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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.

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Fear Free Shelters: Why Natural Lighting Is Important

Heather E. LewisAs we have learned this year during the pandemic, outdoor spaces are healthier for people than indoor spaces. It isn’t just ventilation that is better outside; daylight provides physiological benefits for people and animals that artificial lighting will never replace.

For dogs in shelters, the best you can do for their welfare is to get them outside for enrichment. This must be emphasized before we talk about improving indoor spaces, as even the best indoor space cannot replace outdoor time. Nevertheless, bringing natural daylight into the shelter has benefits for all animals, including homo sapiens.

Reinforcing Circadian Rhythms

Circadian rhythms are the hormonal and physiological cycles our bodies go through, day and night. They tie to our general health, our quality of sleep, and our patterns of eating and resting. Circadian rhythms are also important for reinforcing seasonal patterns such as the growth of winter haircoats.

- Bringing daylight into shelters and allowing dogs and cats indoor/outdoor spaces helps them maintain crucial biological cycles throughout their stay. Circadian rhythm regulation is particularly important for animals who must stay longer in care; for example, dogs with medical conditions requiring continued care.
- As one example of the importance of circadian rhythms, human hospital patients with disrupted day/night cycles suffered poorer cognitive functions, had delirium in greater frequency, and recovered more slowly than they would have without these disruptions.

Boosting Morale for Staff

Animals in the shelter pick up on the morale of staff and volunteers. Sheltered animals are often fearful, and one way we can reduce fear is to provide compassionate and gentle care. Lack of natural daylight in human workplaces contributes to stress, fatigue, anxiety, and depression-related illnesses such as SAD (Seasonal Affective Disorder) and makes compassionate care more challenging. Bringing daylight into the building counteracts these effects and helps support a healthier, more upbeat work environment, which is better for the well-being of all.

Unfortunately, many shelters, especially older ones, are constructed with few windows and little natural daylight. However, there are ways to add natural lighting without huge expense. Here are a few tips:

Construct inexpensive outdoor spaces such as catios, dog exercise yards, and a covered patio or pretty garden pergola where staff can relax and take their lunch or breaks. These are easy to get donations for (relatively speaking), or they can be built on weekends by handy volunteers.
Consider adding “Solatubes,” which are tubular skylights. These introduce daylight from roofs down to the ceiling, and work even in structures that are high overhead. They are relatively easy to install, and they are not as prone to leaking as traditional skylights.
Speaking of which, we have been to several shelters that used to have skylights but covered them when they leaked. Uncover your old skylights and put the effort into fixing them – it is worth it!
Swap out solid doors for glass doors. Adding a glass door adds daylight with very little effort. If you’re worried about security, put an alarm on the door and frost the glass – the soft daylight coming in will be worth the risk of the glass, in most cases.
Add windows. Windows can be harder to add because this involves cutting holes in an outside wall, so add them where they would provide the most benefit. For example, if you have a cat isolation room on a blank outside wall, adding a window will vastly improve the wellbeing of the cats housed in that room while being treated. If you do go to the trouble of adding a window, put a heavy-duty screen on it and design the window to be operable. That way it can be open in nice weather, which provides even more benefit.

Don’t settle for a lightless bunker. It’s not good for you and it’s not good for the animals. As we head into the dark of winter, look for fundable opportunities to get animals and staff outside, as well as for ways to bring daylight in. Everyone will be happier and healthier!

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.

Fear Free Shelters: Lower Stress for Dogs Via Play

Heather E. LewisHealthy play is necessary for the wellbeing of all animals, including humans! For sheltered dogs, play has become increasingly important for many reasons:

We are more aware of the need to provide quality enrichment to sheltered animals.
Shelters are providing more behavioral care for dogs.
Play reduces fear, anxiety, and stress.
Play helps dogs feel more comfortable in the shelter environment.

We love designing for play. There are many small design nuances but here are some basic highlights:

Play Group Space. Play groups must be set up with the support of staff and volunteers, with proper training, as well as within the proper environment. Ideally, play groups will have the following:
- A series of interconnected yards (rather than one large yard) to customize play groups based on dogs’ sizes and size needs.
- Visual barriers between yards and kennels.
- Double-gated entrances for safety.
- Access to water via kiddie pools for the dogs to cool off and to provide a large water source that is less likely to be guarded.
- Shading and reasonable surfaces are important as well. K9Grass (a brand of faux grass) is our favorite, but only if it is installed correctly so that it drains and does not collect water. It also needs to be shaded or it can get too hot for paws.
- Safe fencing that keeps dogs contained without risk of escape.

Water Play. Water play works well for dogs who enjoy play groups and for those who do not. We have started incorporating splash parks for sheltered dogs (see photo). It is spectacular to witness a formerly fearful sheltered dog interacting playfully with water. Splash park plans must be created by people who know how to design for dogs, as they have different types of plumbing, surfacing, and play structures than those designed for children. When we design a splash park, we consider the following:
- Incorporate additional space around the water feature so the dogs can go in and out of the water. This enhances choice.
- Safe surfacing is critical. Our favorite is a soft, grip-textured surface designed for dogs.
- The water itself should be safe. It is not recirculated, so it is best to have the water provide watering to landscaping once it has been used in park fountains.

Individual Play Spaces. We know that some dogs do better with one-on-one time than they do in groups, and we know that water features cannot be used during cold winters. Therefore, do not forget to provide these spaces for your sheltered dogs:
- Walking Paths. These should be loop type with multiple forks along the loop, so that dogs do not have to pass each other side to side. Good walks provide exercise, connection, and some Fear Free training opportunities.
- Ball Throwing Areas. We like to provide a larger yard (60’ long minimum) for flying disc or ball throwing.
- Small (20×20, for example), more fully enclosed yards. These are great for gentle socializing with fearful dogs who may retreat in large yards, or for adoption meet and greet.

As we continue to improve the Fear Free shelter, dedicated play areas are a critical part of the design. It is best to designate outdoor areas for play so everyone gets fresh air, but if your shelter is land constrained, or in an urban location, playrooms can be indoor if necessary.

Regardless of your resources, find ways to incorporate play. For a dog, and especially one who is fearful, play is an important and often shorter path to happiness and comfort, as well as to finding the right forever home.

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.

Photo courtesy Humane Society of Southwest Missouri

Fear Free Management of Feline Diabetes

Julie Liu, DVM
Before learning about Fear Free handling techniques, one of my biggest fears about my cat, Puff, was that he would someday become diabetic and require insulin injections. While he is a friendly cat, he is so resistant to restraint that even applying topical parasite preventive on him monthly could be a struggle, not to mention the nightmare of bringing him to the clinic and handling him for labwork (picture a 12-pound white and orange bucking bronco).

I have encountered a similar level of panic in a number of my clients faced with the diagnosis of diabetes in their cat. Beyond the stress associated with costs of initial diagnosis and treatment, many clients have a high level of anxiety at the thought of giving their cat injections and may even consider euthanasia for a disease that is often ultimately manageable. We can provide a huge service to our patients by educating both clients and our fellow veterinary professionals on Fear Free methods of handling diabetic cats.

Insulin Administration

Fear of needles is nothing new in the veterinary clinic. We see it develop all the time in pets when they jump with the poke of a vaccination. Over time, they begin to anticipate that when their skin is touched, pinched, or lifted, a needle will follow. You may even observe this occurring within the course of the same appointment when you have to give several vaccines. While we set a goal for diabetic remission in our feline patients, unfortunately this won’t be possible or permanent for all cats, so getting clients comfortable with handling their cat for injections is vital.

Prepping Pet Owners

The good news about managing diabetic cats is twofold: insulin needles are tiny and most diabetic cats love food. I normally ask owners to administer insulin while their cat is obliviously munching away on breakfast or dinner. For those with a cat like Puff, taking time to desensitize and countercondition the baby steps leading up to the injection is recommended since these types of cats always seem to know when their owners are up to something.

Start with having the owner find a comfortable location in the house for feeding and insulin administration and practice remaining next to their cat while the cat is eating. Next, have the owner desensitize the cat to being petted between the dorsal shoulders while eating, followed by desensitization and counterconditioning to the owner gently lifting and releasing the skin. For needle-reactive cats, practicing fake injections with the tip of a pen. Using the Fear Free vaccination technique of applying numbing cream a few minutes before injection will help ensure that the process remains more positive and less like a horror movie where the owner is chasing the cat around the house with an uncapped needle.

Blood Glucose Monitoring

Have you ever taken a blood glucose reading from a cat in the clinic while he’s growling and hissing and wondered how accurate your 391 value was? Similar to Doppler blood pressure, if your feline patient has an FAS level of 4 or 5, you may not be able to trust those blood glucose numbers.

To minimize stress hyperglycemia, all of the normal Fear Free recommendations you would make for reducing FAS associated with vet visits apply to in-clinic blood glucose curves: desensitization and counterconditioning to the carrier, low-stress handling at the clinic, and most of all, pre-visit pharmaceuticals. Unfortunately, even with taking all of these precautions, your feline patients will likely experience some stress. If you rely on serum fructosamine you’ll get a general idea of their level of blood glucose control over the preceding week but miss the nadir and other parameters. As a result, home blood glucose monitoring has become a much more common and Fear Free method of assessing diabetic control.

Historically, I’ve asked owners to purchase their own AlphaTRAK™ glucometer kit online and scheduled a technician appointment for a demo with their cat on how to obtain the needed microdrop of blood from the marginal vein along the haired portion of the ear pinna. Similar to desensitization and counterconditioning to handling the cat for insulin injections, the same approach can be used for blood glucose sampling. Using a cotton ball to stabilize the non-haired portion of the pinna and a 27-gauge needle will improve patient comfort.

Clinics can create a standardized home blood glucose curve form containing patient information, current diet, current insulin type/dose, blood glucose level prior to the start of feeding/insulin, and readings every 2 to 4 hours over a 12-hour period. Once this is completed and emailed back to the clinic, a blood glucose curve consult fee can be charged to the owner prior to having the doctor contact the client. While you may get some pushback from clients regarding this fee, keep in mind that the fee is typically a fraction of the cost charged for an in-clinic curve, and client education on home blood glucose sampling will empower owners to verify hypoglycemia if symptoms are seen and seek veterinary care if indicated.

Recently, continuous glucose monitors (CGM) such as the Abbott Freestyle Libre™ glucose monitor have provided another option for Fear Free management of diabetes. While these products are used off label in pets and require an in-clinic visit to apply the device, they can provide continuous interstitial (subcutaneous) glucose sampling for 10 to 14 days on feline patients where an at-home curve is not possible.

Once the small sensor is applied to the skin, the owner simply scans the device with their phone periodically to transmit the data, which can also be shared with the clinic. A glucose curve consult fee can be charged to the owner at the time of application of the CGM that will cover the consult with the veterinarian at the end of the two-week period. CGM can also be used to reduce FAS at the clinic for hospitalized diabetic cats such as those receiving treatment for diabetic ketoacidosis or pancreatitis.

Caution must be used to avoid overinterpretation of glucose readings by the owner, and even when placed correctly the sensors may fail to obtain data. However, the ability to avoid multiple needle pokes at home or in the clinic makes these devices an appealing Fear Free alternative to how we traditionally monitor diabetic patients.

Telemedicine

In the age of Covid and curbside veterinary care, many clinics have ventured into teleconsults, which are a great addition to the Fear Free toolkit. What could be more Fear Free than helping your patient from the comfort of their own home?

Once a veterinarian-client-patient relationship is established based on the rules of your state, clinics can offer paid video teleconsults with an experienced technician or a veterinarian to guide a client through low-stress handling for insulin injections and blood glucose sampling while they are working with their own cat. Teleconsults also allow for education on signs of FAS that the owner may not pick up on such as a flicking tail tip or flattening ears that necessitate a change in handling.

Feline diabetes can be a challenging disease for owners as well as veterinary staff, and as always, we need to consider the client’s lifestyle and the patient’s symptoms in our recommendations. Whether your patient is at home or at the clinic, tailoring your treatment plan to include Fear Free techniques will help build confidence and increase success with disease management.

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.

Success Story: How I Used Fear Free Handling for a Frightened Puppy

Susan Claire, CPDT-KA, FFCATA young man called me because he could not get a harness or even a collar on Oakley, his 6-month-old Pomsky-Klee Kai mix. He explained that this had recently become a problem after an unfortunate incident with a Velcro-closure harness, which accidentally stuck to Oakley’s thick coat. It was frightening and painful for him when the owner pulled it off.

The situation was urgent because Oakley now snarled and snapped at the owner whenever he tried to put a collar or harness on him so he was unable to attach a leash to the dog to take him out for walks. I advised him to try to slip on a martingale collar and leave it on Oakley temporarily until we could get him to accept the harness. I don’t normally use a martingale but in this case it was a logical option.

When I arrived for the first session, Oakley—one of those dogs who never stop moving—showed interest in interactions and did not give distance-increasing behaviors, but he also didn’t ask to be touched. I began by using a clicker to mark and reward every time he stopped moving or made eye contact. Then I laid down a super-soft non-skid consent mat, sat in front of it, and used the clicker to shape Oakley into lying down facing me on the mat.

Then I showed the owner how to desensitize Oakley to first tolerating a stethoscope, then having his feet and ears touched, and finally to a fake injection with an empty syringe. We showed Oakley each item, marking and reinforcing him for sniffing it. We moved each item slowly toward him, always stopping if we observed stiff or avoidance body language. I name each item and procedure so the dog knows what to expect during these sessions, and I advise clients to use the same words while the veterinarian is performing an exam or procedure: “heart” for stethoscope, “feet,” “ears,” and “pinch-poke” for syringe/injection.

After this, we tried to use similar techniques to put a Sensation Harness and then a collar on Oakley. I saw the problem the owner described, so we switched gears. I wanted to know if Oakley was generally fearful, so I set up boxes for nosework, a Snuffle Mat, a Wobbler, and a Spin-it. Oakley engaged with these items enthusiastically, demonstrating no fear. We did a few behaviors on the consent mat (sit, watch me, touch, and down), allowing Oakley to disengage and go to the boxes or Snuffle Mat if he needed to de-stress and return to the consent mat when he was ready to re-engage. I instructed the owner to practice all of the above between our sessions.

During the second session, we repeated the above and added one behavior to the consent mat training: holding the harness for Oakley to see, clicking if he sniffed it or moved his head toward it, and eventually trying to lure his head through it while saying “Put it on” but not restraining him in any way. We were successful with this but not in clipping the harness. We then did some obedience/safety exercises, such as come and loose-leash walking and finished with a game of fetch.

At the third session, Oakley greeted me with distance-decreasing behaviors and physical requests to be touched. He was happy to interact and be touched. When I put the consent mat on the floor, he ran to it and lay down, eagerly awaiting our interactions. The owner and I slowly went through the desensitization-to-handling process and he was able to get the mini Sensation Harness (with its tiny little clip) onto Oakley and clip it, with no snarling, biting, freezing, or avoidance behaviors of any kind from the dog. I was pleasantly surprised and the owner was thrilled.

I advised him to continue to use food while putting the harness on or taking it off to keep the positive association going, to always use the phrase “Put it on” to alert Oakley to what was coming, and to continue the consent mat handling exercises so that Oakley would be comfortable during veterinary exams. I advised as well to always end with a short play session or walk.

The icing was the nice Yelp review from the owner, who described the problem and wrote, “Susan was amazing! She was great to work with and I am so happy with the results!”

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

Design Solutions to Tackle Stress in Treatment Areas

Heather E. LewisMany veterinary practices have developed effective solutions for Fear Free exams and for low-stress patient housing. The next important area to tackle, the treatment room, is an inherently stressful space. Why are treatment rooms so stressful and what can we do to reimagine them?

Treatment rooms are stressful because they are generally designed to be a wide-open space, with many different functions occurring simultaneously. Treatment rooms are this way to ensure efficiency of staffing and safety for patients. For example, animals may be housed in treatment because this is the location where they can be monitored most easily. What if it were possible to maintain safety and efficiency, while de-stressing the treatment and other medical areas of your hospital? I know that it is! Below are a few of our favorite solutions for incorporating Fear Free design concepts throughout the medical areas of the hospital.

Separated Cat Treatment. One of the easiest ideas to implement is a separate cat treatment area located near cat exam rooms and ward. With this design, the cat areas of the hospital can function as a “mini clinic” space. This does not take a lot of room and removes cats from the chaos of the primary treatment space. Designs that include windows into the main treatment room allow for better communication between the cat area and other medical spaces.

Minor Treatment. This treatment space is located behind exam rooms and functions as a quiet area for simple procedures that might need more space or equipment than an exam room might offer. The client can step into this space as well. This minor treatment space is intentionally placed away from potentially frightening and unfamiliar sounds, smells, and activity associated with procedures and surgery. It can remain calmer and quieter because of its placement.

Treatment Curtains. Treatment curtains are borrowed from cubicle curtains used in human medical triage and emergency care. They allow for flexible visual privacy, and they also cut down on noise and visual stimuli, as we have learned anecdotally from using them. A curtain track can be placed in the ceiling around any treatment table to convert it into a semiprivate space.

Separate ICU and Recovery. Separating more critical patients behind glass in the treatment space does wonders. Even if you have few critical or recovering patients, separating them will help create a quieter treatment space and quieter patient space. If you like the idea of glassed wards for more critical patients, ensure that the glass goes to the floor so you can quickly glance in and monitor patients, to continue to keep them safe.

Better Materials and Systems. Once the design is reworked to make treatment areas more specialized, focus on the next layer of design: selecting better materials and systems. Here are a few of our favorite ideas:

Dimmable lighting. Lighting that dims allows you to de-stress the space when things are quiet, such as overnight for hospitalized pets.
Windows and daylight into treatment. Placing some outside daylight in the treatment room can make it feel more connected to the natural environment, helping to de-stress the space and make your staff feel a lot better.
Indoor/Outdoor options. As the Covid-19 crisis has taught us, having some flexible outdoor space can be very helpful for a veterinary practice. What about having a treatment porch, or if that is too ambitious, what about at least having a few operable windows, or a beautiful garden for walking post-surgical patients?
Noise control. Noise control is critical. Use good ceiling materials that cut down on noise. Use quiet casters on your chairs, and quiet latches on cages. Every bit of unnecessary noise is an opportunity to rethink design elements.

We have a long way to go with veterinary treatment spaces, but with Fear Free, we’re on our way to reimagining medical care that is far better for the emotional wellbeing of pets than it has been in the past. We are excited to see your ideas implemented in the treatment room of tomorrow, and we know that we will never look back.

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.

Know Your Breeds: An Expert Shares Tips on Getting Along With Different Dogs

Deb M. Eldredge, DVM
It can be helpful to “know your breeds” for many reasons as a veterinarian but especially for two big ones. The first is health.

Some problems may be breed-specific or at least have a genetic predisposition in some breeds. This can help with your diagnostic planning and, in some cases, could save a life – think of a Border Collie who ingested a tube of equine ivermectin and happens to have the MDR 1 defect.

You might even have a diagnosis simply by noting the breed! A colleague walked through our treatment area one day carrying a West Highland White Terrier pup. She said the pup was not eating well and seemed to have a painful mouth. I looked up from whoever I was working on and said, “CMO – craniomandibular osteopathy. Treat with steroids – most fully recover.” Boy, did I look like a brilliant superhero!

I am very involved with purebred dogs, plus I enjoy genetics, so any articles on problems in purebred dogs catch my eye. Sometimes these articles are in peer-reviewed journals and sometimes they are in AKC or breed club publications. There are also some excellent books out there on genetic problems in purebred dogs and cats. It is well worth the expense to have at least one in your clinic library.

If you work with any breeders at your clinic, keep up to date on those breeds at least. Most reputable breeders can provide you with some excellent information on genetic problems in their breed. Also, put the Canine Health Information Center website on your toolbar.

CHIC is run through the Orthopedic Foundation for Animals in conjunction with breed parent clubs. Not all breeds participate but most do. The clubs determine what are the most common inherited health problems seen in their breed. Then they provide a list of required health testing for a dog to be CHIC-certified. For example, in my main breed, the Belgian Tervuren, a dog must be tested for thyroid, hips, elbows, and eyes to be awarded a CHIC certificate. It is important to note that the dog does not have to be normal for all the testing, but the breeder or owner must have it done and must make the information publicly available on the CHIC website. That helps everyone involved in that breed.

Encourage any breeders you work with to participate in the CHIC program. It is better for the breed and knowing about the CHIC program makes you aware of what problems might be noted in that breed.

Beyond health, there are behavior considerations with many breeds. Working and herding breeds often have a guarding aspect to their instincts. Think about walking into an exam room with a large German Shepherd Dog inside. Appointments go better if you are in the room before these dogs. That way the space is claimed by you and the dogs are less likely to growl or react to you. This is especially true with large male dogs of these breeds who come in with women. Chivalry is not dead in the canine world. (And this may be a reason why curbside appointments in this “time of COVID” actually go fairly smoothly since you are in the room ahead of the patient and the dog has no one to guard!)

These dogs can also react negatively to any kind of direct stare. Remember that Border Collies actually control livestock using their eyes in many cases. They won’t hesitate to stare you down.

On the other hand, most hound breeds, especially scenthounds, are pretty happy-go-lucky and don’t care whose room it is or if you look them in the eye. But check carefully for any pee marking after these dogs leave the room. Sporting dogs are generally outgoing too, although Chesapeake Bay Retrievers should be treated the same way you would working or guardian dogs.

Terriers tend to be physically tough. Knowing that, if an owner says their Schnauzer is acting painful, that dog may be in a great deal of pain. This is not a case to put on hold.

Some breeds have behaviors that border on medical conditions – think flank sucking in Doberman Pinschers, tail chasing in Bull Terriers, or fly snapping (at imaginary flies) in Cavalier King Charles Spaniels. The better an understanding you have of breeds, the better you will be able to serve your patients.

A caveat to these comments – each dog is an individual. There are Mastiffs who would help you carry out their owner’s belongings if you came to rob the house. There are Golden Retrievers who will guard an exam room with intensity. Still, general knowledge of a breed can be helpful in your day-to-day life at the hospital.

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

Deb M. Eldredge, DVM, is a Cornell graduate and the first recipient of the Gentle Doctor Award. She is an award-winning veterinarian and writer.

5 Fear Free Experts Celebrate Their Wins

Kim Campbell Thornton
Blood draws, chemo, happy vet visits, even training veterinary students: Fear Free makes things work. Here are this month’s success stories.

Chemo for Indy

Indy was a middle-aged mixed-breed dog who developed Stage 3a lymphoma requiring weekly treatment under a CHOP chemo protocol. Only one problem: he was an FAS 4-5 patient who did not like to be touched, let alone restrained. How were we going to treat weekly with IV catheter-administered chemotherapy? Spent a lot of time in the early days fine-tuning a PVP protocol that allowed us to work on touch gradient approach so we could eventually hold his paw and use a regular or butterfly catheter to administer therapy. We always had myself and one specific technician available to work on desensitization with gentle restraint and forelimb holding. Lots of treats. For longer IV treatments, we preemptively sedated Indy. By the end of his treatment cycles, he would walk into the chemo room, sit or lie on a padded mat, and let us treat without incidents. Amazing! It works!

Jeffrey D. Palmer, DVM, Elite Fear Free Certified Professional, Burr Ridge Veterinary Clinic, Darien, Illinois

PVP, Tuna Lead to Successful Cat Exam

A new feline patient with a high level of fear, anxiety, and stress went home with gabapentin as a pre-visit pharmaceutical. The exam we performed two days later was great. He was readily eating tuna and happy to be petted. He did well for a complete exam, including radiographs and blood draw. The Feliway-infused towel was also a great help.

Matthew Hudson, DVM, Elite Fear Free Certified Professional, VCA Blum Animal Hospital, Chicago, Illinois

Cat Can Do

We have seen so many success stories with numerous patients, but the best for me is my personal cat. He is an uncontrolled diabetic, and the first year I owned him he had a lot of blood draws and vet visits. He was a wonderful-tempered cat at home, but at the clinic, while he never bit or scratched, he hissed and struggled every time he came out of the cage and became a difficult patient to handle. He is very food-motivated and after we started Fear Free practices and he got squirt cheese and baby food every time he was handled, he now purrs and rubs on everyone when he comes for treatments and is so much happier and easier to handle. I am overall so much more aware of a patient’s anxiety level the moment they walk in the door now, and it gives us a chance to start finding ways to alleviate their stress before it escalates.

Cheri Crane, Elite Fear Free Certified Professional, Customer Service Representative, Healing Paws Veterinary Clinic, Springfield, Missouri

Culture Change

For most of my practice career, I have been involved in student training. Some students embraced the things I taught them about the importance of minimizing fear, anxiety, and stress in patients, while others felt I was “too soft,” “only cared about giving the animals treats,” or “was crazy or misguided in my efforts.” Fellow faculty members sometimes shared these sentiments and even accused me of not being able to “get the job done” when I would elect to postpone or re-plan a procedure for an animal. The revolution of awareness that Fear Free has helped to create in our profession has changed the way I am viewed by students and colleagues. No longer the “crazy Dr. Griffin,” I am the one they ask to teach them about low-stress handling and Fear Free techniques. The art and science of Fear Free have become valued: this is truly a gift for all of us, our patients, and their owners. I look forward to the day when Fear Free is taught in all veterinary colleges and is fully embraced as an indispensable standard of care in veterinary practice.

Brenda Griffin, DVM, DACVIM, Elite Fear Free Certified Professional, Adjunct Clinical Associate Professor of Shelter Medicine, Maddie’s Shelter Medicine Program, University of Florida College of Veterinary Medicine, Gainesville, Florida

Happy Puppy, Happy Vet Visit

I took a client’s puppy to our veterinary office for a happy visit after the previous appointment did not go well for them. We played on the floor, showed off some of their tricks, ate some really yummy food. I was able to ask for a nose target to get up on the scale all on his own! We were able to leave with a calm, happy puppy and his next vet visit went much better.

Jenn Hauta, Elite Fear Free Certified Professional, Fairy Dogmother Training & Pet Care, Nanaimo, British Columbia, Canada

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

Kim Campbell Thornton is content manager for Fear Free Pets and is a Level 3 Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985.

Color Me Fear Free

Heather E. LewisThe way people interpret color is tied strongly to human culture and language. For example, feeling blue means feeling sad, and seeing red means feeling angry, at least in Western, English-speaking cultures. But how do animals see and respond to color? The answers are few, as there is little research in this field of study. We can say that dogs and cats see a narrower range of colors than we do. This is because they have traded color vision, biologically speaking, for superior vision at night. Indeed, dogs and cats see much better at night than people do.

Cats have trichromatic vision, just like humans, but they do not see the red end of the human visible spectrum. Dogs have dichromatic vision, which means they do not see anything in the orange and red range in the human visible spectrum. Both species see slightly into the ultraviolet range. This is fascinating as it means that any material that has phosphorous in it, or a whitening or brightening agent derived from phosphorous, will fluoresce slightly under their vision. For example, a piece of paper is a glowing white object to a cat.

Fear Free color palettes have three objectives relating to the little we do know about animal preferences for color and stress reduction for people and animals alike.

To avoid anything bright white that may fluoresce. This is the reason behind abandoning a white doctor coat. People often react with stress to laboratory coats, and this is called “white coat syndrome.” If we are trying to create a low-stress medical experience for animals, it is likely best to dress veterinary doctors in colors that do not stand out. Thus, Fear Free practitioners prefer softer colors for coats and scrubs. Architects should also check the building materials we are using in hospital spaces and avoid materials that fluoresce. You can test for this by using a Woods Lamp (a black light used in the veterinary and human healthcare industries for detecting ringworm), in a space with the lights turned off. The lamp will identify materials that fluoresce.
To use colors that animals can see well, particularly in low-light conditions. If you were to paint a dog or cat medical ward dark red, and have dim lighting in that space, the space would appear dark grey and shadowy to the animals. A lighter space, painted in hues and tones that are brighter and more toward the blue end of the spectrum, will be more visually understandable to the animals. There is very little research on this idea, but one example is a study in mice, who see similarly to dogs and cats. The study indicated that mice “showed clear and consistent individual preferences for cages when offered a choice between white, black, green and red cages. Overall, most mice preferred white cages, then black or green, and red was the least preferred.”[i]
To use colors that are relaxing to people. Think of a spa, and the colors that are used in a spa, which are often toward the bluer end of the spectrum, or they are nature based. Spa color palettes tend to be relaxing to people and remind them to slow down and move carefully and gently. The research of color on human behavior is well understood; fast food restaurants use reds and oranges because they are NOT relaxing, and they motivate you to move along and finish your food quickly, so the booth may be occupied by the next customer. We want to encourage the opposite behavior.

Do not worry about hard and fast rules about color, as they don’t exist. Quite simply, use color as a reminder to yourself to be more considerate of how our animal friends see, and to support a gentler way of being around dogs and cats, and all the animals you care for.

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.

Prevention and Management: The Girdle Beneath the Glamour

Rachel Lees, RVT, KPA CTP, VTS (Behavior)Teaching cued behaviors, working through desensitization and classical counterconditioning, and clicker training are the glamorous gowns of training plans or behavioral treatment plans. They’re rewarding because this is where owners and veterinary behavior team members can begin to see improvements in the patient.

But preventing and managing undesirable or unwanted behaviors are the foundation garments beneath the fancy dress of behavior modification. Prevention, safety, and management aren’t glamorous, but they are an important part of the plan. If the patient continues to engage in unwanted behaviors, the behaviors will continue to be reinforced (negatively or positively). To avoid this dynamic, the veterinary behavior team must coach clients as much as possible to set the patient up for success and manage any panic, stress, or anxiety present.

Avoiding Triggers and Controlling the Environment

Learning occurs with every interaction. This can work to our advantage when we can strengthen behaviors we like by adding positive outcomes. The goal with prevention is to control the environment and regulate the patient so we can prevent the patient from learning undesirable behaviors during non-training times. An example might be use of crates and playpens to eliminate urine accidents in the home.

Prevention includes setting each animal up for success and manipulating the environment to promote and reinforce desired behaviors. This can be as general as setting a puppy up for success using crate training for assist with elimination training or working with a puppy or kitten during the socialization period to promote positive experiences for lifelong learning.

Prevention can also be as detailed as using white noise to create a sound buffer for a storm-phobic patient or placing an opaque window treatment on front windows to eliminate displays at passersby. Below is a chart with some common behavioral diagnoses and types of prevention that can be recommended for these conditions until appropriate training and behavior modification have been taught and implemented. Some prevention techniques might be temporary, and others might be long-term.

Behavioral Concern	Types of Prevention
Aggression during Grooming and Husbandry Behaviors (Familiar and Unfamiliar People)	Discontinue all forms of grooming and medical care. If medical or grooming care must be performed (in an emergency) the veterinary team should use sedation to prevent increasing fear, stress, and anxiety during these situations
Inter-Dog Aggression	Keep all patients 100% separated to eliminate practice of aggression in any or all potential situations.
Redirected Aggression to a Canine Housemate	Eliminate and manage all triggers that may create arousal, aggression, and frustration. This may include opaque window treatments to eliminate the display at passersby or may include full separation between patients if triggers are unclear.
Fear-Based Aggression to Unfamiliar People	Discontinue walks and keep the patient away during all guest visits. This may include using a crate in a place where the patient cannot see visitors. This will help keep the patient as safe and comfortable as possible while the guest is in the home.
Coprophagia	Pick up stool immediately after elimination to prevent the patient from ingesting the stool later.

Management: Outlets to Minimize FAS While Practicing Prevention

Providing healthy forms of behavioral management can be helpful in creating a calmer and more confident pet. Providing mental, physical, and environmental enrichment can improve any domesticated animal’s overall wellbeing. Providing enrichment can help pets find appropriate outlets for innate behaviors and physical activity. Enrichment can also help to alleviate tension or any fear, stress, or anxiety the pet may be feeling. Enrichment may be used to eliminate unwanted behaviors such as chewing and destruction by young puppies or to decrease or eliminate barking in the crate during guests’ visits. Below is a short list of different forms of enrichment that can be used together or separately as needed:

Puzzle Toys: Puzzle toys that dispense treats or kibble provide human-approved outlets of stimulation, can double as meal opportunities, and can manage and prevent unwanted behaviors such as barking and other attention-seeking behaviors. This type of enrichment can be more mentally stimulating than a 5-mile walk. Advise clients to give these to patients ideally in anticipation of unwanted behavior or after unwanted behaviors have been interrupted. This can set patients up for success, so they do not continue to perform the undesirable behavior.
Sound Enrichment: Whether clients are away from home or looking to create a sound buffer to help prevent unwanted behaviors, their pets can be enriched through sound in a variety of ways. “Through a Dog’s Ear” CDs or iCalm units provide patients with biorhythmic classical music. Studies have shown that classical music can help to reduce respiration and blood pressure. DOGTV is another form of enrichment that can give dogs visual stimulation while also providing different forms of classical and calming sounds. White noise machines can be another buffer to eliminate sounds happening outside the pet’s home environment.
Enrichment Walks: These walks are an outlet to burn off energy while also allowing the dog to sniff and learn about the environment. In the text “From Fearful to Fear Free,” this type of sniffing is described as a form of social media for your pet. Think “Nosebook” and “Pee Mail.” This same type of enrichment can be used for cats who have learned to walk comfortably in a harness and leash. For patients who have been diagnosed with fear-based aggression issues on walks, enrichment walks can be performed in a space with limited human and dog contact such as industrial parkways.

There are many different forms of prevention and management. This article discusses only a few of the options for some diagnosable behavioral issues. This is something that can be recommended by any veterinary team member if a client and patient are waiting to be seen by a veterinary behaviorist. Suggestions such as using baby gates at doorways to prevent dog fights or keeping a patient leashed to a person can be lifesaving recommendations. Stating some of these more obvious recommendations is essential because not every client or dog trainer understands the importance of management and prevention.

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 lead veterinary behavior technician at The Behavior Clinic in Olmsted Falls, Ohio. She loves helping people create and maintain a strong human-animal bond.

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