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What to Know About Recognizing Signs of FAS in Avian Patients

Fear Free

Specific signals of fear, anxiety, and stress (FAS) differ slightly by species, but what remains constant for delivering Fear Free care is to attend to what animals communicate through their body language.

For exotic animal veterinarian Alicia McLaughlin, who practices at the Center for Bird and Exotic Animal Medicine in Bothell, Washington, paying close, constant attention to body language signals throughout interactions and care is vital for protecting the emotional experience and safety of her animal patients and the veterinary team.

In the case of Dr. McLaughlin’s exotic animal patients, signs of FAS may be slightly different and adjusted to depending upon the species. Avians in particular can be challenging for most people to read. But with practice, reading their signs of FAS becomes second nature.

Some signs of increasing fear, anxiety, and stress McLaughlin watches for in avian patients include eyes appearing more round as opposed to soft and almond-shaped. Stressed birds also do not preen themselves and are unwilling to eat even favorite treats. Birds may stand taller on their perch and lean away from a scary object or person, with feathers slicked and held close to the body. If these body language cues are ignored, birds may attempt to fly away or vocalize, or FAS may progress to defensive gesturing, with the bird opening the mouth, lunging, and threatening to bite.

Another aspect of body language to watch for is overexcitement.

“Overexcitement can lead to aggression quickly,” McLaughlin says.

Signs of overexcitement include feathers ruffling on the nape of the neck. A parrot may fan out tail feathers. Parrots have voluntary control over their pupils and can dilate and constrict them rapidly in what is referred to as eye pinning, another sign of overexcitement and a red flag for potential aggression.

Carefully and continually monitoring for signs of FAS throughout preparatory visits and actual veterinary care is protective both for the ability to handle patients in the immediate situation and for building their long-term comfort with care.

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

Fear Free Euthanasia: Help Pets and People Say Goodbye Peacefully

Julie Liu, DVMPet parents will remember their animal’s euthanasia for the rest of their lives, and if their pet is agitated or anxious, they’ll remember that, too. Helping them to plan ahead can make the experience easier for your patients and their families.

When people make the difficult decision to euthanize a pet, there are many other smaller decisions they’ll have to make, such as when to schedule and whether they or their children should be present. Among the details that should be considered on your end is how you can reduce the animal’s fear, anxiety, and stress during their final moments.

When pets have a fear of the veterinarian and are brought in for euthanasia, their stress levels can escalate. The procedures that may take place before euthanasia can be scary or painful, such as being restrained by a veterinary staff member while their front leg is shaved and an IV catheter is placed. While this usually occurs away from the owner, the experience is often stressful enough that the difference is noticeable when the pet is returned to the exam room.

Even if a particular patient doesn’t routinely require anti-anxiety medications, consider them when clients are bringing pets in for euthanasia. Many pet parents have concerns about their sedating effects, but this is one instance where it truly doesn’t matter–sedation will only help the euthanasia go more smoothly. Dispense them at least a few days ahead of time to ensure that the client is able to give a test dose before the day of the pet’s euthanasia. Some anti-anxiety medications such as gabapentin also help reduce pain, so they can decrease discomfort to procedures such as IV catheter placement prior to euthanasia. If your patient is agitated or is still fearful despite oral pre-visit pharmaceuticals, consider injectable sedation prior to euthanasia. The last thing a pet parent wants to see in their time of grief is their pet flailing, vocalizing, or trying to escape. Sedation will decrease stress for the pet and their family.

If your practice routinely uses IV catheters for euthanasias, have clients rub a lidocaine numbing cream such as Supernumb on the tops of their pet’s forelegs several hours prior to euthanasia. IV catheter placement is painful, and numbing the area will make for a more compassionate experience, especially since multiple catheter attempts are sometimes needed in debilitated pets .

In your Fear Free practice, you use treats with patients during routine visits, and you can use them with euthanasia, too. Providing a smorgasbord of vanilla ice cream, lunch meat, cheese chunks, Churu, peanut butter, or whipped cream will allow clients to continue bonding with their pets while lowering their stress. Take care to avoid giving greasy foods such as burgers–while tempting to offer as a last meal, they can cause nausea and gastrointestinal upset.

If you don’t offer housecalls for patient euthanasia, I urge you to consider it. Even pets who don’t have a strong fear of veterinary visits will never be as relaxed at the vet as they will in their home, with their familiar bed and environment. You can even have classical music playing quietly in the background to help create a calming environment. I’ve euthanized several pets in their homes, and in every instance I felt that the experiences of the pet and the owner were better than they would have been in the clinic environment.

Pets deserve to have a Fear Free death as much as they deserve to have a Fear Free life. By considering a patient’s emotional health during their final days, you’ll help make their passing as compassionate as possible.

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.
 

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.

Fear Free CSRs: How You Can Help Prepare Pet Owners

Course Overview

The CSR is the client’s first point of contact with the veterinary clinic. They play an important role in communicating the Fear Free concept and helping the client prepare their pet for a Fear Free vet visit. This module will help CSRs better understand how to “Speak Fear Free” to clients. It will provide sample scripts and tips. It will also provide them with a better understanding of the FAS scale, an awareness of their surroundings, the knowledge of what steps to take to ensure a positive experience for each pet, and more.

This course was written by Louise Dunn.

This course consists of three lessons:

  • Lesson 1: The CSRs Role for the Pre-Visit
  • Lesson 2: Creating the Fear Free Environment
  • Lesson 3: How to “Speak Fear Free” to Clients

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

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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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.

 
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