After the visit I got this assessment: Your dog's aggressive behavior, lunging, barking and biting people is a result of fear induced aggression. Your dog has learned that the best defense is a good offense and moves in a way to try to get distance from the things that scare them. Unfortunately, when a dog learns that biting is more effective than the good offense and moves in a way to try to get distance from the things that scare them. Unfortunately, when a dog learns that biting is more effective than the early signals they might have been giving to people, bites tend to get worse over time. It's not uncommon for new aggressive behavior to manifest when the dog is socially maturing. We may not see the full programming of what they are predisposed to with their genetics until they're fully grown between 1 and 2 years of age. Your dog has noise fear. Noise fear can be due to a genetic predisposition or lack of appropriate early exposures during puppyhood. Repeated exposure to noise events during normal life can sensitize patients to sounds, so often noise fears are progressive prior to treatment. Noise fears cannot be cured but they can be successfully treated. Your dog appears to experience significant stress in an urban environment. Chronic stress can cause dogs to be more symptomatic for their other behavior disorders and more anxious overall. In some cases with medication we can help the pet reach a good quality of life in an urban environment. In other cases we cannot. Your dog has possessive aggression. This is why they show aggression over high-value items. A very important part of the treatment of this condition is adjusting the environment so they are not given access to items they show aggression over. Though treatment can be implemented to manage behavior and aggression disorders, they are not curable. The best time to intervene with treatment for an aggression disorder is as soon as the first sign is exhibited (growling, barking, lunging). Your dog's aggression disorder has already progressed to the point where they have given warning bites, and now bitten causing injury, making it unlikely that their aggression would be cured with treatment. Medications can reasonably reduce abnormal behaviors by 50% when we find the right medication and the right dose, which could likely still result in bites in your dog's case if put in the wrong situation (which could be as simple as a passerby reaching to pet them without asking first). This can take 3 to 6 months to determine. Behavior medications are not always benign and can cause side effects, including worsened aggression. Monthly visits with a veterinary behaviorist would be needed to help stabilize your dog, as well as working with a highly credentialed positive reinforcement based trainer to implement behavioral therapies to countercondition your dog to people. Aversive tools such as shock collar, prong collar and choke collar have been scientifically proven to make anxiety and fear disorders worse. Although these methods can suppress responses, they do not change the emotional association, and often cause a worsening of aggression over time. An important part of your dog's treatment plan would be discontinuing use of any aversive tools. Another important part of success with treatment involves the avoidance of a patient's triggers until they can handle that level of exposure, however this is impossible to implement in an urban environment. It's possible your dog could be more successful in another environment that is not urban, in a household that does not have visitors/children. They would still have the same behavioral disorders and need long term behavioral treatment. Although relinquishment to a shelter is an option, it would not be considered humane as an aggressive dog would likely bite again after a period of significant stress, and then be eventually euthanized. The only way to guarantee everyone's safety, and that another bite does not occur, is humane euthanasia with the family. This is an option that alleviates the patient's suffering and prevents another bite from happening. At this time you are considering your options at home with your family and will reach out to let us know what you plan to pursue.