Blog Archives

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.

Study Compares Electronic-Collar Training with Positive Reinforcement

Linda LombardiAn increasing body of research demonstrates the effectiveness of positive reinforcement training and the risks of aversive methods. Despite this, some trainers still use shock collars even for training simple basic obedience cues, based on various rationalizations about their greater effectiveness.

A recent study in Frontiers in Veterinary Science puts aside for-the-moment issues of welfare and focuses on the question: Is there really a difference in effectiveness between positive reinforcement training and training that incorporates an electronic collar? Using concrete measurements of training success, the authors find no significant difference in number of cues disobeyed. In fact, positive reinforcement was more successful by some measures: Dogs trained with positive reinforcement responded to the trained cues faster and with fewer repetitions.

Sixty-three dogs with reported behavior problems, including poor recall, were assigned to one of three groups. The first group received training that included use of an electronic collar, conducted by professional trainers who normally use this as part of their program. There were two control groups. Control group 1 was trained by the same trainers as the first group but without the use of the electronic collar. Control group 2 was trained by professional trainers whose methods focused on positive reinforcement.

Data was collected for the cues “Sit” and “Come” at three points in the five-day training period. The measures of training efficacy were how many times the cue was given and how quickly the dogs responded.

There was no difference between the groups in how often cues were obeyed. Dogs in Group 2, trained with positive reinforcement only, were more likely to respond to a cue the first time, and they responded more quickly.

Jonathan J. Cooper of University of Lincoln, one of the coauthors, points out some important factors in the methodology of this study. One is that all of the dogs were reported to have poor recall and other off-leash behavior problems such as bothering livestock, which are the most common reasons for using remote training tools in the United Kingdom, where the study took place. “Consequently, we were working with dogs with similar issues with recall, as opposed to having ‘easier’ dogs in the control treatments and the more challenging dogs in the e-collar group,” he says.

Another is that the trainers in all groups were experienced, rather than comparing the methods as used by dog owners with inconsistent levels of skill. In addition, the analysis looks at objective measures of training outcomes, rather than a more subjective measure such as owner satisfaction.

Erica Feuerbacher, professor of Companion Animal Welfare and Behavior at Virginia Tech, says, “I thought the most important thing about this study was that the dogs trained with the shock were not any more compliant. That is often suggested – that shock collar training will produce more compliance in the dog and that they will respond faster. They didn’t find that.”

In fact, as far as speed, the study found the opposite on at least one measure. Dogs in the electronic-collar group and in control group 1, all trained by trainers who normally use the electronic-collar, actually began to respond more slowly to the Sit cue as training progressed.

Feuerbacher is not surprised by this finding. Both groups were trained with aversives, since although control group 1 was not using the electronic collar, these trainers used a mix of methods including negative reinforcement and positive reinforcement. “That kind of aversive training can produce generalized depressed behavior, so we may be getting a little bit of that there,” she says. She also notes that anecdotally, dogs with a history of being trained with both positive reinforcement and punishment may be more hesitant to respond.

Coauthor Cooper believes the results speak to more than just the effect of the use of electronic collars. “I think the findings of the paper have broader application than just use of remote training aids,” he says. “Specifically there is a growing body of research that suggests that reward-based training is not only generally better for dog welfare and dog:owner interactions, but is also proving more effective than aversion-based training for successful training outcomes.”

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.

Fear Free Shelters: Dog Housing Basics

Heather E. LewisAnyone who works in a shelter can agree that it is difficult to create an environment for dogs that helps them relax! Dogs want to be in homes, not in the shelter, so it can be a tricky problem.

What can we do with housing to create the best possible Fear Free temporary home? Here are some tried-and-true dog housing basics for a Fear Free shelter experience.

Double-Sided Housing

This gives dogs access to two different compartments, usually separated by a small door. This arrangement is useful for three reasons:

It is easier to clean the run. While it is important to get the dogs out for exercise, a minor spot clean can be easily accomplished with the dog in the other compartment, which leaves more hours available for meaningful enrichment time. (Note: be cautious of major hose cleaning while a dog is on the other side of a guillotine door as the sound of the hose can be stressful for some dogs.)
The dog has a separate clean side and bathroom side. While it is best to take dogs outside for potty breaks, some dogs cannot make it for long hours without a bathroom break and it is extremely stressful for many dogs to have to soil their living areas. If given the chance, most dogs will choose to eliminate away from where they sleep and eat.
The dog has more space. In shelters, we are often guilty of providing dogs far too little space. Some shelters have double-compartment housing, but they drop their guillotine doors to house more dogs. Unfortunately, this creates more stress for each individual dog, and works against positive outcomes.

Right Size the Housing

What is the right amount of space? It is hard to tell because many dog housing minimum requirements contradict each other. Here are the rules of thumb we follow:

The dog should not touch the sides of the enclosure when moving normally. Happy tail is not happy at all! A dog should wag his tail without hitting it against the run walls. Many runs are too narrow. A five-foot minimum works much better than a typical four-foot-wide run.
The enclosure should allow for choices. If a bed takes up too much room in the run, the dog will not have a choice about whether to lie on the bed or the floor. This is not a good situation, as dogs prefer to have options. Thus, the run should be large enough to allow for a bed, food, water, and an open, unrestricted floor space.
A variety of housing sizes is desirable. Very large dogs and bonded pairs will benefit from oversize or double runs. You can retrofit existing runs with side-to-side openings to allow for this possibility, or simply remove a run panel or two to allow for a few extra-large runs. On the other hand, very small dogs can feel vulnerable and frightened when housed in very large runs. Create a few smaller double-compartment runs or cages with puppy portals for very small dogs who prefer a smaller space, away from the big dogs.

Inside/Outside Is Best

Inside/outside housing has gone in and out of vogue, but it is now considered to be the preferred standard. When given the choice, dogs will appreciate the fresh air and will spend time outside whenever the weather is nice. If you use indoor/outdoor housing, remember these tips:

Upsize the inside portion of the run so the dog is still in a humanely sized space when the guillotine is closed, such as overnight.
Consider local weather when orienting the outside portion. East and south are some of our favorite orientations, while north is often too cold or windy and west is often too hot.
Weatherproof the guillotine door opening with a second weather door such as a saloon-style door.

Properly designed basic dog housing can help support your behavior, health, and adoption programs. It reduces fear, anxiety, and stress, thereby assisting dogs in finding their forever homes.

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

Heather E. Lewis, AIA, NCARB, is a principal of Animal Arts, an architectural firm that has exclusively designed animal care facilities, including veterinary hospitals and animal shelters, for more than three decades. She has worked on dozens of projects across the country, both large and small in her 19 years with the firm. Heather is a member of the Fear Free℠ Advisory Board and assisted in creating the Fear Free facility standards for veterinary hospitals. Heather is a regular contributor to various veterinary industry magazines. She has spoken on the design of facilities for the care of animals at dozens of national and regional conferences including Fetch Hospital Design Conferences, the UC Davis Low Stress Animal Handling Conference, and the Humane Society of the United States Animal Care Expo.

Esophagostomy Tubes: Fear Free Tools for Disease Management

Julie Liu, DVMSeveral months ago, my senior Bichon mix, Dorie, developed severe gastrointestinal issues. She was trembling with pain and nausea, stopped her favorite pastime of body slamming her toys against the couch, and eventually became inappetent.

Medicating Dorie has always been a challenge because she can sniff out anything no matter how well I try to hide it, but during her illness it became impossible. Even worse, the fear, anxiety, and stress (FAS) she experienced during my attempts to medicate her were almost as traumatizing to me as a pet parent as they were to her. When she didn’t respond to hospitalization I brought her to a specialty hospital for endoscopic biopsies, and during her anesthetic procedure the internist placed an esophagostomy tube (E tube).

The sense of relief I felt at having the option to medicate her and feed her through the tube without causing FAS was immense. Dorie was ultimately diagnosed with inflammatory bowel disease and required weeks of immunosuppressive doses of steroids before she started body slamming her toys again, and without her E tube I wonder if she would have recovered.

As Fear Free practitioners we always try to consider a pet’s wants vs. needs, but when treatments are medically indicated for an unwilling sick pet, we have to find a different approach. The use of E tubes provides a compassionate solution to disease management that should be considered for a variety of illnesses and not only as a last resort.

Indications for E Tube Placement

Historically, many veterinarians have recommended E tubes for gastrointestinal diseases such as feline hepatic lipidosis, cholangiohepatitis, IBD, and pancreatitis. These pets can have a prolonged road to recovery and the conversation about E tube placement should be started with clients early–when their pet has had anorexia reported for a few days. At best, syringe feeding an icteric cat with hepatic lipidosis can fall short of the caloric needs required for their recovery. At worst, it can result in aspiration pneumonia, fear of the client, and injuries as the client struggles with the pet.

Conditions that cause oral pain, such as facial trauma and significant dental disease, are additional indications for E tubes when we consider the role of pain in contributing to FAS.

Rather than sending a pet home after full-mouth extractions with some canned food and oral pain medications and hoping for the best, we can have a proactive discussion with the client about an E tube at the time of surgery. This is particularly important in cases where the pet has already had decreased appetite preoperatively and adds minimal time and cost to the procedure. In cases of oral neoplasia where the client is not ready to pursue humane euthanasia, placement of an E tube to deliver nutrition and analgesia may provide at least some relief to the patient until the next quality of life discussion with the client.

In pets with chronic kidney disease, an E tube can make a huge impact on long-term management and maintaining the client-pet bond. I remember attempting to give subcutaneous fluids to my first cat with kidney disease and managing exactly one poke before she jumped off her cat perch and ran away while the fluid line whipped around, spraying fluids everywhere. Some clients are also uncomfortable with handling needles and having to inject their pet with fluids and can inadvertently poke themselves in the process. An E tube can allow a client to administer daily fluids and anti-nausea medications easily without causing FAS or discomfort.

In addition, many pets with CKD find renal diets unpalatable and develop nausea, inappetence, and weight loss as their azotemia worsens, leading their owners to feed them whatever they will eat. Placement of an E tube ensures that their pet will receive both adequate nutrition needed to maintain their body weight as well as the recommended prescription diet to try to slow progression of their disease.

While there may be an increased level of anesthetic risk for patients with CKD or other underlying health conditions, placement of an E tube¹ is very quick (typically less than 30 minutes for placement and radiographic confirmation of location) and can provide weeks to months to even years of benefit. Once the stoma heals, it may be possible to exchange the tube through the same stoma site without general anesthesia by using topical anesthesia and the techniques outlined by Dr. Sheri Ross in 2016, in which she describes one feline patient with CKD whose stoma site was maintained for almost 5 years using E tube exchanges².

Client Education

Perhaps one of the challenging aspects of E tubes is overcoming the perceived stigma attached to the tube itself. Some clients may agree to several days of hospitalization for their pet but draw the line at an E tube because they associate it with end-of-life care. While this may be true with some conditions such as oral neoplasia, in others an E tube can actually save their pet’s life or improve management of a chronic disease. Most pets with an E tube also don’t seem to notice it at all, and will eat, drink, groom, and even body slam their toys with their E tube in place.

Some clients may also feel squeamish at the prospect of handling and using an E tube for their pets. Washable, patterned neck wraps such as the Kitty Kollar³ or Kanine Kollar have been amazing at minimizing the “medical” aspect of E tubes, and their website provides a great starting point for educating owners when initiating an E tube conversation. Once the E tube is placed and the pet is ready to be released from the hospital, provide written discharge instructions⁴ with a recommended schedule for medicating, watering, feeding, and cleaning based on that pet’s calculated water and caloric requirements to ensure that the pet is getting everything they need. Scheduling a teleconsult the following day and printing a weight chart for the patient at every recheck will provide additional guidance and positive reinforcement. When your client realizes how easy it is to treat their pet with the E tube, you can consider asking them to be a resource for others who are on the fence about having one placed for their pet.

Summary

E tubes can be used successfully for a variety of acute and chronic illnesses, and their ability to remove the FAS associated with treatments is significant. Weighing the risks vs. benefits of the brief anesthesia needed for placement is important, but when routine medical management is inadequate, we need to be proactive in advocating for our patients and work together to destigmatize these invaluable tools.

Resources

https://www.cliniciansbrief.com/article/esophagostomy-feeding-tube
Ross, S. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1099-114.doi: 10.1016/j.cvsm.2016.06.014. Epub 2016 Aug 5. Utilization of Feeding Tubes in the Management of Feline Chronic Kidney Disease
https://www.kittykollar.com
http://vhc.missouri.edu/small-animal-hospital/small-animal-internal-medicine/diseases-and-treatments/esophagostomy-tube-information-and-care

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.

Dispelling Dental Myths

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry)Did you know that approximately 80 percent of adult dogs and 70 percent of adult cats have some form of oral disease? Dental problems in dogs and cats are among the top three pet owner concerns, and many have misconceptions about how to provide good oral care. Here is a list of the most common myths your clients believe about pet dental health or questions they have and what to know to answer them.

White teeth equal a healthy mouth.

Not necessarily. The health of the gums is more important than the color of the teeth. Red, swollen gums are a sign that infection is lurking below the gumline. Infection can lead to bad breath, tooth loss, and heart, liver, and kidney disease in pets. The best way to ensure that every pet has a healthy mouth is to have your veterinarian perform a regular oral examination and professional tooth cleaning procedure on at least an annual basis.

Bad breath is normal in pets

Not true. Bad breath is an indicator of an infected mouth. The odor is often caused by by-products of bacteria in the mouth that form plaque and lead to dental disease. Pets with halitosis need a thorough dental exam and cleaning procedure.

Anesthesia is scary, so non-anesthetic dental cleaning is the way to go.

There is always a risk when an animal is anesthetized, but a thorough pre-op examination and blood work along with individualized anesthetic protocols and monitoring reduces pets’ risk during anesthesia. An anesthesia-free dental cleaning provides no benefit to the pet’s oral health. Scaling or scraping the teeth with an instrument only makes a tooth whiter in appearance. Think of the tooth as an iceberg; we see only about one-third of the tooth with the remaining two-thirds below the gumline. Bacteria below the gumline quickly become pathologic and begin to destroy the tissues surrounding the tooth. It is not possible to eliminate bacteria beneath the gumline where damage is done. Scaling without proper polishing roughens the tooth surface, leaving more surface area for bacterial plaque to attach to the tooth surface. Anesthesia-free dental cleanings are dangerous because they give a false sense of security that the pet has a clean mouth, allowing periodontal disease to go undetected and untreated. See more at: http://avdc.org/AFD/pet-periodontal-disease/#sthash.EGBX3IuT.dpuf and http://avdc.org/AFD/

Tooth brushing is too difficult, and my pet hates it and it really doesn’t help anyway.

While not all pets are willing to accept tooth brushing, it is the gold standard for good oral care. It does take time to teach pets to accept tooth brushing. Have a detailed explanation and demonstration for the pet owner such as this: “Start slow, with your finger and some pet toothpaste. Hold the muzzle with one hand and gently insert your finger between the cheek and the teeth and ‘brush’ the teeth. Reward pets with a favorite treat, praise, or game when they accept brushing! You may need to do this every day for a week to ensure your pet learns that it’s okay! Once the pet accepts your finger, begin using a toothbrush but introduce it slowly over several days. You only need to brush the outside of the teeth.” You can also refer clients to this video from Maddie’s Fund.

Feeding hard kibble will keep my pet’s teeth clean.

Most dogs and cats swallow kibble whole, getting no dental benefit. Even if pets chew kibble, the kibble is too hard and breaks apart when the tooth hits it, offering no benefit. Some dental diets are designed to solve this problem. The kibble is larger and softer, comprising a fiber matrix that allows the tooth to penetrate the kibble, thus wiping plaque off the tooth.

6. Bones, chew toys, and tennis balls will help keep his teeth clean.

While your dog will love you for the bone, his teeth may not. The canine jaw does not shift side to side like a human jaw, so when dogs bite down on a bone they often fracture the carnassial teeth. These fractured teeth hurt and can lead to infections and abscesses if left untreated.

Here’s a good rule of thumb when choosing a chew toy: if you can’t easily bend it with your hands or if you wouldn’t want to be hit in the knee with it, don’t give it to a pet. Wild dogs and wolves often have multiple fractures in their mouths due to chewing on bones.

Playing fetch with a tennis ball is a great way to bond with your pet but put the ball away when done. The rough surface of the tennis ball can abrade tooth enamel over time. Dogs who constantly chew on tennis balls often have severely worn teeth that can become painful.

Dogs and cats do not feel pain.

Our pets can’t tell us about the pain they feel, and they often want us to be happy, so they mask the pain. An infected mouth or a fractured tooth hurt and require treatment. Pets need to eat to stay alive so they will often figure out a way to do so that causes the least amount of pain. If clients notice their pet dropping food or only chewing on one side of the mouth, their pet has a problem.

It doesn’t bother me if my pet’s teeth aren’t pretty.

Pets with dental disease have an infection that should be treated just as an infected ear or wound would be treated. This infection is in the oral cavity and every time the animal chews, bacteria is released into the bloodstream, causing a detrimental effect on the heart, liver, and kidneys. There are even new studies linking joint issues to the oral cavity.

Oral disease is an inevitable part of aging.

Pets who receive good oral home care and routine professional cleanings are much less likely to develop dental disease as they age. Many veterinary professionals believe that good oral care can add an average of two years to the life of a pet. Just as age is not a disease, dental disease does not have to be an issue in aging pets.

How can I know if a dental product will really work for my pet?

The Veterinary Oral Health Council gives dental products a seal of approval for either plaque reduction or tartar reduction. The VOHC recognizes products that meet pre-set standards of plaque and calculus (tartar) retardation in dogs and cats. Types of products include special diets, toothbrushes, treats that may contain enzymes to help clean teeth, and treats or toys that can be filled with enzymatic pet toothpaste. Items awarded the VOHC Seal of Acceptance have been proven to work based on scientific studies and protocols. Bright Dental chews and toothpaste are currently in the midst of trials to earn VOHC certification.

References

Pavilica, Z., Petelin, M., Juntes, P, Erszen ,D., Crossley, DA, Skaleric, U, “Periodontal Disease Burden and Pathological Changes in Organs of Dogs.” J Vet Dent 2008 Jun:25(2):97-105.

DeBowes LJ: The effects of dental disease on systemic disease. Vet Clin North Am Small Anim Pract 28:1057. 1998

Debowes, LJ, Mosier, D. Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. J Vet Dent 1996; 12: 57–60.

Maresz, KJ, etal, “Prophyromonas gingivalis facilitates the development and progression of destructive arthritis through its unique bacterial peptidylarginine deiminase (PAD)” . PLos Pathog. 2013 Sep;9(9):e 1003627

Tang, Q, Fu H, Qin B, etal,”A possible link between rheumatoid arthritis and periodontitis: A systemic Review and Meta-analysis.” Int. J Periodontics Restorative Dent 2017, Jan/Feb, 37(1):79-96

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

Mary is a charter member of the Academy of Veterinary Dental Technicians and received her Veterinary Technician Specialty in Dentistry in June 2006. She worked in research for over 28 years, specializing in products aimed at improving oral health of companion animals and continues to work with companies to evaluate the efficacy of their products. Mary is the founder and president of Beyond the Crown Veterinary Education, a veterinary dental consulting service. She was named NAVTA Veterinary Technician of the Year in 2020 and received the AVDT’s Excellence in Dentistry Education award in 2019. Mary is a speaker and wet lab instructor at numerous state and national conferences. She lives on a small farm near Lawrence, Kansas, with her husband, Doug, and has two sons and three grandchildren.

Brought to you by

Older posts

Newer posts