More Clomicalm??

I talked to the doctors at Tufts yesterday, and they want me to try increasing her Clomicalm. I have very mixed feelings about this, and do not really understand the logic behind this decision. One the one hand, the Clomicalm has proven effective for the separation anxiety. Although Stella does not come upstairs on her own like she used to when it is time for me to leave, and she still exhibits some anxiety--her tail is down and she hides in her crate--she is able to take a food treat, and she is no longer pacing, vocalizing, panting and clawing at the gate. I am happy with her progress in this area, and I think that we could both live with this if it never improves.

On the other hand, Stella is getting worse in the noise phobia department, and her mornings seem really horrible. Even when I am not making any preparations to leave, Stella often seems particularly stressed in the morning, and the noise phobia is worse throughout the day. These are the behaviors that I think are new or worse:

• Dislike of getting out of bed in the morning.
  
• Reluctance or inability to eat in the morning.
• Hiding in the yard in the morning; when I bring her inside, she tucks tail and runs upstairs to hide there, often under or by the bed.
• Hiding in the living room under the coffee table, unless she is being held.
  
• Increased sensitivity to noises such as a cell phone or laptop being shut, pages of a book turning, tea kettle activity.
• Fear of objects that might be dropped or make noise--remotes, phones, books.
• Brand new-- fear of clippers, generalized immediately to wanting off the grooming table..

Why, I wonder, can this dog sit calmly in the yard while Lisa runs the weed whacker not ten feet away? Why can she watch the city workers tear up the street in front of the house with curiosity, but startle when I turn the page of a book? It's not the size of the noise, I think, it's the suddenness.

Those questions are interesting, but my questions about her treatment are nagging, and as persistent as her decline in behavior.

• If she is becoming more sensitized to noise, and her other fearful behaviors are getting worse, and in fact never seem to have improved on Clomicalm, why are we pursuing treatment with the Clomicalm alone?

• Is there a larger treatment plan that includes the Clomicalm, or are we hoping to see improvement with this drug? If so, why would we expect improvement in noise phobias?

• Is the improvement with separation anxiety predictive of improvement with noise phobia on Clomicalm? If so, why have we not seen improvement in this area already?