Blog Archives

Design Solutions to Tackle Stress in Treatment Areas

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

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

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

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

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

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

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

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

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

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

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

Navigating Your Practice’s Preventative Care Yellow Brick Road During a Pandemic

Vaccines, Clients & Curbside… Oh My! Navigating Your Practice’s Preventative Care Yellow Brick Road During a Pandemic

Join Dr. Julie Reck, owner and founder of Fear Free Certified Practice Veterinary Medical Center of Fort Mill, for a discussion on vaccines, how to administer vaccines in a Fear Free manner, and how to improve communication throughout your practice to navigate preventative care in a curbside environment.

Brought to you by Elanco.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alone in the Wilderness

Course Overview

Are you the only person in your clinic who has a passion for Fear Free? It’s easy to get discouraged and frustrated when we are surrounded by obstacles. This course provides tools to achieve your Fear Free goals even when you feel like you are all alone in your work. Learn how to get buy-in, implement strategies from the ground up, and encourage your colleagues to join your heart’s work of protecting the emotional welfare of our treasured animal patients.

This course, approved for 1 RACE CE hour, was written by Monique Feyrecilde BA, LVT, VTS (Behavior).

This course consists of five lessons:

Lesson 1: The essence and importance of Fear Free Practice
Lesson 2: Understanding the dynamics of change
Lesson 3: Implementing change within your practice
Lesson 4: Addressing common push-back topics
Lesson 5: Thrive where you’re planted, or transplant to a new garden

5 Fear Free Experts Celebrate Their Wins

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

Chemo for Indy

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

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

PVP, Tuna Lead to Successful Cat Exam

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

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

Cat Can Do

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

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

Culture Change

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

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

Happy Puppy, Happy Vet Visit

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

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

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

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

Color Me Fear Free

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

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

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

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

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

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

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

Lions and Tigers and Hamsters… Oh My!

Lions and Tigers and Hamsters… Oh My!

We invite you to join us for the third installation of our Fun Webinar series to break up your stressful weeks with something to look forward to! These webinars are for our human clients and intended to give you a mental break, learn something new and fun, or cater to your own emotional and mental wellbeing.

Take an hour to laugh and learn! Join Mark Goldstein, DVM for a fun inside look at the unique challenges encountered around caring for and treating captive wildlife. He will draw upon true stories from his recently published book, “Lions and Tigers and Hamsters: What Animals Large and Small Taught Me About Life, Love, and Humanity,” to keep your interest. He will also share additional cases never published, which will entertain and have you laughing while you wonder how he is still alive to share them.

There will be ample opportunity for Q&A regarding anything in the presentation or related questions regarding working with and caring for captive wildlife or animals in general. During these very challenging times, allow yourself the luxury of sitting back with your beverage of choice, with no responsibility except to pamper yourself and reduce your FAS score!

Prevention and Management: The Girdle Beneath the Glamour

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

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

Avoiding Triggers and Controlling the Environment

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

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

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

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

Management: Outlets to Minimize FAS While Practicing Prevention

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

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

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

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

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

Challenges of Animal Pain: 4 Management Tips

Tony Johnson, DVM, DACVECC
Let’s just get this right out of the way first: animals feel pain.

They have different pain tolerances, just like people do (if I step on my pit bull Gwen’s toe, she never notices, but if I accidentally do the same to my Pomeranian, Turley, she’ll scream, run and hide, and not speak to me for days) but sensing pain comes hand-in-hand with having a complex neurosystem and a big brain.

The challenge for us as veterinarians is how we detect and react to their pain.

To address the complexities of animal pain and its management, the International Veterinary Academy of Pain Management (IVAPM) has declared September to be Animal Pain Awareness Month. (https://ivapm.org/animal-pain-awareness-month/) It’s also Pain Awareness Month for another group of big-brained animals – people.

Treating animal pain will always involve some guesswork until someone develops a way for dogs and cats (and horses and iguanas, etc.) to point to their anatomy and say “It hurts right here, doc.” Until that beautiful day, we have to tease out the sometimes-subtle signals of discomfort and adopt a trial-and-error approach, backed up by science whenever possible.

As an ER clinician, acute pain is what I deal with most. I do see animals with chronic pain, and try to help whenever I can, but for those patients I encourage pet owners to seek the counsel of their family veterinarian, since chronic pain will take a solid partnership spanning weeks or months – things that are impossible in the rushed setting of the ER.

With that as preamble, I’ll share some tips from 25 years of ER pain management.

If a condition is known to be painful, treat for pain. Blocked cats are painful. Pancreatitis is painful. Pyelonephritis hurts. Some diseases have pain baked in, and treating pain should always be part of the initial management plan, yet I very often see pets with diseases such as pancreatitis and urethral obstruction go without pain medication. Until the disease has calmed down, assume pain is present and treat for it.

Recognize the signs of pain. Is that cat sitting at the back of the cage hissing because he is afraid, or is it pain? Is the usually sweet and slap-happy Golden now snapping at the kids because his ears hurt? Recognizing an animal in pain is an important first step in managing pain. A trial of pain medication (perhaps even combined with appropriate sedation) can help tease out the complex web of animal pain responses and decrease the fear, anxiety, and stress of painful conditions and hospitalization. Using a validated pain scale (available at https://ivapm.org/, and many other places) can also help to quantify and track pain during treatment.

AAHA, in 2015, developed guidelines for small-animal practitioners that clearly outline ways to monitor and manage pain: https://ivapm.org/wp-content/uploads/2017/03/2015_aaha_aafp_pain_management_guidelines_for_dogs_and_cats-03.10.17.pdf

Use the right class of medication for the disease. Let’s look again at blocked cats and patients with pancreatitis. A blocked cat who is non-azotemic and going home might benefit from an NSAID used cautiously. A blocked cat with a K+ of 8 and a creatinine of 4? The medical board will be knocking at your door if you give an NSAID.

Same holds true for a dog with raging pancreatitis. If he’s vomiting every time the wind blows, an NSAID will only make matters (way) worse. Opioids have minimal GI effects beyond constipation (which I have not seen as a major problem), and we use tons of opioids in the ER and ICU to manage pain. Our brains (and those of our patients) are hard-wired to receive opioids – it’s a gift from evolution and nature. Use it.

Why do brains have receptors for chemicals produced by a poppy largely grown in the Middle East? I have no idea, but for the sake of my patients I am thrilled that they do, and I make use of it every day I am on the clinic floor.

The opioid crisis has certainly made giving opioids a challenge, with increased regulation and paperwork and changes in the supply chain making some drugs unavailable. Try to keep abreast of what’s on and off the market and do your best to make sure you always have a few options for good pain control on hand. I think every hospital needs to have a full mu agonist such as fentanyl, morphine, or hydromorphone on hand for treating severe pain. Butorphanol is great as an adjunct for sedation for minor procedures like lacerations, but it’s just not potent enough for cases of moderate to severe pain.

Sometime more is more. Treating pain with multiple different approaches can result in better pain control and lower doses of any individual medication. Using a lidocaine sacrococcygeal block to help unblock a cat, combined with a full mu agonist like fentanyl, or an opioid agonist/antagonist like buprenorphine, can treat pain from different angles, as well as make unblocking easier.

Look for creative ways to address pain, using different techniques such as local blocks, epidurals, and topical lidocaine patches. Combining classes of drugs such as NSAIDs and opioids, in carefully selected patients, can achieve results that higher doses of either drug can’t achieve.

I have found that learning new techniques can be a great way to fend off burnout and makes me feel as if I am growing as a clinician. Learning new pain management skills aids me in fulfilling my obligation to alleviate animal suffering. Enrolling in CE classes, attending online seminars, and even brainstorming with colleagues can open new worlds to the clinician who wants to learn and grow. It can also make great financial sense to a practice, as owners now accept and even expect advanced pain-control modalities.

The IVAPM offers consultations in pain management and pathways to become IVAPM-certified as a pain management practitioner. (More info at https://ivapm.org/).

We all want our patients to live long, pain-free lives. Learning about pain and learning new ways to manage pain and recognize it will serve our patients better and help us grow as doctors and people.

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.

Opening the Door to Lifesaving: How Portals Can Save Shelter Cats

Opening the Door to Lifesaving: How Portals Can Save Shelter Cats

In this webinar, animal welfare strategist Dr. Sara Pizano will be exploring best practices in animal shelters and how implementing portals and the right disinfectant can decrease upper respiratory infections and ultimately increase live release rates.

Brought to you by Virox Animal Health.

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