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Providing the Optimum Environment for Cats

Many behavior problems in cats develop due to our failure to provide them with their behavioral needs. This presentation with Valarie Tynes, DVM, DACVB, DACAW, will review the social structure of the cat and why multi-cat households can be so stressful. Recognizing these signs of stress and how to avoid their development be covered. In addition, a variety of tips for meeting the environmental and behavioral needs of the cat will be reviewed.

Brought to you by our friends at Ceva Animal Health

Steve DaleRoxy’s arthritis had worsened. Because of the 18.5-year-old Devon Rex cat’s history of gastrointestinal issues, her veterinarian and owners had few pharmaceutical options for managing her pain.

For clients, seeing a pet in pain is the worst. Cats are especially adept at masking pain, so when they actually show they are in pain, they are really hurting. That’s where we were with Roxy.

Gabapentin had been prescribed, but all it did was increase her catnap time. I consulted an expert. “Let me hold Roxy’s paw and we’ll slowly increase the dosage,” said Robin Downing, DVM, internationally renowned for her knowledge about pain in pets.

Dr. Downing consulted with my Chicago, Illinois-based primary care practitioner Natalie Marks, DVM, who welcomed Dr. Downing’s contribution.

Downing gradually upped the dose of the gabapentin, and her persistent yet measured effort appeared to bring results without an accompanying significant primary side effect of the drug: drowsiness.

“Multimodal is the best approach for osteoarthritis for nearly all cats,” Downing says. To that end, we began to employ a tool called an Assisi Loop, which uses targeted pulsed electromagnetic field technology to treat pain and decrease inflammation. That not only benefited Roxy’s osteoarthritis, but also had the potential to aid her GI issues. In addition, for arthritis I give her injections of Adequan.

That was in 2018 and Roxy clearly benefited from the collaboration between Drs. Downing and Marks and the multimodal approach. However, about a year ago, I noted that Roxy appeared to be struggling a tad more and asked Dr. Marks for further advice.

“The struggle we have as small-animal practitioners is that we only have certain pain medications that are safe and approved for cats as they age, and many are contraindicated for cats with other conditions,” Marks said. “Our goal for our patients is for them to have the best quality of life and to be as pain free as possible every day. The beauty of veterinary medicine today is that we have a variety of integrative therapies which are readily available, and I thought about medical massage therapy. And technology can deliver a way to demonstrate options as never before.”

She suggested I contact Rosemary LoGiudice, DVM, who is boarded in veterinary rehabilitation medicine and practices in Hanover Park, Illinois. She is at least an hour from my home, not to mention this was all happening at the height of the pandemic.

Marks said, “I think this may be the perfect use of telehealth. And I believe massage therapy may help.” Dr. LoGiudice agreed.

LoGiudice noted that ideally she would want to get her hands on Roxy to feel her flexibility and for heat in the joints. But she was able to communicate with Dr. Marks, who has known Roxy most of her life and had recently examined her.

Using my phone, I took video of Roxy moving in her own element from different angles as directed by LoGiudice, who says, “When I can see the dog, cat, or horse moving in a natural way, I can get a good feel for stride and how the joints are moving. Very few dogs and cats are going to show me in the exam room how they move at home.”

LoGiudice and I jumped on a Zoom show and tell call. Dr. LoGiudice held a plush dog in her lap. She showed me exactly what to do, where to do it and how much pressure to exert when offering massage therapy. Old-school written directions could never replicate Dr. LoGiudice demonstrating, and then watching me and directing me, “Move your hand slightly lower.”

I gradually spent more time every night massaging Roxy. Roxy not only didn’t fend off the nightly spa treatment, she began to request it. Even now, a year later, when I stop, she paws at my face demanding more.

That was no surprise to Downing. “If this was causing Roxy pain or discomfort, or Roxy didn’t enjoy it, she still moves well enough to walk away,” she says.

Watching video of Roxy two weeks after the start of the Dale Spa treatment, LoGiudice wasn’t surprised either by the effect of medical massage to slightly but noticeably increase Roxy’s mobility and interest in exploring or moving to whatever room my wife and I are in. Also, LoGiudice is now inspired by the idea of using video and video chat to support clients in a way she hadn’t previously considered.

Downing agreed. “There’s no substitute for being hands-on with our patients, and for office visits, but you can certainly observe more remotely than what is possible in an exam room. And to schedule time for a virtual lesson in medical massage therapy, acupressure techniques, or teaching animals how to stretch are only a few examples.”

From her perspective of having known Roxy for more than half her life, Dr. Marks says, “I absolutely saw a difference in Roxy. What I really loved about this collaboration isn’t only about considering integrative care, it’s about how veterinarians are being creative to help all involved, especially at this time. And right now, we do need to be creative. I hope this specific type of partnership and using technology in the way we did with Roxy becomes a model, sticking around long after the pandemic.”

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

Steve Dale, CABC (certified animal behavior consultant), hosts two national pet radio shows and is on WGN Radio, Chicago. He’s a regular contributor/columnist for many publications, including CATSTER, Veterinary Practice News, and the Journal of the National Association of Veterinary Technicians in America. He’s appeared on dozens of TV shows, including Oprah, many Animal Planet Programs, and National Geographic Explorer. He has contributed to or authored many pet books and veterinary textbooks such as “The Cat: Clinical Medicine and Management” and co-edited Decoding Your Dog, by the American College of Veterinary Behaviorists. He speaks at conferences around the world. www.stevedale.tv.
Michael Petty, DVM, CVPP, CVMA, CCRTIf you have ever hit your finger with a hammer, the immediate response is often one of surprise or even frustration. The next day, as you are having trouble using that finger, a common emotion is disappointment at the discomfort you are experiencing and wishing that you had been more careful. What causes that reaction?

The “fear center” and the “pain center” occupy adjacent areas of the brain. The thalamus is the area of the brain that registers pain, and on either side of the thalamus is the limbic system, which is responsible for emotions including fear, anxiety, and the sequelae of stress (FAS).

These two areas of the brain “talk” to each other and send signals back and forth. The thalamus sending signals to the limbic system is what causes your reaction to hitting your finger with a hammer. When this thalamic-limbic crosstalk happens in an animal in acute pain, the animal may lash out at the owner or veterinary staff.

So now consider an animal who is in pain and has been presented to you. If experiencing acute pain, the animal may lash out due to a combination of pain and FAS. If experiencing chronic pain, many of these pets act dull and disinterested. The owner may even comment that the pet just doesn’t socialize and lacks the energy and mobility that she used to demonstrate. Even worse is the animal who has chronic pain, say from osteoarthritis, and now has an acute injury on top of it. The distress in some of these animals is almost too much to bear.

It is easy for us to recognize and treat acute pain, but the diagnosis of chronic pain states can be difficult for a variety of reasons. It takes time to take a thorough history and perform a complete pain exam on dogs and cats. However, there are many resources available to make that task easier, including pet owner-friendly screening checklists for osteoarthritis (Cat, Dog) and expert tips for the OA exam (feline OA exam).

Even with successful diagnosis, the treatment of chronic pain can sometimes be difficult especially if your treatment is narrow in focus. But it is essential to make a timely diagnosis of chronic pain and provide effective analgesia to be successful in therapy. And it is also important that the owner understands your diagnosis, whether through education alone or with the help of radiographs and teaching tools (feline and canine chronic pain). The owner is an essential member of the pain treatment team, both in the evaluation of treatments over time but also in enlisting them in the day to day therapies that might be required.

My approach to the treatment of chronic pain in dogs, for example, is to build a pyramid of treatments, and on the base layer I start with an NSAID. The NSAID I use most commonly is Rimadyl® (carprofen), which I really like for its effects on both pain and inflammation. For many chronic OA cases, there are other factors that can influence the ability to manage both pain and disease progression, and they should all be looked at.

For example, consider the animal next. Is he overweight? One study showed that in an obese dog, losing only about 10 percent of body weight can significantly improve lameness1. In other words, weight loss for an overweight dog can amplify the pain relief achieved with an NSAID alone

What about exercise? Again, one human study showed that one-half hour of exercise 5 days a week for people with knee OA was the equivalent of – you guessed it: an NSAID! So now you have tripled your pain-relieving efforts by building a solid foundation of multi-modal therapies, upon which you can add other therapies as needed.

It is beyond the scope of this writing to discuss all possible treatments: medications, physical therapy, acupuncture, and so forth, but I encourage everyone to read or re-read the 2015 AAHA Pain Management Guidelines for a thorough review of all of the pain management options we have for both acute and chronic pain.

What does the future hold for us? The most exciting thing I have seen on the horizon is the introduction of anti-NGF monoclonal antibodies. NGF, or Nerve Growth Factor, is one of several major “players” in the transmission of pain via the nociceptors. The use of these monoclonal antibodies holds great promise to reduce the sensation of pain in our patients with osteoarthritis. More information about the action of anti-NGF monoclonal antibodies can be found at the New Science of OA Pain website.

IMPORTANT SAFETY INFORMATION FOR RIMADYL: As a class, NSAIDs may be associated with gastrointestinal, kidney and liver side effects. These are usually mild but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including Rimadyl. Use with other NSAIDs or corticosteroids should be avoided.

See full Prescribing Information at:
https://www2.zoetisus.com/content/_assets/docs/Petcare/rimadyl-prescribing-information.pdf

Reference:

  1. Marshall WG, Hazewinkel HA, Mullen D, et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun 2010;34(3):241–53.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.Sponsored by our friends at Zoetis Petcare. ©2021 Zoetis Services LLC. All rights reserved RIM-00324

Rachel Lees RVT, KPA CTP, VTS (Behavior)As a veterinary behavior team member, I strive to strengthen and improve the human-animal bond in every patient and client I encounter. In behavior medicine, though, we are often fighting a losing battle. By the time clients find us, they have exhausted funds trying different training techniques. The relationship between person and pet is hanging by a thread.

These battered bonds are often related to behavior problems such as destruction to the home, inappropriate elimination, and aggression. In a 2013 study by Jennifer Y. Kwan and Melissa Bain, 65 percent of owners relinquished pets for behavior reasons. This study also supported the use of positive reinforcement, finding that use of punishment-based methods resulted in less satisfaction with a pet’s behavior, which can be damaging to the bond.1

The word “repair” means to restore by replacing a part or putting together what is torn or broken or to restore to a sound or healthy state. How can we repair a nearly broken human-animal bond?  The role of a veterinary technician or assistant can be crucial in mending and strengthening this bond.

A skilled veterinary behavior professional should be able to demonstrate the prescribed behavioral therapy plans, coach the client through them, and be flexible with both pet and owner learning styles.2 In my practice, I describe my role as “case manager”:  the person with whom each client is in contact with most frequently. It is my job to relay information clearly and effectively to the veterinarian and be sure that the entire behavior team (veterinarian, trainer, and owner) are working toward the common goal of restoring the bond.

Counseling aspects of behavioral medicine and marriage/family therapy have many commonalities.3 One of the most profound similarities is how change occurs in the context of treatment. In behavior medicine, our clients may come in with negative thoughts, anger, and fears associated with their pet. The veterinary technician or assistant’s role in the behavior team is to change the emotional experience of the pet along with that of the pet owner. When a family walks into our practice and their pet has been displaying owner-related aggression, my first questions are the following:

  • How are you feeling about your pet?
  • Do you feel safe in your home?
  • What is your current relationship with the pet?

The client needs to express their concerns if treatment is going to be attempted. Behavioral therapy is essential, but the context and triggers of the problem are less important until people can form a more positive association with the pet. After the veterinarian discusses the behavioral diagnosis, I typically break down the information in a more down to earth fashion so the entire family can understand the mental concerns their pet has developed. In this way, the family can begin to relate to the pet and see things through their eyes, and this can jump-start the process of rebuilding the bond.

A second similarity to human-based therapy is the difficulties and barriers associated with clients.4 Most of our clients walk into the consultation room and expect to be told they did something wrong. They may be defensive, anxious, and closed off, reluctant to give a detailed behavioral history, which can impact treatment.

Sometimes clients are fearful about sharing a pet’s aggressive behaviors because they do not want to euthanize their pet. They feel as if they will be judged and forced to make an unwanted decision. One of my strongest skills as a behavior team member is gaining the trust of clients and building a strong rapport early on. I want each client and pet to have a wonderful experience with our clinic, but I also want to have a strong connection with that client, share empathy, and understand each issue from their perspective.

Clients may be at the end of their rope, but usually there is an inch of that rope left to work with. I think of the rope as the bond between owner and pet. Hang on to that tiny piece as it is still technically intact! Each client walks into the practice for a reason even if there is only a tiny strand of the bond remaining. If you can open them up, connect, and gain their trust, you can begin to reshape the negativity they feel toward their pet and repair the relationship.

One of the most important terms when repairing the human-animal bond is “empathy,” the ability to have a deep emotional understanding of another’s feelings and experiences.5 For veterinary behavior team members, this ability is crucial for success with any client or patient.  They should be able to identify and empathize with the fear and anxiety the pet and client may be experiencing. This is the first step in modifying the behavior of both. Psychologist Marshall Rosenberg stated it best: “When we understand the needs that motivate ourselves and others’ behaviors, we have no enemies.” 6

I think this is important to recognize when working to rebuild or strengthen a human-animal bond. It is important for the client and veterinary behavior team to see things from the pet’s perspective. The client can then learn that the pet is not their enemy. The pet is not performing these behaviors to spite them. The pet is fearful, stressed, or anxious and may be trying to keep themselves safe.  Being able to take a walk in someone else’s shoes, or paws, is a vital step in deepening the human-animal bond.

Mending the human-animal bond is not an easy task. It takes the expertise of a strong, educated, and skilled veterinary behavior team to even begin to reunite and mend the connection between client and pet. When working in a general practice, any sign that the human-animal bond is deteriorating between a client and patient should be brought to the team’s attention so the veterinarian can make a referral to a veterinary behavior practice.

As veterinary team members, we all want to save the lives of pets. This begins with keeping a strong bond between client and pet. Giving appropriate, science-based recommendations on training and behavioral therapy can be the first step in this process, starting with puppy and kitten visits. If we all work toward a common goal, we can make a difference.

References: 

  1. Kwan Y. Jennifer, Bain J. Melissa. Owner Attachment and Problem Behaviors Related to Relinquishment and Training Techniques of Dogs. Journal of Applied Animal Welfare Science. 2013; 168-183. https://doi.org/10.1080/10888705.2013.768923

2-6.  Shaw K. Julie, Martin Debbie.  Canine and Feline Behavior for Veterinary Technicians and Nurses. 1st edition.  John Wiley; 2015.

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

Rachel Lees, an Elite Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and lead veterinary behavior technician at The Behavior Clinic in Olmsted Falls, Ohio. She loves helping people create and maintain a strong human-animal bond.
 
 
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.
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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.

 

 

 
 
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.
 
 
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.
 
 
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

  1. https://www.cliniciansbrief.com/article/esophagostomy-feeding-tube
  2. 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
  3. https://www.kittykollar.com
  4. 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.
 
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.

  1. 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.

  1. 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.

  1. 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/

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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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