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Finesse the Chin Rest: The Basics and Beyond for Cooperative Care

Course Overview

The chin rest is a valuable cooperative care behavior that allows for a hands-off, consensual way to keep an animal still for veterinary exams, husbandry care, grooming, and other procedures. A chin rest serves as an indication from the animal that he is ready to engage in a handling or care procedure. By giving him a choice to “opt out,” even for a few seconds, chin rest empowers the animal to have a voice and greatly reduces his FAS.

In this course, you will learn the steps for training a solid chin rest behavior to an advanced level and discover its many practical, on-the-job applications.

This course includes three lessons:

  • Lesson 1: Strategies and Equipment
  • Lesson 2: Training and Problem Solving
  • Lesson 3: Taking it to the Next Level

This course was written by Mikkel Becker, CTC, KPA CTP, CBCC-KA, CPDT-KA, CDBC.

Next Level Nail Trims: Cooperative Care Behaviors

Course Overview

This course builds upon the foundational concepts covered in the Fear Free Nail Trims: Trimming Away the Terror course, which included finessed use of distractions, desensitization and counter-conditioning methods, and finely tuned choice of nail care tools.

An understanding of these foundational nail care concepts is recommended before starting this more advanced course. Cooperative care techniques taught in this course are useful both as preventive strategies to improve ease of nail care and as an interventional approach to address already existing FAS with nail care.

Since there is no “one size fits all” approach to nail care training that will work for every animal every time, this course aims to empower you with many options to choose from, depending on the animal you are working with at the time.

There are six short lessons in this course:

  • Lesson 1: Communication & Consent Cues
  • Lesson 2: Treat-Ment Stations
  • Lesson 3: Chin Rest and Bucket Game
  • Lesson 4: Offering Paws and Zen Down
  • Lesson 5: Scratch Board Training
  • Lesson 6: Problem Solving and Coaching Clients

This course was written by Mikkel Becker, CTC, KPA CTP, CBCC-KA, CPDT-KA, CDBC.

Dogs Less Stressed With Owners Present at Exams, Study Shows

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Study Suggests Simple Cage Modification to Reduce Stress in Hospitalized Cats

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

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

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

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

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

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

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

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

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

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

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

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

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

The Link Between Pain and Problem Behavior

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

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

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

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

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

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

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

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

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

Problems of Aging

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

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

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

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

Looking for Changes

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

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

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

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

Treating Both

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

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

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

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

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, co-authored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.
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Top 10 Treats to Win Pet Hearts

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

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

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

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

For Dogs

– Baby shrimp

– Beggin Strips (broken into tiny pieces)

– Canned salmon or tuna

– Warm deli turkey

– Easy Cheese Cheddar & Bacon

– Freeze-dried meats from Pure Bites

– Honey Nut Cheerios

– Kong Squeezable Peanut Butter

– Peanut Butter Captain Crunch

– Slices of turkey hot dogs

For Cats

– Albacore tuna or salmon

– Anchovy paste

– Baby shrimp

– Bonita fish flakes

– Easy Cheese Cheddar & Bacon

– Fancy Feast: Foil packs of any flavor

– Green olives

– Marshmallows

– Vegemite

– Whipped cream

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

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

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

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

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

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

 

 

 
 

Esophagostomy Tubes: Fear Free Tools for Disease Management

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

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

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

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

Indications for E Tube Placement

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

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

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

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

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

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

Client Education

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

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

Summary

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

Resources

  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.
 

A Close Look at Canine Enrichment: What, Why, and How?

Course Overview

True enrichment goes way beyond simply providing dogs with food puzzles each day. For instance, a comprehensive enrichment strategy incorporates all types of enrichment: social, occupational, physical, nutritional, and sensory. This course will show you how to engage all the senses, as well as how to thoughtfully determine which enrichment activities are most appropriate for individual dogs, how to enrich the lives of dogs in a veterinary clinic, and those who are recovering from an injury and on restricted exercise.

This course, approved for 1 RACE-approved CE hour, was written by Laura Ryder, CPDT-KA, KPA CTP, IMDT.

This course consists of four lessons:

  • Lesson 1: Exploring enrichment using all the senses
  • Lesson 2: Identifying the right balance
  • Lesson 3: Enrichment for dogs in the vet clinic
  • Lesson 4: Enrichment for dogs on restricted exercise or cage rest
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