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How to Conduct a Fear Free Pain Exam for Cats

Michael Petty, DVM, CVPP, CVMA, CCRT, CAAPM/strong>The approach to a pain exam in a cat barely resembles what you might do with a dog, who you can take outside on a leash and trot around, and who are usually more accepting of a physical exam for pain. Instead, I am going to describe the team approach to diagnosing pain in cats.

Owners often report that their cat has become grouchy or will even growl and strike out while being petted or picked up. The underlying cause could be that the cat is in pain and doesn’t want to be touched out of fear of causing more pain. It’s much the same as a person with a painful wrist or shoulder; they understand how to move that arm without causing undue pain, but a well-meaning handshake from another person can cause excruciating pain as the person with the painful arm loses control of the movement.

This leads us to the beginning of the pain exam: discussing with the owner behavioral changes they have either observed but dismissed (often as “old age” or some new quirk) or behavioral changes such as elimination outside the litter box. Indeed, a 2020 study published by Daniel Mills et al. in the journal Animals called Pain and Problem Behavior in Cats and Dogs found that it is estimated that almost 80 percent of behavioral issues can be related to various painful conditions; not only musculoskeletal, which is the focus of this discussion, but also other sources such as gastrointestinal pain. Hence it is crucial that every member of the veterinary staff plus the owner be involved in order to properly diagnose, treat, and evaluate the progress of any therapy. Otherwise, the mental snapshot of the animal in pain might be as jumbled as a jigsaw puzzle dumped out of its box.

The pain exam starts with your customer service representative, maybe the most important person in the diagnostic team. They are going to hear the owner say things that an educated customer service representative might recognize as a sign of pain, such as not using the litter box, suddenly fighting with other animals in the house, or hiding in another room. The receptionist then has the ability to ask the owner to video the cat walking across the floor, using a step, or jumping to a favorite spot. The receptionist can also ask them to visit websites, for example www.catredflags.com, to set the stage for a pain discussion once in the clinic.

The pain exam continues with the technician who, clued in by the receptionist that there might be a pain problem, can ask about videos. If the client did not visit any of the suggested websites, the technician can have them do so on a clinic tablet or laptop.

At this point, it is important to ask about behavioral changes: has the cat’s world become less vertical and more horizontal? Does the cat hesitate to jump or jump up in stages using a chair, for example, to reach a windowsill? Does the cat socialize less with humans or other animals in the household? There are more examples on the website mentioned in the previous paragraph. All of these inquiries help to “soften up” the client for the message that their pet may be living in a constant state of pain and has been telling them all along through their actions.

The pain exam concludes with the veterinarian, whose success in diagnosing pain depends heavily on the events and education preceding the examination. Without them, the owner might not see the cat through the eyes of someone trained to recognize pain in cats.

I always start my pain exam by letting the cat wander the room, keeping an eye on how they move and jump. Cats should move like a tiger gracefully moving through the jungle, with a fluidity of movement. Of course, some cats do nothing but hide under a chair during the visit, so this is the importance of asking the owner to take videos: This is my number-one diagnostic tool to know that “somethin’ ain’t right” with the cat’s musculoskeletal system. Pointing out what we see to the owner brings them a new sense of enlightenment regarding the cat’s condition.

Once I know something is wrong, I finally put my hands on the cat to locate the problem. The physical starts with stroking the cat from head to tail, in a gentle pattern. For many cats in pain, this will relax them and build a trust that will allow you to do slightly more potentially painful manipulations. You can also look for areas of sensitivity at this gentler touching. When these painful spots are found, there is no longer any need to revisit them; what more can you ascertain or achieve, besides increased stress in the cat?

The next step is to focus the exam on suspect areas. By this time, you may have an idea as to the general body area where the pain is located. If so, depending on the cat’s FAS score, I may examine only those joints, as the exam is over when the cat says it is over, and further manipulation may result in a heightening of their FAS score, indistinguishable from a response to pain. I find it easier to manipulate the cat’s joints when they are in lateral recumbency.

Manipulation of the elbow in a recumbent position. Please note, this is my daughter’s cat Alvin who is very compliant. This cat is not being scruffed; his head is only being held in place.

However, some cats will not allow that to happen. The exam can also be done with the cat in a standing position.

Examination of the lumbosacral joint in a standing position.

Each joint needs to be gently extended and flexed to look for resistance, but not to the point of causing undue pain. Again, if you are trying to persuade yourself or the owner that there is an issue, this is not the way to do it. For videos on how to do a complete pain exam on a cat, visit https://www.zoetisus.com/oa-pain/feline-exam-videos.aspx to see Dr. Duncan Lascelles demonstrate.

This brings us to radiographs. Some cats have either a demeanor or pain level so high that a physical exam should not be performed. If we are convinced that the issue is pain, it is now become less important to know the exact location, thanks to the approval of frunevetmab, an anti-NGF monoclonal antibody that is distributed to all of the OA joints in the body.

However, if we are not convinced, or we hope to do directed therapy such as acupuncture or rehabilitation therapy, then radiographs are a must. These should always be performed with something to reduce the cat’s anxiety and pain during the radiographic study. I prefer butorphanol as it gives 15 minutes of mild to moderate pain control as well as an additional few hours of somnolence, which can help ease the cat’s anxiety while waiting to go home. Just remember, the pain control lasts only about 15 minutes or so after injection; don’t confuse any sleepiness on the cat’s part past 15 minutes as pain control. And a final word on radiographs. Many cats with OA actually form areas of calcification distant from the joint. If you haven’t brushed up on diagnosing OA on radiographs in cats, you may want to explore that further.

Notice the distribution of calcification in this cat with knee OA. There is a typical lesion on the left knee but both knees have areas of calcification proximal to the joint. Sometimes they will even be seen floating in an adjacent muscle. Another reason to consider that cats might actually be aliens.

Utilizing the team approach and minimal hands-on interaction can greatly diminish the FAS in our painful feline patients who are going to be resistant to touch. Now that we have examined that cat with input from the entire veterinary staff, along with the owner and the cat itself, we no longer have a jigsaw puzzle, and can move forward with the therapeutic phase of their OA treatment.

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

Michael Petty, DVM, a certified veterinary pain management expert and veterinary acupuncturist, is author of Dr. Petty’s Pain Relief for Dogs: The Complete Medical and Integrative Guide to Treating Pain (Countryman Press, February 2016). He owns Arbor Pointe Veterinary Hospital and the Animal Pain Center in Canton, Michigan, and is past president of the International Veterinary Academy of Pain Management.

I Burned Out. Here’s What I Learned

Alyson Evans, RVT, CVT, Elite FFCP, CCFPAs many of you have read previously, I have been suffering from burnout. It took me a full year to accept that I needed to seek professional help to address my emotional ailments. Some days were better than others and some were darker.

From the day I went onto the Sondermind website and filled out the questionnaire about what I needed to address, I knew I was done holding onto so much darkness, hurt, and feelings of failure and worthlessness. A therapist contacted me within the day, and I scheduled my first appointment.

During my first session I burst into tears and felt relief. More, I felt the start of freedom from everything weighing me down. My weekly sessions dove into dark places that I didn’t realize were affecting me in an unhealthy way.

I have learned so much: That the emotional baggage of a recent trauma I had witnessed was called secondary trauma. And that when burnout and secondary trauma come together, the result is compassion fatigue.

I know many people are terrified of seeking professional help, believing it is a sign of weakness. It isn’t. Seeking professional help is a sign of strength and self-worth, recognition that it’s okay to put ourselves first. It’s difficult to do that, especially if we are veterinary professionals, but humans are not meant to fix everything on their own. We aren’t meant to be all-knowing and all-healing, let alone self-healing, at least not without a little help and guidance.

At a recent therapy session, I didn’t have much to talk about other than two vivid dreams, unusual because typically my dreams fade away rather than sticking in my memory. In the first, I was bitten on my right wrist and left ankle by a snake. After some research, I learned that this dream signifies overcoming a mental obstacle or issue as well as dealing with criticism. Both were accurate. I felt like I had been healing but hadn’t fully realized it. In the next dream, our neighbor, with whom I’ve had issues in the past, was drawing beautiful chalk murals on our sidewalk. She told me she wanted to start over and admitted that she had not been very nice to me for the past two years.

When I told my therapist about these dreams, I explained that I thought they were signaling that I was free to move on and move forward from the darkness I had been harboring. My therapist, smiling, nodded her head in agreement and for the first time I felt pride in myself and how far I have come.

My therapist once asked how I would know that I had achieved healing. “Pride,” I said. I would feel proud of myself for learning and practicing the tools I had gained from therapy to self-heal to the best of my ability, for putting aside my self-pride to seek professional help. Now that has happened.

My hope in sharing this journey is that some or all of you will find the strength to advocate for yourself. Take a chance on yourself and seek professional help. Speak up and ask for help or let someone know you are not okay. You can learn how to set boundaries, love yourself, and know that it is okay to not always be okay.

Here are some things that help me daily:

I play calming music in the car to and from work: It’s not just great for a Fear Free visit to and from the vet office for our pets, it is great for our own mental wellbeing going to and from a place that can cause us fear, anxiety, and stress.

When I start to feel stress or anxiety, I ask myself, “Is this helpful or hurtful?” and then move on.

I no longer work through lunch: I need that time to recharge, whether by meditating, listening to music or a podcast, or watching a Ted Talk or Netflix show.

I make plans for the weekend or holidays: Making plans with my family helps us not to stagnate at home but to get out of the house and do things together.

I set a bedtime for the kids: Adults need their own time. Keeping kids on a set schedule for bedtime helps parents stay connected and have time to check in on one another.

I don’t try and solve every problem: We are in an industry where people come to us with problems that we do our best to solve. It is okay to guide family and friends toward solving their own problems and making their own mistakes.

I treat myself: A hair appointment, a new outfit, or a mani-pedi are all ways to relax and feel special now and then.

I explore new options: The best time to explore other opportunities is to do it when we don’t have to. If you are happily employed but want to see what other hospitals are like or what opportunities are out there, investigate them. When we are not in a position where we might have to settle, we can explore our own values in a career and determine what is important to us. Many times, this exercise can help us realize what we value in ourselves or desire in a career path or future hospital.

I accept my feelings: It’s okay to express my feelings, whether someone else agrees with them or not.

I’m open and honest with loved ones: When I allow myself to be vulnerable and talk about how I am feeling or anxieties or fears I have, I allow my family to be part of that, which in turn has helped them feel more involved with my life rather than just being spectators.

Check out our Fear Free on the House page for resources on wellness, quick tips, and more!

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

Alyson Evans RVT, CVT, Elite FFCP, CVBL, is hospital manager at Briargate Boulevard Animal Hospital in Colorado Springs, Colorado.

Knowing How to Make Friends With Parrots Can Lead to New Patients

Barbara HeidenreichYour practice may not specialize in birds, but if there is not a board-certified avian practitioner in your area, you may find yourself seeing pet birds occasionally. Learning how to interact comfortably with them can help you add new clients and keep them and your feathered patients happy.

Unlike a dog or cat that may respond to a new person right away, birds can sometimes require a little extra effort on our part, especially if this is their first visit to your facility.

Birds can often show escape and avoidance behaviors when meeting a stranger. Here are some things you can do to help them to be more comfortable when you are getting to know them in a clinic setting.

Give the bird space: Although it is tempting, try not to go right up to a bird. Give him some time to get used to you being in the same room. Once he is looking relaxed and comfortable you can move a bit closer.
Speak softly: Many parrots respond to our loud voices by getting louder. Parrots can go from calm to highly aroused when we get animated, which can create conditions in which aggressive behavior is more likely to occur.
Move slowly: Birds tend to show fear responses when people move too quickly. You don’t want to scare your soon-to-be new friend.
Approach from the front: Be sure to approach the parrot so that he can easily see you coming. Many birds don’t like it when someone is moving behind them.
Show him something special: Before walking closer to a parrot, it is a good idea to have some preferred food items, small parrot toys, or other desired item with you. Ask the client what the bird likes best. Show the bird what you have to give him before you get too close.
Watch his body language: When you show the parrot the special treat or item you have for him, watch how he responds. If he leans toward you, he is saying he would very much like to accept your gift. If he leans away, he might be saying he is not sure he is ready to make friends right now. If he is not ready, you can always try again later.
Offer the special item: If the parrot leans forward and reaches his beak toward what you have to offer, you can move closer and give him what you have. Whenever you offer a preferred food item or toy to a parrot for the first time, try to present it so the bird has to lean forward to take it with his beak. This way you don’t have to get too close to the bird’s beak, and you can be extra-sure the bird is ready for the item. Sometimes when we get too close or offer the item too fast, a bird might respond by biting.
Offer more items: If the parrot takes the first food item or toy and is receptive, he might look or lean toward you for another one. If he does, that is an invitation to really start getting to know each other. Continue to offer him the desired items. This will cause your new parrot friend to look forward to seeing you.

Once a parrot understands that desired interactions occur in your presence, you will begin to notice more affiliative responses. He might be eager to step onto your hand. He might even talk or sing to see if he can encourage you to come closer to gain desired outcomes. As the bird’s comfort increases, he might even let you stroke the feathers on his head. This can be a good sign that you were very careful not to evoke fear responses and have done a good job building desired engagement.

Making friends with a parrot sometimes takes a little extra effort. But it is a very special compliment when a parrot accepts you as a friend. Pay close attention to your actions when you are meeting a parrot for the first time, and offer him preferred food items and fun toys. To learn more about interacting with, caring for, and managing parrots, seek out the Fear Free Veterinary Certification Program-Avian, which includes how to recognize stress in birds, how to handle and examine them safely, and how to teach cooperative care behaviors.

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

Barbara Heidenreich is an animal training consultant specializing in exotic animals. She consults worldwide working with zoos, universities, veterinary professionals, and conservation projects. She has worked onsite with over 80 facilities in 27 countries. She is an adjunct instructor at Texas A & M University. She has authored two books and contributed to four veterinary textbooks. She is a coauthor of two Fear Free® Avian Certification Courses. Much of her work focuses on training exotic species to cooperate in medical care. Barbara is an advisor for the Animal Training Working Group and the Parrot Taxon Advisory Group for the European Association of Zoos and Aquariums. She has provided her expertise to conservation projects The Kakapo Recovery Program and The Borneo Orangutan Survival Foundation. Her goal is to leave behind a legacy of kindness to animals by sharing her expertise.

Stress and Mental Health Challenges: How Schools Are Helping Veterinary Students Cope

Audrey Pavia
For many young people who love animals, becoming a veterinarian is a life-long aspiration that starts in high school and culminates in acceptance to a veterinary college. Reaching that goal takes an incredible amount of work and dedication and can take a toll on a student’s mental health.

Veterinary schools around the country have come to recognize the emotional challenges veterinary students face as they work to complete their degrees and have stepped forward to provide them with help. Right now, every Association of American College of Veterinary Medicine (AACVA) member school offers some kind of program design to help students maintain mental health.

How It Started

Kathleen Ruby, PhD, a psychologist based in Neskowin, Oregon, helped create the first mental health program for vet students, at Washington State University College of Veterinary Medicine.

“I was hired as one of the first counselors/mental health practitioners in the country for a college of veterinary medicine in 1998,” she says. “At the time, the position was quite ill-defined. It had been set up at the request of several faculty who found themselves counseling struggling students not just academically, but regarding personal issues and mental health problems.”

Dr. Ruby had been informed of two suicides of students in the college within a decade, and between these tragedies, and some faculty feeling uneasy about the one-on-one care many students seemed to require, the administration was persuaded to hire a professional to aid and support students.

“As a PhD mental health therapist with 12 years of experience running a private practice, as well as having helped a medical social worker work with students in my husband’s medical residency, I was seen as a good candidate,” she says.

At first, Ruby’s position was viewed as similar to an in-house university counseling center, where students made counseling appointments when they felt they were needed, and the counselor served as an in-house therapist.

“The program continued this way for a couple of years, and I found myself inundated with anxious, depressed, and overwhelmed students,” Ruby says. “The levels of anxiety, anxiety disorders, and mild to moderate depression were much higher than I was used to seeing in my private practice.”

Ruby notes that most vet students are young adults, which is the prime age for some mental illnesses to appear.

“I found myself dealing with several bipolar breaks,” she says. “Acutely, there were students who were victims of sexual assault, rape, and domestic violence, as well as divorce. More chronically, we had several students who had a great deal of childhood trauma, which they’d been able to cope with until put within the pressure cooker of an extremely difficult curriculum challenge.”

Ruby found–and other counselors in CVMs agreed–that the academic intensity; the closed nature of programs in which classes are small, with approximately 100 students who remain together all four years; the financial challenge of paying for medical school; the young-adult life stage; relationship challenges; and personal challenges inherent in medical training all contributed to making veterinary medical training a challenge to student mental health and well-being.

“Once this was ‘diagnosed,’ we began to craft programs to address some of the major stress points in the environment of training itself,” she says.

Helping Students

Fast forward to 2022, and students at vet schools in the U.S., as well as some in Australia and New Zealand, have access to mental health programs designed specifically for them. In addition, the AAVMC now offers an Accepted Student Wellbeing course for new vet school students, and is partnering with several organizations, including the Veterinary Mental Health Initiative, to create tailored resources on specific topics for students, staff, and faculty.

At University of California at Davis, the school of veterinary medicine student mental health program is designed to be multifaceted to meet student needs through the entirety of their professional school experience, according to A. Zachary Ward, Ph.D., coordinator of mental health and wellness programs.

“We start by interfacing with our first-year students in their first weeks of the program,” he says. “We work to overtly promote the focus on mental health and wellness at our school, and reduce the perceived stigma associated with reaching out for help when needed. We provide multiple presentations on mental health topics over the years and serve as mentors to the Health and Wellness Club, a student-run organization on our campus.”

The program also provides consultation to students, faculty, and staff on mental health-related topics, with particular focus on consultation around how someone can help a student when concerned about their mental wellbeing.

“We also explore methods for promoting mental wellbeing within the systems of our campus,” says Ward. “However, the bulk of what we do is provide direct clinical services to our students through individual psychotherapy, crisis intervention, group counseling, and couples therapy.”

It Works

These efforts to help vet students navigate life is paying off at UC Davis, according to Ward.

“Results can be measured in several ways, using metrics that we use to show psychotherapy works, via students’ responses to mental health symptom surveys and client satisfaction surveys,” he says. “However, to me, it’s the qualitative feedback that we receive from students that really tells me that our program is making a significant impact in their lives.”

Ruby believes the best gauge of success is how far and wide the understanding of mental health issues and the importance of personal well-being has spread throughout all echelons of the veterinary profession in the past two decades.

“Leadership at veterinary colleges and throughout the profession have gone from being somewhat apprehensive about the need for such care and training to becoming enthusiastic supporters and advocates,” she says. “Almost all the colleges now have at least one mental health professional, and some more than one. Most have well-integrated and sustainable wellbeing programs that are woven throughout the curriculum.”

Veterinary mental health and its challenges have been recognized, studied, and reported on throughout academic journals and popular media, Ruby says. She finds that this proliferation of knowledge, resources, training, and awareness-building has been a positive and helpful force within the profession.

“Perhaps the most exciting trend for me is that many of the speakers at educational conferences, and some of the current counselors, authors, and researchers are now DVMs who have recognized the need within their profession and have gone on to get additional certification in mental health and well-being fields to work within and improve the health of their own profession,” she says. “I can think of no greater validation than that!”

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

Audrey Pavia is a freelance writer and author of Horses For Dummies and Horseback Riding for Dummies. She lives in Norco, California, with her two Spanish Mustangs, Milagro and Rio.

Why FeLV and FIV Don’t Have to Be Death Sentences for Cats

By Kim Campbell ThorntonTwo infectious retroviral diseases are often thought of as a death sentence for cats, but they don’t have to be. One is feline leukemia virus, and the other is feline immunodeficiency virus.

Apprehension about transmission and preconceptions about how they can affect a cat’s quality of life or adoption potential often leads to routine euthanasia for shelter cats who test positive for either disease. And some veterinarians may recommend against adopting a cat with FeLV or FIV particularly if clients have other cats in the household.

Life-saving protocols and good guidelines for adopters make those concerns outmoded, however. Cats with FeLV or FIV can live normal lives without being a hazard to other cats. With preventive healthcare strategies and prompt identification and treatment of illness, both diseases can be managed effectively and their spread limited. Moreover, the Association of Shelter Veterinarians and the American Association of Feline Practitioners do not support euthanasia based solely on a cat’s infection status.

FeLV

Approximately three to four percent of cats in the United States test positive each year for feline leukemia virus, according to the 2020 AAFP Feline Retrovirus Testing and Management Guidelines. The diagnosis affects an estimated 60,000 cats in animal shelters annually.

It’s important to know that the disease, which suppresses a cat’s immune system, does not run a straight course, says Julie Levy, DVM, PhD, DACVIM, DABVP (Shelter Medicine). 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 subside. It’s not possible to run a test once and then expect the cat to remain the same throughout life.

More important, people are willing to adopt cats with FeLV and give them the care they need.

There is a high national demand for a lifesaving option for cats diagnosed with FeLV, and more and more shelters are working to place FeLV-positive cats in homes. Programs include Chicago’s Tree House Humane Society, Philadelphia Animal Welfare Society, Operation Kindness in Carrollton, Texas, and Austin Pets Alive!

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. This has made a difference for cats in several ways. One is that recommended options for testing have been pared down to a small menu of the most accurate and cost-effective tests. A long-running study has allowed researchers to determine the most reliable tests as well as to evaluate how the status of cats with the disease changes over time. 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.

Preventing FeLV

The advisory panel of the AAFP recommends that kittens be vaccinated for FeLV starting as early as 8 weeks of age with two vaccines given three to four weeks apart and then boosted when they are a year old. Vaccination of cats for FeLV during kittenhood, followed by a single booster vaccination at one year of age, is the best way to prevent spread of the disease and reduce its incidence.

While it does not consider FeLV a core vaccine for adult cats, the AAFP recommends that adult cats should be vaccinated annually for FeLV if they are at risk. Risk factors include spending time outdoors, living with cats known to be infected with FeLV, or interacting with cats of unknown disease status.

Ask clients or adopters about the lifestyle and vaccination status of other cats in the home. While vaccination doesn’t help cats already infected with FeLV, it is important for uninfected cats who may have access to the outdoors or potential contact with infected cats. It’s not uncommon for indoor cats to accidentally get out of the house or to experience a change in lifestyle leading to time spent outdoors on a regular or full-time basis.

Elanco’s range of vaccines against FeLV are designed to give feline patients a more comfortable vaccine experience. The ½ mL vaccine—containing half the volume of traditional 1 mL vaccines decreases administration time, increasing the comfort of the vaccination. It is also highly purified, using PureFil technology, designed to reduce adverse reactions associated with extraneous proteins and cellular debris. The vaccine line is available in a variety of combinations, including the only 1/2mL FVRCP+FeLV vaccine, to reduce the number of injections that may be needed.

FIV

Along with FeLV, feline immunodeficiency virus is one of the most common causes of infectious disease in cats worldwide. Cats typically acquire FIV through bite wounds when they fight with FIV-infected cats. A cat’s FIV status should be determined at the time of adoption or if the cat later becomes ill or has any risk of exposure.

But an FIV-positive test does not make a cat unadoptable. While the possibility of transmission is there, exposure to an infected cat is not as risky to uninfected cats as previously thought. FIV-positive cats living amicably with disease-free cats do not appear to pass on the disease. Nor do FIV-positive queens pass on the disease to their kittens. Casual contact, such as allogrooming or sharing water bowls, has not been found to be a common or efficient route of transmission. And while FIV is contagious among cats, it’s not transmissible to humans.

FIV infection can have three phases: acute, asymptomatic, and progressive. In the acute phase, occurring one to three months after infection, cats may have mild signs or no signs. It is followed by an asymptomatic, or latent, phase, which can continue for months or years. They may or may not progress to symptomatic disease.

With good care, some infected cats can live for many years with good quality of life. Some cats show no signs at all, although they remain infectious. However, because FIV affects the immune system, cats with the disease can be more prone to respiratory, dental, eye, or skin infections. Other signs associated with FIV include fever, lethargy, chronic diarrhea, and weight loss.

Clients or adopters caring for cats with FIV should protect them from injuries or wounds that could lead to secondary bacterial infections, as well as from other viruses and parasites that could cause illness. Best management practice is for these cats to live indoors, where they are protected from exposure to potential injuries and infections and prevented from spreading the disease to other cats.

A vaccination for FIV is not commercially available in the U. S., nor is it recommended by any veterinary organizations or schools of veterinary medicine. Its use can complicate diagnosis of FIV infections. Vaccinated cats produce antibodies indistinguishable from antibodies induced by natural infection, making test results unclear if a cat’s vaccination history is unknown. Cats vaccinated for FIV should have a microchip or tag indicating their vaccination status.

The bottom line is that cats with FeLV or FIV are often young, healthy in the moment, enjoying life, and can make great companions. With good care protocols, they can live happy lives with people and other cats.

Click-thru URLS

Fear Free https://fearfreepets.com/

Blog https://fearfreepets.com/blog/

Elanco Animal Health https://www.elanco.us/

American Association of Feline Practitioners 2020 AAFP Feline Retrovirus Testing and Management Guidelines (sagepub.com)

This post is brought to you by our sponsor, Elanco, the maker of TruFel Ultra Vaccines.

TruFel, Ultra, Purefil, Elanco, and the diagonal bar logo are trademarks of Elanco or its affiliates.

When Burnout Overwhelms You, What Comes Next?

Alyson Evans, RVT, CVT, Elite FFCP, CCFPSix months ago, I wrote about my experience with burnout. I thought then that I had reached my lowest low, but I was wrong. Here’s what has been happening since then.

I have been doing nail trims and anal sac expressions in my neighborhood for the last three years. Recently, one of my neighbors had asked on our community Facebook page if someone in the veterinary field could answer a question. Her dog was limping, and she didn’t know what to do. One of the neighbors offered her some doggy aspirin she had bought at the pet store. I quickly advised against giving unprescribed medications to her pet.

The conversation turned into a bullying session. One of my neighbors told me I shouldn’t try to act like a veterinarian. I have never felt so disrespected in the 15 years I have been in this career.

I shut down.

The next thing I knew, I was in my closet, crying, repeating to myself, “I don’t care, I don’t care anymore. Why should I care about others’ pets if I am going to be treated like crap? I’m done.”

I may have been improving with burnout, but I had just hit a whole new level of compassion fatigue.

I had a full weekend’s worth of nail trims to do and was going to make a little more than $200 in five hours. I didn’t care about the extra money anymore and canceled all appointments for the foreseeable future.

In tears, I explained to my husband why I had given up making extra money on the side. It was clear he wanted to help but didn’t know what to say or do. I knew I needed professional help.

Now I’m in the process of finding a therapist I can connect with. Until then, my family and I have adopted the following tools to help reduce stress:

–Simple Habit, a meditation app. My son uses it to fall asleep and settle down. He will ask to meditate to go to sleep now.

–A “coming home” routine: The spouse who is home first allows the second spouse to “finish coming home.” This gives them some quiet transition time to put their bags down, change clothes, and relax. When they’re ready to engage with the other spouse to prepare for the evening, they come out of the bedroom or wherever they choose to decompress.

–Boundaries with kids: I explain to my son that I need time to talk with his dad and ask him to sit quietly and watch a short show or play ABCmouse, a reading app. I also set timers in the house called, “Time to get ready for bed,” “Time for bed,” and “Quiet time is over.”

–Communication: When I start to feel like I’m getting anxious, I communicate how I am feeling and what I need to be able to come back down to earth.

Most of all, we continue to remind each other to slow down, be present, engage, and take time to listen to one another. My husband and I are working to improve our communication with our 3-year-old son so we can help him become an emotionally intelligent person, something his dad and I still work on ourselves.

We make time to have difficult conversations, and when we get into arguments, we try to make it a conversation, being mindful of raised voices, body language, and facial expressions. When necessary, we call each other out in a respectful way, in the moment, to help the other become aware of what they are doing.

The Fear Free way of thinking has helped me in so many aspects of my life. I use the techniques with my own son when he has doctor appointments as well as in everyday life. I communicate with him, making sure he knows what is coming up next, where we are going, what the doctor will do next. He is better behaved and calmer when things are explained to him, in most settings. I think that most children would respond to situations in a calmer manner when a Fear Free or Considerate Approach is taken.

In a work setting, my current team is emotionally intelligent, and all know the battle that I am fighting, which helps. Openly discussing things with your team can not only help you to become stronger but also to be seen with more respect and empathy than if you suffer in silence to spare everyone else’s feelings. Maybe someone on your team is suffering as well and doesn’t have the courage to speak up. Sharing your battles may give them strength to seek help for theirs. I wish more practice managers and owners would spend a day, at least, in a Fear Free certified hospital.

The most important message I want to send is that the battle of burnout is ongoing, and it’s not one you can win on your own. It doesn’t fix itself overnight or with a couple of therapy sessions.

Here is a quote I read frequently from Rachel Ashwell’s book “Painted Stories”:

“There is a time for taking action and creating work, and there is also a time for rest and seeking new ideas. Learning when you need space will help you to build a more sustainable creative practice.”

Check out our Fear Free on the House page for resources on wellness, quick tips, and more!

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

Gabapentin Reduces Stress in Feline Patients, Study Shows

Julie Liu, DVMNo sooner do you read the alert, “Caution, will bite!” on your next patient’s chart when you hear him enter the building: loud yowls in the waiting area, followed by hissing, growling, striking, and screaming when you dare to peek at him through the carrier in the exam room. Is it a scene from a veterinary horror movie? Nope, just a senior cat who’s been losing weight for a couple of months, is overdue for rabies, and oh by the way, can you also trim his nails?

Fear of the veterinarian is a common finding among our feline patients and unfortunately, left unaddressed, can often escalate to aggression and worse veterinary care. Cat parents may put off bringing their cat to the vet due to the stress involved, and veterinarians are often unable to perform an exam, diagnostics, or treatments due to risk of injury. If you’ve ever attempted to “examine” one of your feline patients by observing them solely from the carrier, a recent JAVMA study¹ may bring hope.

In the double-blinded, randomized, placebo-controlled study, two groups of healthy cats at least 6 months of age were given either gabapentin or a placebo capsule two hours before the first of two veterinary visits. One group had a history of fear-based aggressive behaviors (FAB), and the other did not.

During the vet visits, the cat parent was present but did not interact with the cat, and the vet attempted to go through the following steps with a standardized clinical exam, corresponding to a compliance score of 0 through 9: no handling; removing the cat from the carrier; cardiopulmonary auscultation; abdominal palpation; intraoral exam; ocular exam; otic exam; rectal temperature; and finally, return of the cat to the carrier. The exam was stopped if the cat tried to bite or scratch the vet, but the exam continued if the cat hissed or growled. On the second of the two visits, performed a mean of about 15 days after the first visit, the cat received the opposite treatment of either placebo or gabapentin and the steps to attempted clinical exam were repeated.

The results suggested that the compliance scores of cats in the FAB group that received gabapentin were significantly higher (median, 9) than the same cats with FAB that received a placebo (median, 0.5). Forty-two percent of the cats receiving gabapentin did experience some side effects, most commonly drowsiness and myorelaxation. However, all adverse effects had resolved after approximately 10 hours, which is a reassuring point to make with concerned cat parents. In addition, most cat parents in the study rated the gabapentin and the placebo as being fairly easy to administer with regular food.

If you’re not using gabapentin routinely for your feline patients to reduce stress, now is a great time to start. An easy way to get cat parents on board is to send home a “Fear Free goody bag” that includes two free doses of 100 mg gabapentin (a trial dose and a day-of dose), an individually packaged Feliway wipe, and the Fear Free handout “How to Prepare Your Pet for a Veterinary Visit.”² Cat parents who balk at having to pay a dispensing fee for a gabapentin prescription may welcome a sample, and gabapentin is so inexpensive that the cost vs. benefits of actually being able to handle and treat your feline patients will pay off a thousandfold. Just make sure you discuss potential side effects and recommend that they give the gabapentin in a tasty treat such as Churu to avoid causing a food aversion with their regular canned food.

If the cat parent does their part by administering the gabapentin to their fearful cat, we as Fear Free Certified Professionals must do ours and use feline-friendly handling. A perfectly mellow cat floating away on a cloud of gabapentin is going to come crashing to earth if they’re scruffed or dumped out of their carrier. While removal from the carrier was the second step in this study’s standardized physical exam, if a cat doesn’t want to come out of the carrier on their own, they’ll often become much more stressed when they’re removed from the familiar environment of their carrier. Try removing the top of the carrier and allowing your feline patient the option of hiding in the towel–you’ll find that you can often do an entire exam, vaccines, and sample collection this way without the cat escalating to FAB.

For more info on feline-friendly handling, check out the updated, amazing, and free AAFP webinar by Dr. Ilona Rodan.³ Even experienced cat people will learn some great tips on ways to keep their feline patients as relaxed as possible.

Kruszka, M., Graff, E., Medam, T., & Masson, S. (2021). Clinical evaluation of the effects of a single oral dose of gabapentin on fear-based aggressive behaviors in cats during veterinary examinations, Journal of the American Veterinary Medical Association, 259(11), 1285-1291.
https://fearfreepets.com/wp-content/uploads/2017/09/Preparing-for-the-visit-store.png
https://catvets.com/education/online/webinars/feline-friendly-handling-interactions

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 is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Parrot Prep: How to Set Up Avian Training and Behavior Classes

Rachel Lees, RVT, KPA CTP, VTS (Behavior)Behavior problems are a common cause of relinquishment and euthanasia in most domesticated species, including parrots. When obtaining a new pet, clients have specific expectations and ideas about what normal behavior looks like for each species. Whether they have a dog, cat, bird, or guinea pig, these choices are most likely made from a positive experience the client had in the past.

But what happens when things do not go as planned? What if expectations are too high and the pet obtained is unable to live up to the client’s expectations? Biting, screaming, and feather picking are parrot behaviors that many new owners are not prepared for when they acquire their pet. In the avian world, euthanasia is much less likely as most veterinarians are hesitant to end a bird’s life due to the client’s convenience, but this makes it more likely that the bird will be rehomed multiple times.

What if we were able to prepare our avian clients for behavioral problems before they start? What if avian rescues could work to teach birds specific cued behaviors to help eliminate aggression in some of these pets?

Psittacine preparatory programs or avian prep programs can be life-changing for birds and a great resource for owners to understand normal bird behavior, create realistic long-term expectations, and work toward creating an environment that is mentally and behaviorally enriching. They also help teach cued foundation behaviors used to eliminate and replace unwanted behaviors (just as we do with dogs and cats). Avian prep programs can help to strengthen the human-animal bond, keep birds in a home long-term, and increase the bond between client, bird, and clinic. Bonus: offering such programs also increases revenue through fees and the sale of products and treats.

Creating the Course

Who will teach the courses? What are the most important topics to teach? What foundation behaviors are most important and why? These are all great questions and we will break them down below:

Educator/Instructor: An avian veterinarian or veterinary technician with a special interest in birds should instruct this course. The individual should be knowledgeable in avian communication, body language, forms of enrichment, and use of positive reinforcement for training. An exotic-animal trainer may be an ideal instructor if one is in your area. This trainer should use and recommend positive reinforcement. Avoid use of aversive training techniques, which can increase fear, stress, and anxiety in all species.

Curriculum Breakdown

I recommend creating a four-week course. The first two weeks can be taught virtually or in person without the client’s bird present. The goal in the first two weeks will be to review the basics of avian communication, enrichment and environmental set up, learning theory and use of positive reinforcement (with a marker), and answer client questions. The third and fourth classes will focus on teaching cued behaviors with the birds present in the hospital. (See the chart below)

To prevent potential disease transmission or other risks for birds brought to class, take the following measures:

Waiver (indicating risk to client, bird, etc.)
One owner per bird
Clients should bring their own equipment and reinforcers (carriers, towels, etc.)
Birds will need to have a current examination by a veterinarian, complete blood cell count, and Chlamydophila screening in the past year.
- Old World parrots such as African greys, lovebirds, and cockatiels must have a negative test for circovirus
All unwanted behaviors (feather picking, etc) should have been medically worked up prior to working solely on behavior.

Class	Topic and Discussion Points
Class One (Humans Only)	· Introduction and Client Problem Behavior Discussion (Why are they here and what are they seeing at home?)· Avian Communication · Environmental Enrichment/Management
Class Two (Humans Only)	· Environmental Enrichment/Management (cont.)· Learning Theory and Using Marker Training · Marker Mechanics and Preparing for Birds in Class
Class Three (Humans and Birds)	Break down into 5- to 10-minute training sessions with short breaks in between.· Name Orientation · Target · Step to Me · Off · Station Training
Class Four (Humans and Birds)	Break down into 5- to 10-minute training sessions with short breaks in between.· Name Orientation · Target · Step to Me · Off · Station Training

Foundation Behaviors to Teach

The following behaviors can be useful to have trained and generalized prior to problem behaviors starting. Response Substitution is a term used when we want to replace an unwanted behavior with a new behavior. Teaching and creating strong cued behaviors can help to eliminate and give alternative responses in situations involving attention-seeking or aggression.

Name Orientation: Teaching birds their name can help with obtaining their attention to interrupt unwanted behaviors and ask them to offer a different behavior.

Target Training: This behavior can be used to teach the bird to move from one place to another by teaching them to place their beak near the target.

Step to Me: Cue a bird to move to handler’s arm or hand to be transported from one place to another.

Off: Cue bird to move off of handler during periods where conflict may occur.

Station Training: Teach bird to go to a specific location on cue. This can be used as an alternative behavior.

Avian prep programs and training classes are currently scarce but ideally courses like this will become as routine as dog training classes. Pet birds deserve just as much of a chance to be successful in the home environment as dogs or cats. If you or others you know are teaching a course like this, please update us on the Fear Free for Professionals Facebook Group. We would love to see your photos and ideas for these courses as well as your feedback!

Resources

Luescher, Andrew. Manual of Parrot Behavior. Blackwell Publishing. 2006

Shaw, Julie K. and Martin, Debbie. Canine and Feline Behavior for Veterinary Technicians and Nurses. Wiley & Sons, Inc. 2015.

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

Rachel Lees, an Elite Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and veterinary behavior technician at the University of Tennessee College of Veterinary Medicine. She loves helping people create and maintain a strong human-animal bond.

Fear Free Success Story: Hanover Veterinary Hospital

Sandra ToneyHanover Veterinary Hospital in Cedar Lake, Indiana, has the distinction of being the first veterinary hospital in the Northwest Indiana region to become Fear Free Practice certified.

Lindsay Pollard, FFCP (Veterinary), the hospital’s practice manager, says they began trying out some Fear Free methods after hearing about the concept. “A few of our staff members obtained individual certifications,” Pollard says. “After learning more and attending a few conferences where Fear Free was highlighted, we decided to go all the way.” Hanover Veterinary Hospital completed the program to become Fear Free certified in December 2018.

When deciding to become a Fear Free Practice, the biggest difference has been in the way he interacts with the animals after certification, says owner Jeremiah Bieszczak, DVM. “The biggest change has been reading body language and emotional state/stress level and addressing that instead of pushing through it. We are better able to read pets and have more tools and knowledge to deal with these situations.”

Many long-term clients are delighted with the constructive visits they’ve had with Fear Free, and new clients are thrilled with the difference between them and their previous veterinarian, says Pollard. Oftentimes they mention the care and compassion used when handling their pets. Pollard feels they’ve made much progress with many of the patients since becoming Fear Free certified.

Fear Free helps all pets, but scared pets often need Fear Free much more to turn their lives around. Pollard has one patient in particular whom she’ll always remember and says Fear Free methods changed everything for this dog.

The pet was a 14-year-old female shepherd mix. Sally, who has since passed away, desperately needed help. “Prior to our Fear Free certification, both Sally and her owner, Sara Zilz, dreaded coming to the vet. She also had some fear aggression and anxiety issues at home. She had a very high FAS and was fearful to the point of aggression,” says Pollard. “Our exams with her were very limited at best and it took several staff members to accomplish anything with her at all.”

Sally had been adopted by Zilz from the humane society when she was 9 weeks old. She didn’t notice any problems with Sally until she took her for training and Sally became spooked by large signs in the store hanging over her head. Then she began showing other fearful behaviors. Zilz says Sally disliked smoke from the grill and even hated when someone blew out a candle. She started having food-guarding issues and was even afraid of shadows on walks.

Zilz says she never thought about potential problems at the veterinarian’s office. “I had her boarded at Hanover. Dr. Bieszczak came out when I picked her up and nicely said something along the lines of ‘She needs to be medicated before we will take her for another boarding.’ This broke my heart. I did not realize she was that bad.”

A veterinary technician named Bobbi became Sally’s best friend when she was boarded. Bobbi would sit in her kennel with her and try to get her to come out. She wouldn’t even go outside to potty. Bobbi called Zilz several times and asked if she could do some things to help her. After that, Bobbi became Sally’s veterinary technician of choice.

After they became Fear Free certified, Bieszczak started Sally on fluoxetine, an anti-depressant. This medication was a game-changer for her. Pollard says they also started doing happy visits with Sally, using treats with her during exams and treatment, and including calming pheromone products during her happy visits and exams/treatment. They also tried to keep the same staff member working with her all the time, and kept detailed notes on her likes and triggers, constantly adapting their plan and approach to better suit Sally individually.

“She made more progress with each happy visit and regular visit until eventually she was happy to see several staff members,” Pollard says, “and she was happy coming into the building. Sally would readily accept most treatment from us with the help of some treat distractors and enforcers.”

“At one point, I felt everyone wanted to give up on Sally. Once I saw the Hanover Veterinary Hospital staff was not giving up on her, I knew things would be okay,” says Zilz.

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

Sandra Toney has been writing about cats for over 25 years and is an award-winning member of Cat Writers Association and Dog Writers Association of America. She has written for many print and online magazines about cat health and behavior as well as authoring eight books. She lives in northern Indiana with her cat, Angel.

Words on Birds: Collecting an Avian Behavior History

Rachel Lees, RVT, KPA CTP, VTS (Behavior)To successfully identify behavior concerns and recommend a treatment plan, a veterinary professional should be proficient in collecting a thorough behavioral history. It’s essential to gather information on daily routine, environment, training history, and other lifestyle and behavior facts.

With feathered companions, this is especially important, as many avian behavioral issues may be related to lack of environmental stimuli; specific relationships with members of the household; the owner’s behavior; and daily schedule and routine, to mention a few key pieces of behavioral history taking. Most veterinary behaviorists require a client to complete a behavioral questionnaire prior to the pet’s appointment, but even with this information, they must act as detectives, sifting through the information and asking further questions in the examination room.

This article will discuss four aspects of collecting an avian behavioral history. Having a thorough understanding of the situation can help the veterinary team reach a diagnosis.

Gaining Client Trust

This first step is an important factor in taking a history, even though it doesn’t relate to the bird’s behavior. Veterinary professionals should present themselves in a way that promotes and creates an open and honest relationship with the pet owner. If the client feels judged, the history obtained may not be accurate history, leading to misdiagnosis.

Humans communicate visually and verbally. Actively listening and appearing open, sympathetic, and relaxed are important when entering the room to evaluate the patient and meet the owner. When in an exam room with clients, I mention specific behaviors that may be challenging to ignore and tell the client that everyone makes mistakes and we all lose our tempers. I evaluate the client’s nonverbal body language and based on that, I may state that there is zero judgment in this space and that we are a safe zone. We support owners and understand that they are in the office to help their pet. It is not our job to judge, but to help the owner and pet move forward.

Abnormal vs. Normal Behavior

Clients who obtain parrots may or may not fully understand normal parrot behavior. Many clients bring their bird in for behavioral evaluation only to learn that the behavior is normal for that species. Parrots, for instance, are inherently loud, destructive, and messy. The parrot walking into the consultation is going to be the same parrot walking out. Giving the client clear expectations can be informative for clients and help them understand long-term goals for modification of unwanted behaviors. Communicating that some of these behaviors are normal can educate the client and lead to a discussion on how to manage the behavior moving forward.

Observing Behavior

This can be the most challenging part of obtaining the behavior history. It is important for the veterinary professional to witness typical behavior for the bird. With birds, the majority of behavior is going to be displayed in their home environment where they feel most comfortable. Most birds will alter their behavior in the presence of unfamiliar people. While using video to evaluate the behavior is valuable, it may add new, potentially “scary” stimuli to the situation, and this may influence the bird’s behavior.

To help to counteract this, have the client bring the camera or tripod into the environment a few days prior to collecting video and data. This should help the bird habituate to the camera and reduce or eliminate behavior changes. In the text Manual of Parrot Behavior, edited by Andrew Luescher, DACVB, it is recommended that clients film the following prior to the consultation:

Interactions with each household member (or members of the home who routinely interact with the bird)
Interactions with owner during:
- Meals/eating
- Playing
- Snuggling
Routine behavior in the cage (with owner in the room)
Routine behavior in the cage (without the owner present)
Film a “Bird View” video of what the bird sees from the cage
- Full circle view

The goal of these videos is to give the veterinary professional insight to how the bird interacts at home. The veterinary team can then read and understand the animal’s body language as it is displayed during each circumstance or situation. Caution the client against purposefully eliciting aggressive behavior or frightening the bird. The goal is for the videos to provide a glimpse of the bird’s everyday behavior and comfort level with interactions and surroundings.

Evaluating Physical Environment

The bird’s environment can play a large role in normal or abnormal behavior patterns. This can become a concern when diagnosing a behavior condition. When evaluating the pet’s physical environment, look at the following:

The bird’s cage
- Size
- Construction
- Cleanliness: A dirty cage space can cause increased stress and anxiety
- Location: Where is the cage located? In the common room with the family and or owners? Is it in an isolated space away from human interaction? Is it in the center of the room? Certain locations can increase stress and anxiety.
- Stimuli and surroundings near the cage: The cage is where the bird spends a large amount of time. Since parrots are a prey species, certain sounds, objects, or conditions may be more concerning to them, causing increased fear, stress, and anxiety. Specific objects such as clocks or portraits may increase stress and anxiety (“Why is the scary portrait staring at me?”). Loud sounds, cigarette smoke, and air quality are other factors that can make the parrot uncomfortable.
Toys and enrichment:
- Are perches and play gyms present in a social gathering space? This may suggest that the bird is able to loosely and comfortably play and interact with the equipment in the presence of people and other unknown stimuli.
- Assess the type of toy, size, construction materials, and suitability. Toys that are too challenging become uninteresting. Each toy should match the preference of the bird. Variation and rotating toys can be a useful tactic to keep toys as “fun” as possible. Some birds may not know how to play with toys, and for this reason may be more dependent on and bonded to the owner.

Veterinary professionals may also request that the client submit a video tour of the home. This can aid them in knowing what the pet may be experiencing based on human movement, placement of items, and daily routine.

These are just a few of the considerations to take into account when obtaining an avian behavioral history. Other areas to assess and discuss are the patient’s signalment, breed, developmental history, prior environmental information, and grooming. We will dive into other aspects of taking an avian history in a future blog post.

Reference:

Luescher, Andrew. Manual of Parrot Behavior. Blackwell Publishing. 2006

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

Rachel Lees, an Elite Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and veterinary behavior technician at the University of Tennessee College of Veterinary Medicine. She loves helping people create and maintain a strong human-animal bond.

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