear infections, allergies, full anal glands, tooth decay, overgrown nails, joint or spinal issues are all things clients have dealt with. I had a client once whose dog suddenly started growling and lunging at their toddler. This was unusual behavior and when I referred to their vet, it was discovered the dog had a deep ear hematoma. But it wasn’t until my consult with them that we identified body language and behaviors that I thought necessitated a vet visit.
What can pain look like?
- Being “stubborn” or frequently stopping on walks
- Reluctance to get up from resting or move off furniture
- Waking up in the middle of the night/pacing
- Licking
- Not enthusiastically eating meals or skips breakfast often
- Sloppy sits, where one leg kicks out to the side or the dog has their weight shifted and isn’t sitting square
- Bunny hopping going up stairs or running
- Skipping while walking/running
- Partial/focal seizure
- Shifting weight off one leg
- Toes dragging on walks (nails may show wear on the top of them)
- Vomiting/bilious vomiting
- Leg trembles when walking/standing
- Panting when not hot or exercised
- Tail lowered or doesn’t wag as frequently
- Head shaking (like when they’re wet)
- Scratching ears/body
- Chewing/licking joints
- Irritability/aggression
- Reduced play or social interactions
- Grunting or groaning when lying down
- Circling/hesitating to lie down
- Whining
- Reluctance to climb stairs
- Hesitation jumping in/out of car
- Body posture hunched/head down
- Resting on the floor more when previously would be on furniture
- Hiding
- Body handling issues (doesn’t like feet touched or to be brushed/groomed)
- Reluctance to cross slippery surfaces like hardwood or tile floors
Some of these may be more obvious to spot than others but when we look at these things in combination with behavior changes we may be able to get better answers and make a plan. If your dog isn’t eating consistently or skips breakfast on the regular, it might not be that they’re just picky…it may indicate that there’s some undiagnosed GI issue at play. You may not think to mention these behaviors to your vet, but they are an example of important information to communicate so your vet can explore the underlying reason why your dog isn’t eating.
Pain or other physical issues can cause behavior changes. Any sudden behavior change, whether it’s a lapse in housetraining, reactivity, a regression in separation anxiety or anything else new, requires a vet check. A competent, qualified trainer will refer you to a vet when needed or help you know what is important to communicate to the vet. A less qualified trainer may not know how to identify these signs or may run a client through an extensive training program, which likely won’t be successful if the dog is actually in pain and that’s causing the behavior changes. My standard protocol when dealing with noise-related behavior issues is to refer for a vet check for a thorough physical exam to determine if pain is a factor.
One of my most memorable cases involved a dog experiencing severe and increasingly generalizing noise sensitivity. On the surface, it looked like a classic case of a dog struggling to adjust to a major life change—her family had recently welcomed a newborn, and naturally, the owners assumed the new baby was the source of her distress.
But when I dug deeper into her history, something didn’t sit right. This dog had previously been hit by a car. Despite being cleared as “recovered” and “fine” by both her surgeon and general vet, my behavior consultation raised red flags. Based on her responses and the overall clinical picture, I strongly suspected unresolved pain—or, at the very least, severe anxiety—and recommended a referral to a veterinary behaviorist (VB) for a full assessment, including a pain evaluation and possible medication consultation.
Initially, the family was hesitant. Understandably, cost was a concern, and with the recent addition of their baby, they were convinced that the dog’s issues stemmed from difficulty adjusting to the new household dynamic. Since two veterinarians had already declared her injury resolved, they questioned the need for further evaluation.
We discussed starting behavior modification and noise desensitization, but I was reluctant to proceed without ruling out pain. Pushing a dog through training while they’re in discomfort risks not only failure, but can actually make the problem worse—associating the training process with pain and amplifying their stress.
Several months later, with the dog’s noise sensitivity worsening, the family finally agreed to consult the veterinary behaviorist I had recommended. I sent over my notes and observations ahead of time. During the initial exam, the VB noted clear signs of physical discomfort: reluctance to bear weight on the left hind leg and apprehension when palpating the left knee. The vet shared my concern: was pain the root cause of these behavior changes?
A month-long trial of NSAIDs (no anti-anxiety meds) was prescribed. At the follow-up, the improvement was striking. The dog’s reactions to noises were significantly reduced, her recovery after triggers was much faster, and in many cases, she didn’t react at all. Because the medication prescribed was strictly for pain—without any calming or anxiety-reducing properties—we had a clear answer. Pain was the missing piece.
As I had suspected all along, the baby wasn’t the issue—she was a red herring. The dog had been in pain, and once we addressed it, the behavioral symptoms almost completely resolved.
And the best part? This entire case was handled remotely.
This is consistent with the findings of a 2018 study by Fagundes et al. Noise sensitivity was compared between two groups of dogs, those with and without pain. Those dogs with discomfort and noise sensitivity had onset of their signs later in life (on average 4 years later) as well as a more generalized association with environments and avoidance of those environments, not just the noises. These dogs responded well to treatment when the pain was identified and treated.
The most recent update is that they consulted with a different surgeon and in fact determined there is “instability in her knee, which can be helped with surgery” and she was scheduled for another knee surgery with this new surgeon.
A less qualified trainer may not have felt confident in their initial assessment to encourage the clients to pursue the specialist consult or may have wasted time and resources focusing on the new baby as the trigger, and that wouldn’t have resolved the dog’s issues. Or maybe they would have not pushed since the surgeon and general vet cleared the dog as “fine” but I knew this dog needed another opinion and it wouldn’t be a waste of the client’s money. Yes, training can be expensive and so can seeing a specialist. But, wasting money on training that isn’t going to get you results is also expensive. A competent trainer is worth the investment. And if you don’t know what to look for in a professional, this post can help.
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