From Pit Bulls To Pugs: State Farm Is A Good Neighbor
Learn now to educate adults and children about responsible pet ownership, the importance of being kind to animals, the benefits of volunteerism, why State Farm doesn’t judge dogs on the basis of breed when issuing its policies, and the 25-year history of the State Farm Arson Dog Program, one of the only accelerant detection canine training programs in North America. Sponsored by State Farm.
The Science for Pheromone Therapy: Show Me the Evidence
In this webinar, Gary Landsberg, DVM, DACVB, DECAWBM (CA) discusses what pheromones are and how they work, as well as evidence of efficacy for use in home and in the veterinary clinic. Sponsored by our friends at Ceva.
Additional references available here.
It would be wonderful if there were easy and objective parameters to identify pain. For example, heart rate above a certain increase would equal a certain pain level. That would make pain assessments black and white and simple. Unfortunately, as with so many areas of veterinary medicine, pain is not black and white or simple. Pets with chronic pain may not show any physiological changes such as an increase in heart or respiratory rates. Some of those physiological changes we associate with pain may also be reflective of fear. So while physiological parameters can help in pain assessments, they are not the mainstay.
In veterinary medicine we rely mainly on behavioral parameters to score pain. Reading behaviors is always a bit subjective, and individual pets can muddy the waters even more. Conscious pets (as opposed to pets under anesthesia) may be stoic or may be overly sensitive to touch due to fear resulting in the “drama queen.” Owners may be adept at observing behavioral changes or somewhat oblivious.
Scales To Consider
Colorado State University has pain scales set up for acute pain assessments in dogs and cats. Their system looks at behavior, response to palpation of or around a surgical site, and body tension. A non-painful dog is clearly comfortable resting in his cage, doesn’t mind any palpation, and is relaxed. At the opposite end of the scale, the very painful dog may be moaning, licking or chewing at his surgical site, fairly unresponsive to his surroundings, cries or acts aggressive if palpation is attempted, and stays rigid to protect the painful area. Cats show somewhat similar signs, although very painful cats may allow more handling than they did previously as they concentrate on their pain.
With the Glasgow Composite Pain Scale, the University of Glasgow looks at a variety of behaviors and watches for changes over time. For dogs there are 30 descriptor options within six behavioral categories, including mobility. People evaluate resting behaviors of the dog, reactions to any action around the injured area, changes in the dog when out of the cage and moving, and the dog’s overall attitude. Dogs receive a numerical score for each area, which are then added to aid in a treatment plan. For cats there are 28 descriptor options within seven behavioral categories. The short form allows for periodic re-evaluations of the pet.
AAHA has a set of three criteria that work well for both acute and chronic pain assessments but are quite general. Maintenance of normal behaviors, loss of normal behaviors, and development of new behaviors are indicative of a problem the pet is dealing with. At the veterinary hospital, an astute veterinary technician can pick up on changes a pet shows from pre-surgery to post-surgery for example. That can help staff determine the pet’s level of pain and what type of pain modification to try. One pet may need medications while another pet may be comfortable with a padded bed to lie on.
Types Of Pain
Most of the developed pain scales look at pets with acute injuries. Pain is sharp then, and behaviors most likely to be changed and easy to interpret. Chronic pain can be trickier to evaluate. Many pets “cover up” chronic pain or develop ways to adapt to minimize any pain by the way they move or other changes in habit.
For chronic pain, the input of owners is almost always necessary. An owner may comment that the cat no longer hops up on the counter or that the dog wants to turn around after only going a half mile on his daily walk instead of the usual mile. Sometimes an owner may not bring up these observations, but a skillful history taking will elicit changes that indicate pain. Careful observation by clinic staff may also lead to notes such as “less weight bearing on right hind when walks or trots.” Those subtleties may not be noticed by the owner due to gradual changes over time.
As with so much of veterinary medicine, pain assessments will vary with each individual animal. Sharpen your observation skills so you can pick up the tiny changes that indicate a pet in discomfort. Pain scoring systems will help to organize your thoughts but your own skills are the most helpful to the pet you evaluate.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
“I wish we would talk more about it,” says Joyce A. Login, DVM, Zoetis senior manager of veterinary specialty operations. “Sometimes I think we don’t bring it up in the room as much as we could. It’s a challenge.”
As a veterinarian you are trained to see and feel changes in pets that owners might not, such as abnormal postural displays or heat on a specific joint, but listening to what people say about their pets’ behavior and drawing out details with questions is an important part of the exam process.
“We can help the owner when we’re asking history and possibly pull out some information in how we ask our questions,” Dr. Login says.
Some of the following obvious and not-so-obvious statements you might hear from owners can open up a discussion:
–He doesn’t like it when I touch him there.
–She doesn’t always use her litter box anymore.
–He used to enjoy being picked up but now he squirms away.
–She’s started pooping inside the house even though she has a dog door.
–We used to go on long walks, but now he conks out after a mile.
–She’s reluctant to go up or down the stairs.
–He doesn’t jump on the bed or sofa anymore
–She used to love the kids and now she walks away when they want to pet her.
–He doesn’t groom himself very well anymore.
–She sleeps in the closet instead of hanging out with us while we watch TV.
Changes in litter pan behavior are much more likely to indicate that a cat has pain issues rather than a urinary tract infection. Dogs who defecate outdoors and then defecate again in the house may be doing so because it’s painful for them to squat for very long so they don’t complete the act outdoors. Animals who potty inside the home even though they have a pet door may find it painful to go through the door because it whacks them on an already aching hind end as they exit.
The real red flag is resistance to touch, says Robin Downing, DVM, DAAPM, DACVSMR, at Downing Center for Animal Pain Management in Windsor, Colorado.
“While animals cannot and do not anticipate or fear their own death, they very much anticipate and fear pain,” she says. “As a consequence, when we as veterinarians meet and interact with dogs, and particularly cats, who are reluctant for us to handle them, the most likely explanation is that those animals are painful and they know that when a human touches them it hurts, so they are anticipating and fearing that pain and doing everything they can to prevent being handled.”
Before performing a pain palpation, she demonstrates the amount of pressure she’ll be using on an owner’s forearm, so the person recognizes that it’s not a painful level of touch.
Finding that what they thought were breaks in normal behavior—not socializing, not wanting to be touched or picked up, losing housetraining or litter box training—signal that an animal is in pain can be an eye-opener for owners. Some break down in tears when they realize their pet has been hurting.
“We have a clientele who believe it’s a normal thing for their dog or cat to become less active as they age because they’re getting old, and what we need to do now is really shift our attention to educating our clients to understand that old age is not a disease and that there are things we can do to prevent these negative consequences from happening in the first place and specific things we can do to intervene on a dog or cat’s behalf if they are in pain.”
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
What’s that you smell?
We know that dogs’ and cats’ sense of smell if far superior to ours. What can we do to to optimize their olfactory experience? In this webinar, Fear Free Practice Certification Manager Dr. Rachel Abrams will take a closer look at Optional Facilities Standard 4.8 “Cleaning protocols to improve olfactory experience for pet are in place.”
All webinars in this series open with a brief overview of the path to practice certification and conclude with a live Q&A session.
Fear Free Facilitates Clinical Success
Dr. Ralph Harvey
Join board-certified anesthesiologist Dr. Ralph Harvey for tips and tricks to taking your Fear Free sedation efforts to the next level. This webinar will feature a case discussion as well as sedation hacks you don’t want to miss!