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Take a Fear Free Approach to Sharing the Fear Free Approach with Colleagues

By Linda Lombardi
Introducing Fear Free techniques to colleagues who aren’t familiar with them or who may be resistant to change can be daunting, but Fear Free principles apply to people as well as pets. Here’s how they can help.

Tabitha Kucera, a veterinary technician, has learned a lot from her experiences teaching Fear Free to other veterinary professionals, and maybe the biggest lesson is the importance of using the same principles on people as you do on animals.

“Positive reinforcement encourages initiative and creativity, it forgives mistakes, it creates enthusiastic learners and accelerates learning,” she says. “It’s the same for people.”

Build a Constructive Culture

The benefits should seem obvious once you’ve worked with animals that way. But applying these methods doesn’t always come naturally, she says. She recalls a class she attended at the Karen Pryor Academy. Most of the students were trainers, along with Kucera and two other vet techs. At one point, each person did an exercise in front of the class and then fellow students were asked to talk about what they thought had been done well.

“For the techs it was harder than for the dog trainers, and that was an epiphany for us,” she said. “We talked about it later—it’s that we’re not used to getting constructive feedback.”

Not only was it more difficult to give positive comments, it was also frustrating at first to get them.

“We were like, why don’t you tell me what I did wrong? Just tell me what I did wrong so I can fix it.”

But if you’ve studied behavior, you know all the reasons why “Just tell them when they’re wrong” is a bad way to train. One is that just saying “no” to the wrong behavior doesn’t tell the learner what the right behavior is. If you want staff to use less stressful techniques, saying “Don’t do this,” while well-meaning, doesn’t communicate the desired alternative.

“If you’re used to scruffing, I can’t just tell you not to scruff, which is what I see a lot of,” she says. “I hear a lot of ‘less is more,’ but what does that mean? You need to define the behavior you want.”

Say No to No

Maybe even more important is the effect of all those “nos” on the recipient.

“With positive reinforcement, the biggest difference is we focus on the good,” she says. “The way some other training techniques work—and the way people often work with each other—is we focus on the negative: I’m going to tell you what you did wrong and completely ignore all the good stuff you did. That creates an environment where people are afraid to make mistakes and afraid to ask questions.”

Being told that you’re wrong is essentially a form of punishment, and learners who are afraid to make mistakes because of repeated punishment soon shut down and are afraid to try anything. That makes it impossible to learn something new. And imagine the frustration of doing the same thing for years and then being told it’s wrong. We wouldn’t do that to an animal, but we often don’t realize we’re doing exactly that to our fellow humans.

“You can’t punish them when this is how they were taught,” she says. “I say, ‘You’re not wrong in what you’re doing, but fortunately medicine progresses, and we’ve learned a lot of great new ways to handle animals that make it easier for us and for them.’”

Be careful, too, of how interactions can convey the message “You’re wrong” without saying exactly that out loud. “You can’t run over and say, ‘Let me take over,’ because then you just insulted that person,” she says. “When I see things that are concerning, I’d just say, ‘Hey, you guys need some help?’”

Show, Don’t Tell

Simply using the techniques and letting people see what happens can be the best way to start. “First thing first, wherever I am, I use these skills, and people notice,” Kucera says. “Soon they’re coming to me and asking if they can learn this.”

It’s important to remember that trying something new can be anxiety-provoking, especially if you’re invested in and comfortable with techniques you’ve been using for years. Make it clear that it’s okay to try and fail. “I also don’t say ‘It’s do this or die,’” she says. “Try it one time, and if it doesn’t work, we’ll do it the way that you’re comfortable.”

Another thing that we know for our animals but often forget for our fellow humans is that different reinforcers work for different individuals. When she’s trying to persuade people of the benefits of Fear Free, Kucera says, everyone cares about decreasing fear and stress in the animals, but other motivators can differ by role. For a practice owner, she’ll talk about the business advantages, while for a tech who restrains animals, she’ll say, “You’re in your 30s; you need to go home and not be in pain every day.”

Set Realistic Goals

When Kucera talks to people who are excited by her presentations, she often has to talk them down a bit. “I say, ‘I love your enthusiasm, but I don’t want you to go back to your shelter or hospital and say we have to do all this right now,’” she says. “Because I did that in the past, and it shuts people down.”

Remember that new skills need practice. “I set realistic expectations for people: I don’t expect you to do this perfectly tomorrow,” she says. And start slow, just like you would with a pet. “Pick one or two things for your practice or shelter and start there, because from there it’s going to spread like wildfire but not if you don’t set your staff up for success.”

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Don’t Leave Me: Why, When, and How to “Take Pets to the Back”

By Amy Shojai, CABC, Fear Free Certified® Professional
Pet owners may object to having their animals “taken to the back.” Here’s what to consider when deciding whether it’s necessary.

Jill Breitner, a former vet tech and Fear Free certified professional and dog trainer, frequently writes about pet issues. She has also trained vet techs on low-stress handling techniques. When her 8.5-pound dog Timber recently ate a guest’s dark chocolate candy bar, they hurried to the emergency clinic.

As vitals were taken, Breitner used Fear Free techniques to restrain Timber and even talked with the veterinarian about the program. “I asked to be in the room for the injection to induce vomiting,” Breitner says. The vet pushed to take Timber “to the back” for immediate treatment instead, arguing that Breitner might have to wait an hour for treatment if she insisted on being present. “That made no sense to me,” Breitner says.

After she pressed for an explanation, the upset vet walked out. Anxious to get Timber the care she needed, Breitner threatened to write about her bad experience. “Within three minutes, the veterinarian and a tech were back in the exam room with the drug injection to induce vomiting,” Breitner says. Within two minutes, Timber brought up the chocolate, wrapper and all.

Why Pet Parents Object

There may be good reasons for treating patients “in the back” but many pet parents object and have valid concerns. For Fear Free practices, it is incumbent to acknowledge these concerns, provide explanations, and perhaps take a closer look at ways to reduce fear, anxiety, and stress in both pets and pet parents.

Pets are calmer. Many veterinarians believe pets act calmer without the owner present. In some instances, this is true. Yowling cats fall silent, and struggling pups go limp. Others argue, however, that certain pets seem calm only because they’ve shut down out of fear. Motionless doesn’t equal fear free.

At the same time, very protective or sensitive dogs may become more upset by their owner’s emotional state. Veterinarians must be able to evaluate each individual situation.

Restraint issues. It’s true that not all pet parents know how to safely and effectively restrain pets in a stress-free manner. There may also be liability issues if someone is bitten.

Breitner says, “It would be appropriate in an emergency, life or death situation needing immediate attention. Still parents can ask that the dog be sedated in their arms, before they bring them to the back, even at this time of emergency. Pets feel safer and less fearful with their parents.”

When concerned about proper restraint, pet parents can still be present perhaps by holding a lickable treat while the staff restrains and performs the treatment. Teach clients how to distract, gently restrain, and restrain animals for less stressful future visits for all involved.

Staff discomfort. Having the pet parent present may raise the practitioner’s FAS level. It may take longer to perform a blood draw, for example, when the owner inadvertently interferes. Maybe the vet worries about getting the perfect needle stick with a non-professional audience. As a former vet tech, I’ve assisted in many surgical procedures, but it’s different when the patient is your own animal. Very few clients have the temperament to witness surgery on their own pets, but may still be eager to be with them up until sedation takes effect.

Equipment access. The standard clinic design can make the back a much more convenient location for treatment. Staff has ready access to proper lighting, sinks, supplies, emergency equipment, and more.

Exam rooms that are tiny and awkward to maneuver in can make large dogs feel trapped. Open spaces of “the back” reduce this stress. There may also be insurance concerns that prevent non-clinic personnel from entering certain areas. Radiographs, for instance, require protective gear and exposure data records.

Habit. The trend to take pets to the back appears to be a uniquely American veterinary habit. If you’ve always done it that way, it’s time to explore other options. In fact, some pets do much better with their owners present. Cats and dogs may be given vaccines while on a pet parent’s lap as a treat is offered, or even in the waiting room in certain instances.

How to Make it Work

Communication is key, as is mutual respect. Pet parents have become more educated and are learning to be better advocates, Breitner says. Nobody wants to resort to threats to make themselves heard, and it’s unfortunate when veterinarians feel put on the defensive. Find out what clients want and expect.

Ask if a cat or dog does better or worse with them present. Is the client phobic about seeing needles or blood, or so upset they’re not helping the situation? Does someone have special skills—a dog trainer, perhaps? Are they familiar with low-stress handling?

Breitner agrees that communication goes both ways. She suggests that pet parents plan for time to wait or offer to reschedule during a less busy time to make it easier to stay in the room with the animal.

When your professional opinion means taking the pet “to the back” offers better treatment options and less stress, explain why. Think about offering the option to come to the back with the animal.

“When vets listen better, they can communicate better,” Breitner says. “This relationship of trust between parent, pet, and vet goes a long way toward ensuring that their patients and clients feel safe while in the clinic.”

Every pet parent and animal is different. Being inflexible about your procedures may actually increase FAS in the animal and the owners—and you. It may also hurt your practice when clients choose to stay with their animals and walk away from your practice.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Ways to Minimize Stress Diarrhea In Patients

By Deb M. Eldredge, DVMWe have all been there. The embarrassed client who pokes her head in the door and asks if we have a hose to clean her dog off. The carrier with the yowling cat and the fetid odor with an owner who is embarrassed and says her cat “might need a little cleaning and could the carrier be cleaned too?”

Plan Ahead

Even before you work on the stress aspects, think about how to physically minimize chances of stress diarrhea. Ideally these pets are scheduled early in the day for their office appointments. That way the owners can skip the pet’s morning meal – and maybe even the evening meal of the night before if need be. Less in means less out. Obviously doing this depends on the health of the pet and how the owner manages feedings but it might be a solution.
There may be dietary changes that help with a specific pet. Think plain canned pumpkin for fiber to help keep stools firm. Advise owners to avoid any special or extra treats for a day or two before the appointment.

Travel Trauma

A careful history can enlighten you about the cause. Is it the car travel? Some pets just don’t handle car rides well. Or is it only when the pet actually senses and anticipates a veterinary visit? Sometimes it is both factors. The important thing to realize is that Fear Free procedures must be instituted ahead of the veterinary visit to help these animals.

If it is the car travel, consider dispensing anti-nausea medications ahead of the visit (yes, vomiting often accompanies stress diarrhea). Look at calming combos that help with travel anxiety such as Travel Calm, an essential oil combo for dogs who get carsick. Send clients home with canine or feline pheromone products—wipes or sprays—that the owner can use in the carrier and car to and from the clinic. For patients who have a history of travel-related diarrhea, offer to prescribe PVPs—pre-visit pharmaceuticals—such as gabapentin or trazodone to help them relax.

Encourage families to give the nervous dog an extra-long walk and possibly some playtime early on the morning of the appointment to try and stimulate bowel emptying before the dog gets in the car or enters the clinic. Playtime at home for a cat might help as well.

Counterconditioning

Long term, especially if the diarrhea is specifically associated with arriving at the veterinary clinic, you can try some counterconditioning techniques to help put a stop to loose stools. Encourage owners to take their pet for short trips ending up in the parking lot of the veterinary clinic. Then dogs can get out and get some special treats or, even better, some playtime with a favorite toy such as a tug. Cats can get favorite treats. Then happily turn around and take them home. Pets will come to associate trips, even trips that end up at the dreaded vet clinic, with some good things.

As pets deal with a clinic utilizing Fear Free practices, the fear and panic they previously showed when traveling to or arriving at the clinic should subside. As fear and anxiety decrease, so should episodes of stress diarrhea. Everyone will be happier!

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Nutraceuticals for Fear, Anxiety, and Stress? What to Consider

By Linda LombardiDo you have clients asking about using nutraceuticals for their pets’ behavior issues? Here’s a primer on what they can—and can’t—do.

The term “nutraceutical” is a mashup of “nutrition” and “pharmaceutical.” Beyond that, because they’re unregulated, there’s no legal definition, and every journal article you read will likely start by spending several paragraphs grappling with this fact. For practical purposes, nutraceuticals are food-derived substances that are claimed to have an effect on health. For example, alpha-casozepine, derived from milk protein, affects neurotransmitters in a similar way to benzodiazepines and may help reduce anxiety.

Looking at a list of these products, their claimed effects, and how they’re sold, it can be a little difficult to see how they are different from drugs–after all, some drugs are derived from nature, too. Lisa Radosta, DVM, DACVB, of Florida Veterinary Behavior Service in West Palm Beach, says, “They are really in my mind not that much different from drugs, except they’re unregulated, but in the mind of the consumer they are different because they are ‘natural,’ and that is something that a lot of people are looking for.”

The desire for something “natural” can be based on misconceptions both about nature and about drugs. “Natural” doesn’t necessarily equal “safe”: the natural world is chock-full of poisonous substances. In some cases, clients may simply need some reassurance about the drug options.

“When clients are thinking of behavior meds, they’re thinking of sedatives that will ‘turn their animals into zombies’ and change their personalities,’ says Jill Orlando, DVM, DACVB, of Carolina Veterinary Behavior Clinic in Raleigh, North Carolina. “When they think of a supplement, they don’t think it’s going to affect their animals as strongly as what they perceive a behavioral drug does.” She also notes that people may unconsciously project the stigma of human mental illness–and the associated medications–onto their pets.

But there can be reasons to consider these products beyond client psychology, if only because there are so few approved medications for fear, anxiety, and stress in animals. The trick is to sift through the research to figure out the safe and effective choices.

Dr. Radosta prefers to use the term “supplement” to also include products derived from herbs– essentially all the products clients may find on the internet or at high-end pet stores and bring in to her with questions–and they all require the same careful consideration, first, for safety.

“A lot of these supplements haven’t been given to a group of dogs to see what they do to the liver, to the kidneys; nobody knows,” she says. “So that’s kind of scary. On the other hand, we shouldn’t throw the baby out with the bathwater. The research does show that some of them can offer benefits for fear, anxiety, and stress in animals. We don’t want to throw things away just because they aren’t a drug, but we also don’t want to assume they’re safe.”

Consider the source of a product. “What I tell my clients and veterinarians is, we try to use supplements from companies that we trust–as much as you can trust a company. We try to use supplements made by pharmaceutical companies. It’s not that I love pharmaceutical companies, but it’s that I can hold someone responsible.”

Whatever the source, read the research and evaluate the evidence yourself. Given the lack of regulation, you first need to know if a product has been properly tested for safety in dogs and cats. “For me, that’s key. Did someone give this to a bunch of animals? What is the LD50? Do we know? We shouldn’t be playing around with an animal’s life.”

Regarding evidence for effectiveness, methods of studies can vary widely. One thing to consider, says Orlando: “Is the research done on the actual product, or is it done on the functional ingredient in that products? That’s not to say that that information isn’t useful, but it doesn’t necessarily prove that product is effective.” Other factors include but are not limited to the following:

Species used in the study: was the research done on dogs and cats or only on rats and mice?
What condition was studied? If a study was narrowly focused on, say, separation anxiety, the substance may not work for other types of anxiety.
What was evaluated? Actual behavior or physical measurements such as stress hormones? Both types of studies have strengths and weaknesses.

If you’re still not sure, Dr. Radosta says, consult a veterinary behaviorist—that’s why they’re there!

Once you’ve decided on a product, Dr. Radosta says, make sure clients have reasonable expectations about efficacy. The common expectation that “natural” means “won’t affect the animal as strongly” is correct; it means it’s not going to have as strong a beneficial effect as a drug. Where you might get a 50 percent effect on a behavior from a drug, you can expect about half that from a supplement. “That in my practice is considered a positive outcome, and the day the client takes the supplement home I make that very clear,” she says. “If you say your dog is 25 percent changed, that’s a success.”

Because effectiveness is reduced, more than one supplement may be needed. One of Dr. Radosta’s clients whose dog has an extreme storm phobia now administers 11 capsules a day, a regimen that might add more stress for some owners and pets. These products also tend to be more expensive than their pharmaceutical counterparts, a cost that can add up quickly.

Finally, with either supplements or medications, the ideal solution relies on more than just pills; it should also involve behavioral modification. Realistically, though, this isn’t always going to be possible. Not everyone can afford a skilled trainer, and sometimes life is just too overwhelming to add another burden on clients’ time. “I meet a lot of people here in south Florida who are taking care of elderly parents and I do discuss that with them, but I have empathy,” Dr. Radosta says. “I say straight up: your life looks really stressful to me, how are you feeling, can you do this?”

But nearly everyone can handle some simple changes such as crating a fearful or aggressive dog in another room when company comes to avoid exposing a pet to triggers.

“Behavior modification can’t always happen,” Dr. Radosta says, so sometimes we do what we call medication and management: supplements or medication–something that changes neurochemistry–and managing the environment so the behavior can’t occur.”

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Pain Scales: Choosing The Best One For You And Your Patients

By Deb M. Eldredge, DVMOne of the tenets of Fear Free is that pets should also be as pain free as possible. A pet in pain will be fearful, potentially defensively aggressive, and clearly not happy. Before pain can be treated, however, it must be identified and, to a certain extent, quantified.

It would be wonderful if there were easy and objective parameters to identify pain. For example, heart rate above a certain increase would equal a certain pain level. That would make pain assessments black and white and simple. Unfortunately, as with so many areas of veterinary medicine, pain is not black and white or simple. Pets with chronic pain may not show any physiological changes such as an increase in heart or respiratory rates. Some of those physiological changes we associate with pain may also be reflective of fear. So while physiological parameters can help in pain assessments, they are not the mainstay.

In veterinary medicine we rely mainly on behavioral parameters to score pain. Reading behaviors is always a bit subjective, and individual pets can muddy the waters even more. Conscious pets (as opposed to pets under anesthesia) may be stoic or may be overly sensitive to touch due to fear resulting in the “drama queen.” Owners may be adept at observing behavioral changes or somewhat oblivious.

Scales To Consider

Colorado State University has pain scales set up for acute pain assessments in dogs and cats. Their system looks at behavior, response to palpation of or around a surgical site, and body tension. A non-painful dog is clearly comfortable resting in his cage, doesn’t mind any palpation, and is relaxed. At the opposite end of the scale, the very painful dog may be moaning, licking or chewing at his surgical site, fairly unresponsive to his surroundings, cries or acts aggressive if palpation is attempted, and stays rigid to protect the painful area. Cats show somewhat similar signs, although very painful cats may allow more handling than they did previously as they concentrate on their pain.

With the Glasgow Composite Pain Scale, the University of Glasgow looks at a variety of behaviors and watches for changes over time. For dogs there are 30 descriptor options within six behavioral categories, including mobility. People evaluate resting behaviors of the dog, reactions to any action around the injured area, changes in the dog when out of the cage and moving, and the dog’s overall attitude. Dogs receive a numerical score for each area, which are then added to aid in a treatment plan. For cats there are 28 descriptor options within seven behavioral categories. The short form allows for periodic re-evaluations of the pet.

AAHA has a set of three criteria that work well for both acute and chronic pain assessments but are quite general. Maintenance of normal behaviors, loss of normal behaviors, and development of new behaviors are indicative of a problem the pet is dealing with. At the veterinary hospital, an astute veterinary technician can pick up on changes a pet shows from pre-surgery to post-surgery for example. That can help staff determine the pet’s level of pain and what type of pain modification to try. One pet may need medications while another pet may be comfortable with a padded bed to lie on.

Types Of Pain

Most of the developed pain scales look at pets with acute injuries. Pain is sharp then, and behaviors most likely to be changed and easy to interpret. Chronic pain can be trickier to evaluate. Many pets “cover up” chronic pain or develop ways to adapt to minimize any pain by the way they move or other changes in habit.

For chronic pain, the input of owners is almost always necessary. An owner may comment that the cat no longer hops up on the counter or that the dog wants to turn around after only going a half mile on his daily walk instead of the usual mile. Sometimes an owner may not bring up these observations, but a skillful history taking will elicit changes that indicate pain. Careful observation by clinic staff may also lead to notes such as “less weight bearing on right hind when walks or trots.” Those subtleties may not be noticed by the owner due to gradual changes over time.

As with so much of veterinary medicine, pain assessments will vary with each individual animal. Sharpen your observation skills so you can pick up the tiny changes that indicate a pet in discomfort. Pain scoring systems will help to organize your thoughts but your own skills are the most helpful to the pet you evaluate.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

How To Communicate Calm To Your Canine

By Mikkel BeckerAre you helping or hurting your pet by providing comfort? You may have heard that comforting a pet when he’s frightened is the wrong thing to do because it “reinforces” that he’s right to be fearful. I’m here to share the good news with you that this concept isn’t correct. Here’s what to know about calming your pet.

You’re not “reinforcing fear” by providing comfort to a pet. Many animals act calmer if they are near their favorite human or if they are handled and interacted with in a manner they find reassuring.

You may, however, escalate your pet’s stress if he picks up on cues that you are nervous or on edge. If you are attempting to comfort him in a way that’s different from how you normally interact with him, such as hovering or jumping to attend to him immediately, it may signal to your dog or cat that you are upset. His response may be to become worried himself.

If petting, massage, and T-touch handling help your pet to visibly settle, by all means, do it! But if the dog or cat avoids touch or acts agitated or upset with handling, give him some space or interact in a more hands-off manner such as redirecting his attention to a food puzzle or other favorite toy.

Left untreated fears can escalate overtime. Although it is ok for your dog to seek comfort with your presence when he is afraid, allowing that to be the sole coping strategy can be a recipe for disaster. For example, if your dog becomes frightened by something when he is home alone, he might panic because he has not learned any other successful coping strategies. Talk to your pet’s veterinary team about who they recommend for assistance in addressing your pet’s fears before they escalate.

Dogs pick up cues from people on whether to relax or panic. The more comfortable and calm you feel, the more likely your pet will pick up the message and relax in turn.

To communicate a calm demeanor, start by working with your pet’s veterinary team to create an action plan for responding to fear, anxiety, and stress in the home. Knowing how you’ll react to your pet’s angst is empowering for you and communicates to your pet that all is well.

To reinforce that calm demeanor for yourself, practice deep breathing and mindfulness. Settling down with a relaxing read, watching a feel-good show, or playing music you like are other potential ways to decrease your own stress and, by extension, your dog’s.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

When Pets Hurt: How To Help Owners Break The Pain Chain

By Kim Campbell ThorntonDo you talk to your clients about whether their pets are in pain? It can be a difficult subject to discuss, in many instances because it just doesn’t come up. Sometimes pet owners overlook subtle changes in behavior that can indicate pain or assume that those changes are a normal by-product of aging. You may need to bring up the subject yourself, especially if you are seeing a senior pet or one who resists examination.

“I wish we would talk more about it,” says Joyce A. Login, DVM, Zoetis senior manager of veterinary specialty operations. “Sometimes I think we don’t bring it up in the room as much as we could. It’s a challenge.”

As a veterinarian you are trained to see and feel changes in pets that owners might not, such as abnormal postural displays or heat on a specific joint, but listening to what people say about their pets’ behavior and drawing out details with questions is an important part of the exam process.

“We can help the owner when we’re asking history and possibly pull out some information in how we ask our questions,” Dr. Login says.

Some of the following obvious and not-so-obvious statements you might hear from owners can open up a discussion:

–He doesn’t like it when I touch him there.

–She doesn’t always use her litter box anymore.

–He used to enjoy being picked up but now he squirms away.

–She’s started pooping inside the house even though she has a dog door.

–We used to go on long walks, but now he conks out after a mile.

–She’s reluctant to go up or down the stairs.

–He doesn’t jump on the bed or sofa anymore

–She used to love the kids and now she walks away when they want to pet her.

–He doesn’t groom himself very well anymore.

–She sleeps in the closet instead of hanging out with us while we watch TV.

Changes in litter pan behavior are much more likely to indicate that a cat has pain issues rather than a urinary tract infection. Dogs who defecate outdoors and then defecate again in the house may be doing so because it’s painful for them to squat for very long so they don’t complete the act outdoors. Animals who potty inside the home even though they have a pet door may find it painful to go through the door because it whacks them on an already aching hind end as they exit.

The real red flag is resistance to touch, says Robin Downing, DVM, DAAPM, DACVSMR, at Downing Center for Animal Pain Management in Windsor, Colorado.

“While animals cannot and do not anticipate or fear their own death, they very much anticipate and fear pain,” she says. “As a consequence, when we as veterinarians meet and interact with dogs, and particularly cats, who are reluctant for us to handle them, the most likely explanation is that those animals are painful and they know that when a human touches them it hurts, so they are anticipating and fearing that pain and doing everything they can to prevent being handled.”

Before performing a pain palpation, she demonstrates the amount of pressure she’ll be using on an owner’s forearm, so the person recognizes that it’s not a painful level of touch.

Finding that what they thought were breaks in normal behavior—not socializing, not wanting to be touched or picked up, losing housetraining or litter box training—signal that an animal is in pain can be an eye-opener for owners. Some break down in tears when they realize their pet has been hurting.

“We have a clientele who believe it’s a normal thing for their dog or cat to become less active as they age because they’re getting old, and what we need to do now is really shift our attention to educating our clients to understand that old age is not a disease and that there are things we can do to prevent these negative consequences from happening in the first place and specific things we can do to intervene on a dog or cat’s behalf if they are in pain.”

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Thought for Food

By Tamara Grubb, DVMIn human medicine, postoperative nausea and vomiting are among the most prevalent and concerning of all postanesthetic complications. The conditions are so common and have such an impact on human health care that they have earned their own acronym from the National Health Library, PONV.

A recent PubMed search of PONV garnered almost 10,000 hits. For the human patient, PONV is unpleasant and results in dissatisfaction with perioperative care (Gan et al. 2014). Humans would pay extra to prevent PONV (Gan et al. 2014). Unfortunately, PONV is more than just an annoying occurrence. Vomiting itself can cause other postoperative complications, and PONV has been called “distressing” by humans who experience it (Gan et al. 2014).

As all veterinarians and veterinary technicians can attest, PONV also occurs in veterinary patients, and we should ask ourselves this question: is PONV distressing to our patients? Could PONV lead to or add to fear, anxiety, and stress (FAS)?

The author of a recent review of nausea and vomiting in veterinary patients makes a strong argument that these conditions could cause or compound FAS and could be considered an animal welfare issue (Hay Kraus 2017). The point is made in the review that Brambell’s Five Freedoms of animal welfare include freedom from discomfort, pain, and distress. PONV likely causes discomfort, could contribute to pain, especially in patients with preexisting abdominal pain, and could potentially be distressing.

Maybe we can’t definitively know whether an animal experiencing PONV is “distressed” or not, but we can argue that reduction of PONV is medically beneficial to our patients. Potential adverse effects of PONV include dehydration, electrolyte imbalances, esophagitis, aspiration pneumonia, exacerbation of pain, and elevated intracranial and intraocular pressure. In addition, PONV is likely to cause anorexia and may even contribute to agitation in the recovery phase of anesthesia.

Fortunately, we have drugs, such as maropitant, that decrease the incidence of PONV and the associated adverse effects. Numerous studies describe the anti-nausea and anti-emetic effects of maropitant in both dogs and cats (Hay Kraus 2017). One study also showed that dogs receiving maropitant returned to normal food intake postoperatively more rapidly than dogs not receiving maropitant (Ramsey et al. 2014). At 20 hours post-anesthesia, 93 percent of the dogs receiving maropitant versus 46 percent of the control dogs had returned to normal feeding. This could aid in alleviating dehydration, electrolyte imbalances and any nutritional deficits that might affect healing.

In the same study, dogs receiving maropitant had a better quality of recovery than control dogs. This could be due to decreased PONV and could add support to the theory that PONV is distressing to veterinary patients. In human medicine, administering sedatives that also decrease the incidence of PONV is recommended for treating emergence delirium in children (Dahmani et al. 2014).

Finally, reduction of PONV is not only medically appropriate for the patient, it is also important for maintaining the human-animal bond and pet-owner satisfaction with perioperative care. Nausea, vomiting, and anorexia are major concerns for pet owners, and presence of any of these conditions generally leads to owners assuming that their pets are experiencing diminished quality of life. As in human medicine, pet owners are concerned enough about PONV to pay extra money for its prevention (Hay Kraus 2017).

The bottom line is that PONV can be a medical concern both on its own and through complications caused by the act of vomiting or the vomitus itself (i.e., aspiration). PONV can exacerbate pain. PONV may contribute to FAS. Owners are concerned about PONV. We have drugs with high safety margins that effectively alleviate or eliminate PONV, and one of those (maropitant) may even play a role in analgesia. So why wouldn’t we treat or prevent PONV, regardless of the motive?

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Senior Cats: How To Uncover Their Health Secrets

By Kim Campbell ThorntonRead part one of this series here.

We all know that cats are tough to decode. They hold their secrets tightly, refusing to share how they feel. Old cats are especially wily when it comes to concealing illness or pain. Being able to see through their camouflage is key to keeping them healthy and serene in their golden years.

In her lecture “It’s Not Just Old Age: Optimizing Health Care for Senior Cats,” presented earlier this year at the Western Veterinary Conference in Las Vegas, Susan Little, DVM, board-certified in feline practice, shared some of her secrets for questioning owners and examining cats to get at the truth within.

Get All The Info

Dig deep. Owners might not mention certain things because they assume changes they see are normal in an old cat instead of realizing that they could be related to disease or pain.

One study found that 55 percent of owners don’t know that cats can have kidney disease without appearing sick, and 38 percent don’t know that senior cats can develop osteoarthritis. Subtle signs of sickness that owners might attribute to old age or fail to connect to illness include not using the litter box, being less social or less active, eating or drinking poorly, weight loss, a change in sleeping habits, and bad breath.

We often hear that it’s important to ask open-ended questions to gather details, but Dr. Little recommends a combination of open- and closed-ended questions because so many variables influence the answers, including the cat’s age and the owner’s level of experience with cats. She likes to start with open-ended questions and then narrow her focus with closed-ended questions.

Phrase questions to elicit specifics

“I’m still learning to take a good medical history,” Dr. Little says. “It’s an art; it’s a real skill.”

For instance, instead of asking, “Have you noticed any changes in your cat’s litter box use,” say “Tell me about your cat’s litter box use.”

That’s a good way to get detailed comments about urine output, stool quality, and litter box behavior that owners might not think to mention. If the owner says, “He forgets where the litter box is,” maybe he didn’t forget, Dr. Little says. Maybe the litter box is downstairs in a dark basement and it hurts to go down the stairs or it’s too dark in the basement, and he can’t see very well anymore. These types of questions can give you a bigger, better picture of what’s going on with a senior cat.

Visual Aids And Other Feedback

It’s a cliché that a picture is worth a thousand words, but the fact remains that pictures help. Show owners a fecal score chart with actual pictures of poop, not just line drawings, and ask them to point to the one their cat’s poop resembles.

“Not all owners know what is normal, especially if the cat’s stool is like that all the time,” Dr. Little says.

Know how much the cat eats. Many owners don’t measure food; they just keep the bowl topped up. For free-feeding owners, ask them to weigh the bowl of food morning and evening for a few days or even a week. The difference tells you how much the cat actually eats.

Before owners come in, ask them to complete a questionnaire on their cat’s pain levels. This should be done at home so the answers can be thoughtful and not rushed. One to consider is the Feline Musculoskeletal Pain Index, available from North Carolina State University.

It’s also a good idea to ask owners to fill out a diet history form at home or ask them to use a smartphone to photograph the bags or cans for everything they give their cat.

“People always forget what they feed the minute they walk in the vet’s door,” Dr. Little says.

Other useful assessment tools to give owners, in advance if possible, are the free downloadable brochure How Do I Know If My Cat Is In Pain?, free nutritional and other health guidelines from World Small Animal Veterinary Association, and checklists from the Indoor Pet Initiative, including a health history questionnaire and environmental needs for senior pets.

In the next post, how Dr. Little conducts successful exams with senior cats.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Thunder Fears? Help Owners Recognize, Treat Them Early

By Kim Campbell ThorntonPet owners, and people in general, tend to ignore problems until they become too troublesome to ignore. It’s human nature to put off dealing with things if we’re not sure how to proceed or think it will be too much work. If you live in an area that’s prone to thunderstorms, though, you can help clients stave off pet fears and phobias before they become serious.

“Veterinarians should routinely ask clients about their pets’ responses to storms,” says Pamela Perry, DVM, a behavior resident at Cornell University College of Medicine in Ithaca, New York.

Ask clients what happens during a thunderstorm. Does the cat hide? The dog tremble? Those mild fears can worsen over several thunderstorm seasons. Waiting to treat them can make the problem that much more difficult to manage. Be preemptive and recommend treatment promptly, while signs are still at the subtle stage.

“They might be coming in for something totally unrelated to storm phobia, but they mention that the dog is fearful during storms or that their other dog at home has storm phobia,” says veterinary behaviorist Lore Haug, who practices in Sugar Land, Texas. “I’m like, ‘You need to get on top of that right away.’”

Suggestions can be as simple as suggesting setting up a safe room or getting the pet a snug-fitting wearable that may have a calming effect.

Know how to advise clients on setting up a safe room. It can be a small guest bath or closet with no windows, a basement, or something as simple as a crate with a cover thrown over it. Their pet may choose his own safe space, such as inside the bathtub. Wherever it is, it should be ready and available at any time.

Clients should encourage pets to go there by placing a stuffed Kong or treat-filled puzzle toy in the room daily so the animal knows that good things happen in that room. Remind clients never to close the pet in the room or crate, which can create a feeling of being trapped. If owners know a storm is expected during a time they won’t be home, they should prepare the room by putting a long-lasting treat or favorite toy in it, turning on a white noise machine or other noise blocker, and plugging in a pheromone diffuser.

Be familiar with product options for pets fearful of storms. Calming clothing includes Thundershirts, Storm Defender Capes, Anxiety Wraps, Mutt Muffs, and Calming Caps. Depending on the product, they fit snugly on the body, providing soothing pressure; reduce storm-related static charges; or limit the pet’s exposure to scary storm-related sights and sounds such as lightning and thunder. Recommend drowning out storm sounds with white noise machines, the whirr of a box fan, or relaxing music such as Through A Dog’s Ear or Through A Cat’s Ear. Certain nutraceuticals and pet foods contain soothing ingredients such as l-theanine, caseins, L-tryptophan, and B vitamins and are marketed for pets with storm-related fears.

“Resources like that are easy for owners to implement and don’t require a huge behavior modification program,” Dr. Haug says.

Finally, be familiar with the client’s lifestyle and environment. If medication is needed, that information will help you determine the best choice for that particular animal.

“Make a choice about the effect you want to have happen, what medication fits with that, and how it can work in the owner’s lifestyle,” says veterinary behaviorist Lisa Radosta, who practices in West Palm Beach, Florida.

For instance, some owners are in and out but have a flexible schedule that allows them to premedicate a pet if a storm is in the forecast. For that owner, Radosta says, “I’m going to send her home with Sileo because that works fast and she’s generally going to be home to administer it.” For owners who are gone all day, she might suggest long-lasting clonazepam or gabapentin.

“Make a choice,” she says. “Don’t just throw a drug at it because you like it.”

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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