tbe_admin, Author at Fear Free

That Hurts, But I Won’t Tell You About It: How to Find and Help Your Feline OA Patients

Jason Doolittle, DVMFelis catus – the domestic cat – is an amazing animal who delights and surprises even those of us who have spent years working with them. Among their many unique personality traits is their ability, highly evolved and adapted over thousands of years, to mask their pain when frightened, surprised, or otherwise stressed. It should be no surprise, then, that when your feline patients are in an unfamiliar environment, surrounded by sights, sounds, and smells they don’t recognize (such as a veterinary exam room), they will be inclined to mask their pain.

Cats in these situations also commonly experience fear, anxiety, and stress (FAS). FAS can cause a cat to mask their pain but could also result in behaviors easily mistaken for signs of pain. Partnering with your client, the cat owner, is essential to make an accurate diagnosis of pain in your feline patients.

Helping our feline patients with osteoarthritis (OA) starts at home, with our clients. As you are aware, cat owners are highly attuned to even small changes in their cat’s habits, personality, and idiosyncrasies that make them unique. Partner with your clients and teach them to screen for OA pain at home with a validated Cat OA Checklist produced by Zoetis. On this website, there are three simple screening steps that should only take your clients a few minutes to complete:

The first step utilizes animations to show healthy cat movement in performing several activities (e.g., climbing upstairs) compared to how cats move with joint disease. Your clients will be asked to check on the animations that are consistent with how their cat moves and that are suggestive of OA-related pain.
The next step evaluates, on a scale, the cat owner’s perception of their favorite feline’s emotional and physical well-being. Because OA is a chronic disease that can affect cats emotionally, this is an important step in connecting to the disease state.
The third, and final, step briefly summarizes, with yes/no questions, general behavior changes.

Once complete, clients can enter their email address to receive a copy of the checklist results. In some cases, clients will see the need to bring their cat into you for evaluation; others will need some encouragement to make an appointment. Consider recommending that your clients email the checklist results so you can identify those who might need to be seen.

To help prepare you for these kitties who will be coming to your office, Zoetis has created a website that provides you with resources such as helping to build cat owner awareness of feline pain, talk through the OA checklist they have completed, and feline orthopedic exam resources, including demonstration videos. This website contains a link to a printable version of the Cat OA Checklist that could be used, for example, with a client who has come into your office with their dog but has a cat at home that you haven’t seen in several years to encourage them to seek veterinary care for their feline companion.

It is important to remember that using Fear Free and Cat Friendly principles may mean that some cats who are coming to you to be evaluated for OA may require pharmaceutical help to remain calm. Keep in mind that some anxiolytic regimens may also produce analgesia and alter your exam findings. Objective diagnostic tools, such as orthopedic radiographs, are also an important part of the complete clinical evaluation.

Orthopedic exams and diagnosing OA in cats are yet more reminders that cats are not small dogs! As you partner with your cat-owning clients by asking them to screen their cats in the environment where they are most likely to show signs of OA, you will be better able to diagnose your arthritic feline patients. This partnership will greatly enhance your reputation amongst your clients who will see you as a trusted advisor to their beloved and treasured cat companion.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.Sponsored by our friends at Zoetis Petcare. © 2021 Zoetis Services LLC. All rights reserved. NA-02588

What to Know About Recognizing Signs of FAS in Avian Patients

Fear Free

Specific signals of fear, anxiety, and stress (FAS) differ slightly by species, but what remains constant for delivering Fear Free care is to attend to what animals communicate through their body language.

For exotic animal veterinarian Alicia McLaughlin, who practices at the Center for Bird and Exotic Animal Medicine in Bothell, Washington, paying close, constant attention to body language signals throughout interactions and care is vital for protecting the emotional experience and safety of her animal patients and the veterinary team.

In the case of Dr. McLaughlin’s exotic animal patients, signs of FAS may be slightly different and adjusted to depending upon the species. Avians in particular can be challenging for most people to read. But with practice, reading their signs of FAS becomes second nature.

Some signs of increasing fear, anxiety, and stress McLaughlin watches for in avian patients include eyes appearing more round as opposed to soft and almond-shaped. Stressed birds also do not preen themselves and are unwilling to eat even favorite treats. Birds may stand taller on their perch and lean away from a scary object or person, with feathers slicked and held close to the body. If these body language cues are ignored, birds may attempt to fly away or vocalize, or FAS may progress to defensive gesturing, with the bird opening the mouth, lunging, and threatening to bite.

Another aspect of body language to watch for is overexcitement.

“Overexcitement can lead to aggression quickly,” McLaughlin says.

Signs of overexcitement include feathers ruffling on the nape of the neck. A parrot may fan out tail feathers. Parrots have voluntary control over their pupils and can dilate and constrict them rapidly in what is referred to as eye pinning, another sign of overexcitement and a red flag for potential aggression.

Carefully and continually monitoring for signs of FAS throughout preparatory visits and actual veterinary care is protective both for the ability to handle patients in the immediate situation and for building their long-term comfort with care.

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

Fear Free Euthanasia: Help Pets and People Say Goodbye Peacefully

Julie Liu, DVMPet parents will remember their animal’s euthanasia for the rest of their lives, and if their pet is agitated or anxious, they’ll remember that, too. Helping them to plan ahead can make the experience easier for your patients and their families.

When people make the difficult decision to euthanize a pet, there are many other smaller decisions they’ll have to make, such as when to schedule and whether they or their children should be present. Among the details that should be considered on your end is how you can reduce the animal’s fear, anxiety, and stress during their final moments.

When pets have a fear of the veterinarian and are brought in for euthanasia, their stress levels can escalate. The procedures that may take place before euthanasia can be scary or painful, such as being restrained by a veterinary staff member while their front leg is shaved and an IV catheter is placed. While this usually occurs away from the owner, the experience is often stressful enough that the difference is noticeable when the pet is returned to the exam room.

Even if a particular patient doesn’t routinely require anti-anxiety medications, consider them when clients are bringing pets in for euthanasia. Many pet parents have concerns about their sedating effects, but this is one instance where it truly doesn’t matter–sedation will only help the euthanasia go more smoothly. Dispense them at least a few days ahead of time to ensure that the client is able to give a test dose before the day of the pet’s euthanasia. Some anti-anxiety medications such as gabapentin also help reduce pain, so they can decrease discomfort to procedures such as IV catheter placement prior to euthanasia. If your patient is agitated or is still fearful despite oral pre-visit pharmaceuticals, consider injectable sedation prior to euthanasia. The last thing a pet parent wants to see in their time of grief is their pet flailing, vocalizing, or trying to escape. Sedation will decrease stress for the pet and their family.

If your practice routinely uses IV catheters for euthanasias, have clients rub a lidocaine numbing cream such as Supernumb on the tops of their pet’s forelegs several hours prior to euthanasia. IV catheter placement is painful, and numbing the area will make for a more compassionate experience, especially since multiple catheter attempts are sometimes needed in debilitated pets .

In your Fear Free practice, you use treats with patients during routine visits, and you can use them with euthanasia, too. Providing a smorgasbord of vanilla ice cream, lunch meat, cheese chunks, Churu, peanut butter, or whipped cream will allow clients to continue bonding with their pets while lowering their stress. Take care to avoid giving greasy foods such as burgers–while tempting to offer as a last meal, they can cause nausea and gastrointestinal upset.

If you don’t offer housecalls for patient euthanasia, I urge you to consider it. Even pets who don’t have a strong fear of veterinary visits will never be as relaxed at the vet as they will in their home, with their familiar bed and environment. You can even have classical music playing quietly in the background to help create a calming environment. I’ve euthanized several pets in their homes, and in every instance I felt that the experiences of the pet and the owner were better than they would have been in the clinic environment.

Pets deserve to have a Fear Free death as much as they deserve to have a Fear Free life. By considering a patient’s emotional health during their final days, you’ll help make their passing as compassionate as possible.

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

Julie Liu, DVM, CVA (Certified Veterinary Acupuncturist) is a small-animal veterinarian who practices in Austin, Texas. In addition to advocating for Fear Free handling of pets, she is passionate about feline medicine and senior pet care.

Placing Cats With FeLV: What to Know

Kim Campbell ThorntonAt University of Florida, Julie Levy, DVM, DACVIM, DABVP (Shelter Medicine) focuses on the health and welfare of animals in shelters, humane methods for cat population control, and feline infectious diseases.

One of her successes in the latter area is determining the most reliable and effective way to test cats for FeLV, a disease for which approximately three to four percent of cats in the United States test positive each year. The diagnosis affects an estimated 60,000 cats in animal shelters annually. And until recently, the diagnosis has frequently been a death sentence for cats.

In a study published last year in Journal of Feline Medicine and Surgery, the researchers—who included Dr. Levy—state “Overpopulation of cats in shelters, combined with limited shelter resources, apprehension about viral transmission and preconceptions about how FeLV infection may impact quality of life or adoption potential often lead to routine euthanasia for shelter cats following a single positive FeLV test.”

But their findings suggest a high national demand for a lifesaving option for cats diagnosed with FeLV and have made a difference for cats in several ways. One is that the recommended options for testing have been pared down to a small menu of the most accurate and cost-effective tests.

“In the past, veterinarians and shelter managers were confused about what kind of sample they should collect from cats, what tests they should run, and how much they could trust the results. There are so many point-of-care and laboratory options that it could be overwhelming,” Levy says. “Our work with naturally infected cats in animal shelters has helped us address outdated dogma and to streamline testing .”

That’s important because more and more shelters are working to place FeLV-positive cats in homes. Levy’s interest began because in the past, cats who tested positive for FeLV were often routinely euthanized. Because of that dire consequence, she says, testers were so fearful of misdiagnosing cats that they often ran multiple tests, sometimes with varying results.

And the disease, which suppresses a cat’s immune system, does not run a straight course. It affects different cats in different ways and at different times. Levels may change over time depending on a cat’s immune status. Some cats live with the disease with little problem. It may flare up if the cat is stressed or has a comorbidity such as an upper respiratory infection and then die back down. It’s not possible to run a test once and then expect the cat to remain the same throughout life. Accepting that screening for FeLV is often fraught with a level of uncertainty, Levy suggests pairing a simplified testing process with a goal for saving cats regardless of the results.

“Let’s just identify these cats as infected or not infected as best we can and then get them into the right homes and support them and not try to achieve some level of control or absolute knowledge that isn’t attainable,” Dr. Levy says.

But why would shelters place cats infected with a disease that is commonly considered a death sentence?

Because life-saving protocols and good guidelines for adopters mean that FeLV is not necessarily a death sentence. And because people are willing to adopt cats with FeLV and give them the care they need.

The adoption study showed high national demand for a life-saving option for cats diagnosed with FeLV. In it, researchers state: “The majority of cats referred to the FeLV program were adopted, demonstrating that programs centered on adopter education and post-adoption support can create lifesaving outcomes for most FeLV-infected cats, despite uncertainty regarding their long-term prognosis.”

The study also noted that FeLV infections could not be confirmed in approximately one in five cats referred to a large FeLV adoption program, a reminder of the risk of basing a cat’s fate on a single positive test result.

That FeLV adoption program, begun by Austin Pets Alive!, was the springboard for Levy’s research to identify the most practical testing protocols.

In collaboration with IDEXX and APA, which places hundreds of FeLV-infected cats from around the country each year, University of Florida researchers enrolled 130 infected cats who were fostered, tested monthly, and then followed over time. Previously, many small studies had evaluated one test at a time, but none had compared so many different tests at the same time, in the same cats, repeatedly.

“That has allowed us to determine what the more reliable tests are and to evaluate how the status of cats changes over time,” Dr. Levy says. “It changes a lot more than we expected.” They were also able to evaluate the survival rate of cats in relation to their test results.

Originally, the study was not expected to run for more than a year, a year funded by $160,000 from Maddie’s Fund, plus professional time contributed by researchers, testing donated by IDEXX, and discounted testing from other laboratories. But the researchers recognized the value of the information they were gathering and knew they would never be able to repeat it. They didn’t want to lose track of the cats or of the very engaged group of cat owners who wanted to help.

Support from ECHF allowed the study to continue beyond that first year. Vicki Thayer, DVM, then executive director of ECHF, thought the work was important enough to support and put through an out-of-cycle proposal to ensure they could continue the work. The funding allowed staff to spend time staying in touch with the cats and to complete another two rounds of testing for a year for some longer-term results.

“ECHF has always been so tuned in to the emerging needs of cats and the emerging research opportunities,” Levy says. “This is a great example of recognizing a critical moment in time for cats on a critical disease that was killing a lot of cats, either medically or because of inappropriate euthanasia.”

Four years later, the cats are part of the largest group of infected cats that have been followed for the longest period of time. They are real-world cats under real-world conditions.

The result is a new test available through the IDEXX commercial diagnostic lab that can not only provide confirmation of infection but also information about the cat’s prognosis. Using a new quantitative PCR test, shelters can now identify whether a tested cat is likely to be a long-term survivor or develop disease and mortality early. The study also found that whole blood is the best sample for testing, rather than serum or plasma. That’s good news because whole blood doesn’t have to be processed before it’s tested.

Levy recommends using a high-quality point of care test in a “one and done” screening process for most newly acquired cats and then managing the cat appropriately according to the test results. Shelters or practitioners who want to go to the next level of testing—to follow up on a positive screening test or to screen blood donor cats, for instance—can choose the quantitative PCR, a DNA test that identifies the extent to which a cat is affected by FeLV. The long-term follow-up study by the University of Florida study showed that if there’s a lot of FeLV when cats are first diagnosed, they are more likely to develop early disease and to have a shorter lifespan.

And “manage appropriately” doesn’t mean euthanize. But that message still needs to get out to veterinarians. Too often, cats with FeLV are stigmatized as poor risks for adoption when in fact their condition can be supported like other chronic diseases. The retrovirus is impossible to cure, but a cat with FeLV can live for many years without illness and without spreading the disease to other cats if they are adopted into single-cat homes or with other FeLV+ cats.

“We need to do a better job of sharing the life-saving paradigm with veterinary practitioners,” Levy says. “It is very frustrating to place an FeLV+ cat with an informed adopter, only to have their veterinarian convince them that the cat should be euthanized,” Levy says. “That’s just very old school thinking.”

In fact, the Association of Shelter Veterinarians and the American Association of Feline Practitioners do not support euthanasia based solely on a cat’s infection status.

The assumption is that people won’t want to adopt cats if they don’t know how long they’re going to live or if they might require expensive treatment toward the end of their life. That’s frustrating to Levy.

“People adopt old dogs or dogs with medical conditions all the time,” she says. “They’re like, ‘Yes, this animal needs a home. I like him. Nobody knows what the future will bring. And even if he has only a few years left in life, he’s a good dog for me, and I want to be there for him.’”

They feel the same way about cats with FeLV or other diseases such as FIV, she believes. Those are often young cats who are healthy in the moment, enjoying life, and are great companions. In an adopter satisfaction survey, 74 percent of respondents had a “very positive” experience living with an FeLV-positive cat adopted from APA and 21 percent had a “positive” experience; 73 percent were “very likely” to adopt a FeLV cat again and 11 percent were “somewhat likely” to do so.

The shelters that are starting adoption programs for cats with FeLV are proving Levy’s point, using creative and fun programs to place the cats.

“Very often, the thing that tips a shelter over to trying it is when a favorite cat turns up positive or a foster home ends up with a positive cat and they can’t possibly euthanize it,” Levy says. “So they take this ‘dangerous’ step of adopting it out and it goes so well. They’re like, ‘Oh my gosh, why didn’t we do this sooner?’”

That’s what happened at Tree House Humane Society in Chicago. A foster caregiver raised some neonatal kittens who tested positive later and no one could bring themselves to euthanize them. They adopted them out and the adoptions were so successful that they now feature FeLV cats at their new cat café. They are popular adoptees thanks to good education and public relations. A cat café in Seattle has a similar program, focusing on FeLV cats from local shelters.

The Austin model provides good data on the viability of such adoption programs, especially when they are combined with the education and support of local veterinarians, as well as how to put them in place. The programs create optimism and enthusiasm for saving cats who could be considered some of the most vulnerable in the shelter system.

“We need to be better at providing the continuing education to private practitioners, so they also feel this optimism about caring for these cats,” Levy says.

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

Kim Campbell Thornton is content manager for Fear Free Pets and is an Elite Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985 and is a recipient of multiple awards from the Cat Writers Association, Dog Writers Association of America, and American Society of Journalists and Authors. When she’s not writing or editing, she’s snuggling with Harper and Keeper, her Cavalier King Charles Spaniels.

Dogs Less Stressed With Owners Present at Exams, Study Shows

Linda LombardiSome aspects of the experience of visiting the veterinarian are generally recognized as stressful to pets, such as strange noises, unfamiliar people and animals, and being handled in uncomfortable ways. Less clear – and now even more relevant in the wake of the pandemic – is a question asked by a recent study: how are pets affected by whether or not their owner is present during the exam?

In research published in Journal of the American Veterinary Medical Association in November, 32 dogs underwent a standardized exam consisting of examination of the head, palpation of lymph nodes and body, axillary temperature measurement, heart rate assessment, and respiratory rate assessment. The exams were recorded on video under two conditions, with owners present or absent. Behaviors indicating fear were assessed, including reduced posture, avoidance, escape, lip licking, body shaking, yawning, and vocalizing; physiological measures were also taken.

Based on their findings, researchers concluded dogs were less stressed when the owner was present during the exam.

“When the owners were allowed to be present with their dogs, they did have more reduced fear levels: reduced vocalizations and reduced temperature, and we also saw some female dogs had lower heart rates when they were with their owners,” says coauthor Anastasia C. Stellato. “So our results show that, if possible and if it’s appropriate for that client, to allow owners to be in the exam room could have a beneficial impact.”

Owner presence didn’t eliminate fear: more extreme responses, such as attempting to escape, were the same in both groups, despite the superficial nature of the exam. “It’s important to keep in mind that the exam we conducted was very passive,” says Stellato. “It was on the ground, they had a traction mat, we didn’t even use rectal temperature, and yet we still saw those fearful responses.”

So while those reactions indicated that the dogs would have preferred to avoid the exam, owner presence apparently allowed them to tolerate it somewhat better.

The study found an age difference in that older dogs lip-licked less than younger dogs when their owner was present. It’s possible that this was the result of a stronger bond developed over the years, but since length of ownership was not recorded, this remains a hypothesis for further investigation.

One finding that was surprising to the researchers was that owner-present dogs yawned more. Yawning is a complex behavior in dogs, so this result is difficult to interpret. “It was contrary to our expectation, so it requires further investigation,” says Stellato.

On the whole, the results suggest that when possible, allowing the owner to be present can be a simple way to reduce stress.

Veterinary behaviorist Karen van Haaften, senior manager of behaviour and welfare at British Columbia SPCA, says: “I think it’s a nicely designed study. It’s randomized and controlled, which is nice to see in a clinical study. I personally am not surprised by the results of this paper, but I think it’s really useful information for both veterinarians and pet owners to know, and I think it’s a timely one to consider, because during COVID, most vets are not allowing pet owners into the hospital.”

Even after the pandemic is over, pets will still need to be separated from their owners sometimes, so ways to mitigate the stress of this experience need to be considered. Van Haaften says: “When I read this, I’m asking myself, why are we seeing this response? Is it the social support — the bond that the pet has with the owner — that is reassuring to them? Or is the lack of familiarity? They don’t see anything in this clinic environment that feels familiar to them. Probably it’s both, but if the second, we can work on that.”

When pets do need to be separated from their owner, she says, consider how to include things familiar to the pet in the experience.

“We can interact with them in the way that we see that the owner does – use cues the owner uses, use training that they already know, walk them in on equipment that’s familiar, maybe bring something familiar from the owner into the room with them.”

Post-pandemic, we can return to the idea that familiarizing pets with the clinic in advance; for instance, dropping in simply to get some treats and meet friendly people. “If you do that a couple times a week they’re going to love going into the clinic — now it’s a familiar place where good things happen to them.”

And in some cases, a very little bit of familiarization right before an exam can make a big difference. “For some dogs, it doesn’t take that long to bond with a person,” van Haaften says. “If a technician or someone spends five minutes feeding cookies, performing trained cues with a dog, suddenly, now they’re good friends, and the dog has a familiar person they can go into the clinic with.”

Some clinics are doing exams outdoors for pets who are stressed inside the clinic, which can allow the owner to be nearby and this might be worth continuing for some pets as well. In general, van Haaften recommends flexibility and attention to individual differences.

“Behavior during vet exams is really complicated, and different techniques are going to work with different animals,” she says. “Be creative, be willing to be flexible about how you do exams to give your patients the best experience.”

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, coauthored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.

Study Suggests Simple Cage Modification to Reduce Stress in Hospitalized Cats

Linda LombardiThe veterinary clinic or hospital can be a stressful place for cats, full of strangers and strange noises and sights. A recent study suggests a simple and inexpensive way to reduce this stress by use of plexiglass sheets hung over the front of the cage.

In the study, thirty pet cats were placed in one side of two connected cages (the starting side, left or right, varied randomly) for 70 minutes. There were three conditions: open cage vs a cage-front covered by clear plexiglass; open cage vs opaque plexiglass; and clear vs opaque plexiglass. Observers calculated stress scores from the cat’s behavior during the first and last 15 minutes and recorded how much time was spent in each cage.

The cats who were most stressed in the first 15 minutes spent significantly more time in the cage that blocked the most incoming stimuli: they preferred either type of plexiglass to the open cage, and preferred opaque plexiglass to clear.

Coauthor Kyle G. Mathews, DVM, MS, DACVS of North Carolina State University says the idea behind the study was to find an affordable way to make clinics less stressful, while still allowing a full view of the patient. The opaque plexiglass is “like looking at the cat through a pair of sunglassses,” he says, which is much better than other inexpensive possibilities. “When you put a towel over the cage, or you give them a hiding box, you can’t see the animals.” When staff need to open the door to look at the hidden cats, that adds stress; if there’s a problem, staff might not notice in a timely fashion. “They may have IV lines, and that makes giving them a hide box difficult, because they could get their lines tangled up,” he adds.

Other possibilities are more expensive. For example, louvered windows, such as those used for privacy in conference rooms, would probably work. “You’re looking down at an angle and can see the cat, but the cat looking straight out can’t see the room,” he says. “But these are very expensive and have to be custom made.” In comparison, inexpensive plexiglass cut to order can be bought fairly cheaply and all that’s needed is to attach hook and loop fastener strips to hang it from cages.

If you’re wondering why not a one-way mirror, they ruled that out immediately for good reasons. “A one-way mirror only works if there’s light on one side, and dark on the other. So the person in the dark room can see the person in the light room, but the person in the light room can’t see the person in the dark room,” he says. “So we’d need the light in the cage with the cat and the room would need to be dark.”

While they may be a start, barriers won’t solve all the problems that stress cats. In particular, while plexiglass sheets block light (a 74.4 percent reduction for opaque and 13.9 percent for clear), they do little to block noise (only a 4.5 percent reduction). Although no one has specifically studied the effect of noise on cats, it’s almost surely a problem, especially in an echoing stainless steel cage.

“Eventually, if people don’t want to rebuild a room for cats, we may need to design a cage that has insulation around the outside of it, but still stainless inside that you can clean,” he says. “But noise reduction is going to be a more expensive alteration. So this was our first attempt at looking at, is there something relatively cheap that a practitioner could use to retrofit their clinic that would make it feline friendly.”

Further research also needs to be done in a real hospital setting: this study was done in a special room, with video of the sights and sounds of a veterinary inpatient ward projected onto a screen. But in the meantime, the results suggest that it’s worth trying and doesn’t appear to have any downsides. “The indication is that it probably is helpful, especially in the most stressed-out cats,” he says. “It’s not going to hurt them – they’re not going to move away from it, there was no indication that was the case.”

Board-certified veterinary behaviorist Margaret E. Gruen, Assistant Professor of Behavioral Medicine at North Carolina State University and a Fear Free Certified Professional, agrees that this is worth trying, noting that odors, separation from owners, lack of hiding places, and sounds of people talking and monitors beeping are all stressors for cats, making hospitalization and recovery more difficult for them as well as increasing morbidity. They may refuse to eat or be hesitant to use the litter box. And anxiety is often difficult to differentiate from pain in cats. Looking at ways to mitigate these stressors while still being able to easily observe feline patients, especially when they are ill or recovering from procedures, benefits both veterinary teams and the cats themselves.

“The cats, and their people, will appreciate it,” she says. “And having happier cats in the hospital is a win for everyone.”

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, co-authored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.

The Link Between Pain and Problem Behavior

Linda LombardiFor some animal behavior issues, the need for a medical workup is clear. While a cat who stops using the litter box certainly may be under stress or have social problems in the household, the first step is to rule out bladder or kidney issues.

But there are also medical issues where a potential connection to a behavior problem may be less obvious. One that can be tricky to diagnose and that affects behavior in a wide range of ways is pain.

A recent article published in the journal Animals reviewed records of 100 dogs seen by the 13 coauthors and found that conservatively, a third of them involved some form of pain, and in some cases possibly up to 80 percent.

Coauthor and board-certified veterinary behaviorist Margaret E. Gruen, DVM, Ph.D., of North Carolina State University says, “We want to raise the consciousness that there are a lot of things where pain can be a contributor.” When clients come in with behavior issues, she says, “we want to be really specifically looking for discomfort, even if it’s behavior where we’re not immediately thinking, oh, that could be pain.”

It can be tricky, because pain in animals is not always obvious. “Unless you are really well versed in pain, it can be hard to pick up a painful animal in the exam room,” says Mike Petty, DVM, CVPM. “They put on a show about how well they feel. We will see dogs limp across the parking lot and then quit limping when they hit the front door.”

This means that knowing how to look for it is critical. “Primary care providers must keep an open mind that absolutely any change in their patients’ behavior that the client reports can be related in some way to pain. That means doing a good pain palpation as a part of every examination,” says Robin Downing, DVM, DACVSMR. “Only by including a pain palpation in every examination will a practitioner become proficient in identifying even subtle pain in patients.”

It’s also important to be aware of the many demonstrated connections. An increasing number of behavioral effects of pain and discomfort are being found in research. As more of these are studied, what’s “obvious” changes. “Compulsive licking in cats is a fantastic example,” says Dr. Gruen. While this was once commonly assumed to be a result of stress, after research revealed that approximately three-quarters of cats with compulsive licking actually had an underlying dermatological issue, such cats are now more likely to be treated correctly.

A less well-known example involves compulsive behaviors such as stargazing, fly-snapping, and pica. Research has shown that these can result from gastrointestinal problems in dogs.

And while inappropriate elimination as possible evidence of pain is well known in cats, it’s perhaps less frequently considered that pain can also be connected to housesoiling in dogs. “Oftentimes it’s too much effort for the dog to go and find their owner, or they dread going down the three steps into the backyard,” says Dr. Petty. “So they will sometimes go to the door and urinate or defecate there, or sometimes won’t even go to the door and just do it wherever they are.”

Problems of Aging

It’s often not easy to tell the difference between pain and cognitive decline, both of which can happen as pets age — and the two can interact as well.

“If a dog is acting weird, it might not be simple cognitive decline; it might be cognitive decline driven by pain,” says Petty. “Sometimes animals are in so much pain they can’t even think straight, so they’re much more likely to have behavioral issues.”

A sign such as apparent disorientation could be due to physical issues: a dog who seems to be stuck standing on a rug might be reluctant to cross a slippery floor because walking on it hurts. An apparent decrease in sociability could also be due to undiagnosed pain: “If you’re getting up and moving around the house, they’re less likely to follow you from room to room,” says Petty. “I always say to these clients, let’s make sure there isn’t a pain issue that pushing your dog over the edge, while we look at this cognitive issue.”

Petty thinks that teasing apart these potential causes is especially important because they often push people toward the decision to euthanize, since the dog doesn’t seem to be enjoying life and the pet-owner bond can be affected. Treating pain can help, as well as encouraging owners to modify their expectations for an aging pet. It may not be that the dog doesn’t enjoy his favorite activities anymore so much as they need to be modified: say, rolling the ball a short way instead of throwing it across the yard. He tells clients, “Think of what the dog used to like to do and tone it down.”

Looking for Changes

Because pain isn’t always obvious on examination, listening to the owner’s observations is crucial — but these may also need to be guided.

“When I speak with my clients about the possibility of pain in their pets, I alert them that any changes in behavior must lead us to at least consider pain as the culprit,” says Dr. Downing. “So, this means changes in eating and drinking, changes in getting onto furniture/beds, reluctance to ascend or descend stairs, decreased grooming (cats), restlessness at night (or the converse – – sleeping excessively), decreased interaction with human or animal family members, “grouchiness,” any changes in housetraining or litter pan use, objections to petting/brushing, decreased stamina on walks, or any other changes they may witness.”

But even for owners, these changes can also creep up so slowly that they almost don’t notice them. “It’s very common with chronic pain issues that once they’re treated, the owner says, ‘I just realized it’s been two years since he jumped on a couch,” Petty says. He strongly recommends using a questionnaire such as the Canine Brief Pain Inventory starting when pets are six or seven years old. “If you give this to every dog owner that walks in for their annual exam and have them answer these questions, you’ll be amazed at the red flags that come up.”

Lack of change where it can reasonably be expected can also be a hint, where behavior modification isn’t working. “If we have a patient who is working with someone, and they’re doing lots of appropriate things and not making progress, that’s when you want to think, let’s look even closer,” says Gruen. “Are we seeing anything that could be pain?”

Treating Both

Finally, it’s also important to remember that even when an underlying medical issue is identified, both medical and behavioral treatment may be needed.

“We need to know what the medical conditions are but that doesn’t necessarily mean treating that will solve the behavior problem,” says Gruen. “A good example is noise phobia.” In a dog who has some pain along with some fear of fireworks, for example, tensing up at the frightening noise may also cause physical discomfort. “That gets associated with the noise, so worsens the behavior problem.”

Similarly, when cats have urinary tract issues or pain that causes them to start avoiding the litter box, simply solving the medical problem may not be enough. “You can treat the infection, but the aversion is set up and persists,” she says.

Likewise, simply treating the behavior isn’t going to work if an underlying medical issue has been missed. “Making changes in those other pillars of the treatment plan is important and will be helpful, but it’s an uphill battle if you have an untreated medical concern,” says Gruen. “Particularly if it’s pain and discomfort, because that affect so many things.”

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, co-authored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.

Research Shows New Medical Treatment for Painful Canine Stomatitis

Sandy RobinsCanine stomatitis is a painful condition characterized by inflamed lesions and ulcers in a dog’s mouth, making it difficult for affected dogs to eat and function normally. A veterinary dentist says new therapeutic treatments along with proper dental hygiene may effectively control and sometimes cure this debilitating disease.

There is no known exact cause for canine stomatitis, also known as canine chronic ulcerative stomatitis (CCUS). Jamie Anderson, DVM, MS, DAVDC, DACVIM, adjunct professor at the Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, has played a key role in research and treatment of this disease since 2013. She wants to dispel the belief that CCUS is the result of oral contact with plaque. Nor is CCUS directly related to periodontal disease as previously thought, she says.

“While research has shown that 40 percent of dogs with this condition also have severe periodontal disease, the remaining 60 percent do not,” she explains. “And we also now know that bacteria on the tooth surface that can result in a plaque buildup does not in fact cause the disease.”

Dogs suffering from this disease develop severe inflammation and oral ulcers on the tongue, the mucosa, and the inner surfaces of the lips. Because it’s so painful, a dog may have difficulty eating and be reluctant to open the mouth. This can result in weight loss. Other typical signs include fetid breath, thick, ropey saliva, blood-tinged saliva, visible irritability, depression and lethargy, and pawing at the mouth.

Susceptible Breeds

Commonly affected breeds include Maltese, Norwich Terriers, Labrador Retrievers, Greyhounds, Miniature Schnauzers, Chihuahuas, and Cavalier King Charles Spaniels. The condition is generally seen in dogs six years and older.

Dr. Anderson first became fascinated with this condition in 1991 during her residency at University of Pennsylvania and received her first grant to study CCUS in 2013 from the Foundation for Veterinary Dentistry. Her first study involved 20 dogs.

“Terrier breeds as well as Labradors were common in the study,” she recalls. “Most were neutered and older than nine years of age.” Under general anesthesia, a thorough oral evaluation was performed, and a Canine Ulcerative Stomatitis Disease Activity Index score was assigned. This score allowed for a before-and-after numeric description of response to therapy.

Anderson found that the number, size, and shape of the ulcers varied between dogs. Most of the ulcers were distributed symmetrically, appearing at the same site on both the left and right side. The ulcers were generally in contact with an opposing tooth surface and its plaque.

A full mouth set of dental radiographs was taken, and there were no radiographic findings unique to the condition. A biopsy from each dog was taken from an ulcer occurring in the cheek mucosa, and the samples were evaluated at University of California, Davis.

The pathologist found there was either erosion or ulceration of the epithelium; the sub-epithelium was where most of the cells causing inflammation resided. These cells were mostly lymphocytes (white blood cells) and plasma cells. With special staining in a subset of the cases, the team could determine that numerous inflammatory cells were present, including B cells and T cells, a T cell regulatory cell called FoxP3, and an interleukin called IL17. These cells play an important role in defending the mucosa from attack from outside the body and from self-attack, Anderson says.

Anderson’s second study set out to prove that the spectrum of pathologic changes and the types of immune cells present in CCUS were different from periodontal disease, with the goal of better understanding both diseases.

“We accepted 24 dogs with CCUS into this study, as well as dogs with severe periodontal disease, and healthy dogs as controls. Our research highlighted three histologic subtypes of ulcerative stomatitis, namely lichenoid, deep stomatitis, and granulomatous. Though these are not clinically apparent, we believe that these different subtypes represent a spectrum of the disease. And ultimately, the overall findings from this second study allowed us to conclude that CCUS is an immune-mediated inflammatory disease,” she says.

Hopeless Teeth

It has been common for veterinary dentists to extract healthy teeth to remove the plaque they believed to be causing the disease. Anderson believes the focus should be on extracting what are known as “hopeless” teeth — those that are no longer functional and that cause inflammation due to periodontal disease or endodontic disease.

“These dogs then need to be treated medically with systemic anti-inflammatory and immune-modulating drugs and topically with anti-plaque home care,” she says.

“While I do recommend the extraction of hopeless teeth from periodontal disease or as a result of fractures, further research has shown that plaque is not likely responsible for a mucosal ulcer,” she says. “We evaluated 100 samples, including healthy and periodontitis controls, to determine the spectrum of bacteria, the microbiome, involved in the CCUS lesion. The DNA isolated from the lesions was evaluated using next-generation sequencing methods. We found that the oral microbiome of the lesion in the cheek mucosa was unique and specific and varied significantly from the healthy dogs and those with periodontitis disease in the study.

“Consequently, our findings suggest that medical therapy, rather than extraction of healthy teeth, is most appropriate,” she says. “These medications control the disease, and in some cases, over a longer period of time on them, can cure the disease. If one regimen is not tolerated well, I will switch and try the other.”

Therapeutics

The first treatment is a combination of three drugs: 20 mg/kg of pentoxifylline, 5 mg/kg of doxycycline, and 200 to 250 mg of niacinamide taken orally twice daily.

“You can switch out the doxycycline for 10 mg/kg of metronidazole taken every 24 hours,” she says. “The side effects of such combos are typically inappetence or gastrointestinal upsets, likely due to the pentoxifylline.

“As the condition of the mouth improves, I will drop down the pentoxifylline dose to once every 24 hours, ultimately tapering it off, hence the importance of annual COHAT examinations,” she says.

The second drug combo consists of 5 mg/kg of cyclosporine (Atopica) and 10 mg/kg of metronidazole taken orally every 24 hours.

“This requires specific monitoring in dogs suffering from hepatic disease, along with further regular testing to ensure the medication is adequately suppressing the immune system,” she said.

John Lewis, VMD, FAVD, DAVDC, practices at Veterinary Dentistry Specialists in Chadds Ford, Pennsylvania. He has written about stomatitis in veterinary magazines and journals and says he has not utilized these protocols frequently enough yet to have a feel for their effectiveness.

“I believe more board-certified veterinary dentists are utilizing these or similar protocols,” he says.

“However, there are a number of diplomates that are having success treating canine stomatitis from a surgical standpoint (extraction of teeth that align with ulcerated areas) rather than with medical therapies, similar to the currently accepted approach to feline stomatitis. Canine stomatitis, thankfully, is infrequent compared to feline stomatitis.”

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

Inset photo courtesy Jan Bellows, DVM, DAVDC.

Top 10 Treats to Win Pet Hearts

Mikkel Becker, CBCC-KA, KPA CTP, CDBC, CPDT-KA, CTCFor pets, treats are like currency. Just as few of us will expend much effort to pick up a penny, but would risk ripping the seat out of our pants for a dollar, pets too crave high-value treats. Let’s face it; not all treats are created equal. There are certain flavors, textures, and even temperatures pets prefer over others.

It’s crucial to use “the good stuff” when it comes to treating effectively and gaining a pet’s keen appetitive interest in the face of distractions and change that are beyond a pet’s comfort zone, as happens when they are removed from the comfort of home and taken into the veterinary hospital environment.

Many Fear Free Certified Professionals have their own “tricks of the treats” to persuade even the most finicky of pets to chow down and lick their lips. Dr. Marty Becker, founder of Fear Free and a Fear Free Certified Professional himself, is rarely in the exam room without a ready supply of top-shelf treats that he and his team generously hand out as pleasant distractions and high-currency mood boosters to help deliver a more optimal emotional experience for pets during veterinary healthcare.

Here are his top 10 pet-preferred treats for Fear Free veterinary care.

For Dogs

– Baby shrimp

– Beggin Strips (broken into tiny pieces)

– Canned salmon or tuna

– Warm deli turkey

– Easy Cheese Cheddar & Bacon

– Freeze-dried meats from Pure Bites

– Honey Nut Cheerios

– Kong Squeezable Peanut Butter

– Peanut Butter Captain Crunch

– Slices of turkey hot dogs

For Cats

– Albacore tuna or salmon

– Anchovy paste

– Baby shrimp

– Bonita fish flakes

– Easy Cheese Cheddar & Bacon

– Fancy Feast: Foil packs of any flavor

– Green olives

– Marshmallows

– Vegemite

– Whipped cream

Dr. Becker and the team at North Idaho Animal Hospital pay special attention to economical means of delivering tasty treats by ordering many of the above options in bulk for a lower price. They keep treats fresh and easy to pull out for individual patients by dividing the bulk size into smaller portions when possible, placing them into small, treat-size Ziplock bags and storing in a refrigerator or freezer until needed. The team will pull out treat options from the freezer to thaw in the fridge overnight. Warming the contents in a microwave-safe container for 7 to 10 seconds prior to the exam releases fragrant aromas and heightens flavors.

Pets with allergies and other special dietary needs receive treats specially chosen treats. Oftentimes the owner will bring in a pet’s favorite treats, such as blueberries, apple pieces, or green beans. An alternative is to warm the pet’s regular hypoallergenic food or treats in the microwave to enhance scent and flavor. A canned version of the pet’s regular food or a compatible alternative soft food and treats can be delivered through means of a food-dispensing toy. Or fill small paper cups with dilute beef bouillon or tuna juice and freeze to make a long-lasting popsicle the pet can lick. Remember, pets are coming in hungry, so even their regular food warmed up can seem like manna from heaven.

Deliver tiny tastes or portions. The pet may receive dozens of treats or continuous licks of a treat during the exam, but their appetite is maintained through small amounts (think Cheerio-size or smaller) or slow delivery methods such as from a food puzzle.

How do Dr. Becker’s favorite Fear Free treats stack up with your own go-to treats? What would you add to the list?

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

Mikkel Becker is the lead animal trainer for Fear Free Pets. She is a certified behavior consultant and trainer who specializes in reward-based training that’s partnered closely with the pet’s veterinary team. Mikkel is the co-author of six books, including From Fearful to Fear Free.

Why Fear Free Is Better Medicine

Tony Johnson, DVM, DACVECCFear limits options.

When a patient is fearful of seeing me at a veterinary hospital, their world shrinks to two options: flee or fight. Neither one is fun for them or helps me do what I’m supposed to do for the patient and the family who loves them: find out what’s wrong and make it better.

With patients who are driven by fear, their natural instincts kick in and they resist everything we need to do to get them well.

I’m sure you’ve all been there when trying to treat a fearful patient. Patients displaying aggression are driven by fear. The vast majority of them don’t display this type of behavior at home – so why do they revert to aggression when we are trying to help them?

Think of their first few visits to the hospital and try to see it from their perspective. The car ride. They are likely apprehensive when loaded into the car or carrier. Their owner may try to soothe them with calming words, but fear takes hold.

The sights and smells. When they arrive at the hospital, they can smell the fear from dozens – hundreds – of other pets before them. They can smell the odors of the hospital – cleaning and disinfecting products, the cautery unit in surgery, the parvo dog in isolation. Their heightened sense of smell, many thousands of times what ours is, wafts all of these to them: smells of sickness and death. They sense that this is a bad place.

After this – needles, restraint. The inability to move. The fear of being atop the exam table with no place to run.

Is it any surprise, then, that they would grow to dislike this place and its occupants?

We know that we want to help them. We know that a vaccine will prevent deadly diseases, that a spay will prevent unwanted pregnancies and pyometra…but they don’t.

Lest I be misunderstood – I am not saying that a veterinary hospital is a bad place – not at all. I love them and I know the good that veterinarians do each and every day to protect and preserve animal health and promote healing. We just need to find a way to explain it to our patients.

Since we can’t use words (or my favorite means of communication – interpretive dance), we have to show them by our actions. We have to note the aspects of our places of work and our way of handling them and convey the concept that this is not a bad experience. We have to make their perception of this is a bad place become Hey, this ain’t half bad.

I know it can’t happen each and every time – I can’t take the time to cozy up to the Great Dane that just came crashing into my ER with a GDV – but I can take the time to make sure his post-op stay is as free of pain and anxiety as I can safely make it.

Fear Free is a mindset. It’s a new way of looking at our interactions with patients to suss out aspects that can be improved, spikes of fear that can be dulled, practices and protocols that can be improved.

Why?

You can look at it as a moral imperative – we have taken an oath. It’s the right thing to do. No patient should be worse off for seeing us.

You can look at it practically, as well.

Imagine the stress of trying to do a toenail trim or a heartworm test on a 90-pound dog displaying fear and aggression. That dog is probably recalling all sorts of memories, stretching back to puppyhood, of nauseating car rides, stressful physical restraint, triggering smells.

Now imagine a dog who saw each visit before this one as a chance for treats, pets, and gentle interaction. Happy visits – just in and out the door, and he didn’t even notice the DHLPP jab because he was too busy licking peanut butter off of a kind hand and the veterinarian giving the shot used a brand-new needle. Imagine a dog who received safe sedation for a laceration instead of being held down and receiving nothing but Brutacaine.

Which dog do you think will let you trim his toenails with less stress – for all of you?

Fear Free isn’t just about the patients. How many times do you think your top-tier tech will wrestle with that dog before she hears the siren call of nursing school? How many times will you look at the chart of the FAS 5 dog and feel your heart sink? Feel burnout creeping ever closer?

This doesn’t happen with a calm pet who knows that a visit to a veterinary hospital is a good thing, not a terrifying experience. In my 20 years of emergency practice, I’ve seen fear quite literally kill many patients – patients who are barely coping with illness at home, who then take a lethal turn when the fright of a car ride or veterinary visit tips them over the edge. Fear Free could have saved many of them.

If you take a patient who’s comfortable with the whole process in a veterinary hospital – check-in, physical exam, diagnostic tests, and going back home – you have a patient who doesn’t want to flee or fight me or my team. They’re cooperative and calm – they might enjoy the whole thing if we give them love, confidence, and, of course, plenty of treats). And judicious use of sedatives and analgesics can help offset the fear, anxiety, and stress of visits and procedures. Fear Free patients will let me run the tests and do the physical exam that gets me the answers I need to deliver the best care I can.

Without fear – when pets are Fear Free – it’s not only easier for everyone, it’s better medicine. It’s less stress – for everyone. It’s fewer shots in the dark. Fewer guesses, fewer misdiagnoses, fewer “let’s-see-if-this-fixes-it” treatments ending in lost time, bad outcomes, and problems like global antibiotic resistance. Fear Free practices mean more pets go home faster, and you and your staff are happier and more productive.

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

Dr. Tony Johnson, DVM, DACVECC, is a 1996 Washington State University grad and obtained board certification in emergency medicine and critical care in 2003. He is currently Minister of Happiness for VIN, the Veterinary Information Network, an online community of 75,000 worldwide veterinarians, and is a former clinical assistant professor at Purdue University School of Veterinary Medicine in Indiana. He has lectured for several international veterinary conferences (winning the small animal speaker of the year award for the Western Veterinary Conference in 2010) and is an active blogger and writer.

Older posts

Newer posts