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.
You’re not “reinforcing fear” by providing comfort to a pet. Many animals act calmer if they are near their favorite human or if they are handled and interacted with in a manner they find reassuring.
You may, however, escalate your pet’s stress if he picks up on cues that you are nervous or on edge. If you are attempting to comfort him in a way that’s different from how you normally interact with him, such as hovering or jumping to attend to him immediately, it may signal to your dog or cat that you are upset. His response may be to become worried himself.
If petting, massage, and T-touch handling help your pet to visibly settle, by all means, do it! But if the dog or cat avoids touch or acts agitated or upset with handling, give him some space or interact in a more hands-off manner such as redirecting his attention to a food puzzle or other favorite toy.
Left untreated fears can escalate overtime. Although it is ok for your dog to seek comfort with your presence when he is afraid, allowing that to be the sole coping strategy can be a recipe for disaster. For example, if your dog becomes frightened by something when he is home alone, he might panic because he has not learned any other successful coping strategies. Talk to your pet’s veterinary team about who they recommend for assistance in addressing your pet’s fears before they escalate.
Dogs pick up cues from people on whether to relax or panic. The more comfortable and calm you feel, the more likely your pet will pick up the message and relax in turn.
To communicate a calm demeanor, start by working with your pet’s veterinary team to create an action plan for responding to fear, anxiety, and stress in the home. Knowing how you’ll react to your pet’s angst is empowering for you and communicates to your pet that all is well.
To reinforce that calm demeanor for yourself, practice deep breathing and mindfulness. Settling down with a relaxing read, watching a feel-good show, or playing music you like are other potential ways to decrease your own stress and, by extension, your dog’s.
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.
In this course, you will learn ways in which the Fear Free Animal Trainer can partner in Fear Free efforts to keep animals calm during veterinary care, procedures, and even on the day of surgery. This includes teaching animals the concept of a Treat-Ment station, training them to accept passive restraint, and acclimating them to sounds and equipment used during common diagnostic procedures.
While it’s impossible to train for every possible scenario, general training strategies can be practiced, such as training a dog to lie on his side while being handled, preparing him for an injection, or teaching him to indicate his willing consent for handling or care.
Through several in-hospital and at-home video tutorials, you will learn step-by-step how to proactively prepare animals for procedures such as ECGs, radiographs, ultrasounds, surgery, and more.
This module has been approved for 1.5 CEUs from CCPDT, IAABC, and KPA as well as 1 RACE approved CE hour.
How many times have you seen an animal shy away from the blow dryer or the nail clippers? How about trembling in the bathtub? Many animals don’t necessarily enjoy having their feet handled, getting a haircut, or taking a bath. But there’s a lot that groomers can do to make those things more comfortable (and even fun!) for them.
The Fear Free Groomer Certification Program teaches you how to use Fear Free concepts to ensure that the grooming experience is as enjoyable as possible for every pet, every time. Step-by-step video clips and slides show you how to teach animals to love the grooming table, clippers, the bathtub, the blow dryer, grooming shears, the groomer’s loop, and more.
Whether it is the animal’s very first visit to the salon or they have already developed a fear, you can help them. You’ll learn how to recognize even the most subtle signs of stress, and you’ll be well equipped on how exactly you can help a pet who is feeling stressed.
You’ll learn how to set the salon environment up to help ensure Fear Free grooms, from the moment a pet enters the salon, throughout the groom, and until the moment they leave. This includes shop layout, sights, sounds, smells, entrances and exits, and more.
All this translates into happier pets, more frequent visits, and satisfied pet owners spreading the word about how much fun their dog or cat had at your salon. Decrease stress on you and the animals, and increase your revenue!
The purchase of the Fear Free Groomer Certification Program provides you with an annual membership for the program, which requires an annual renewal fee and completion of additional annual CE to maintain your membership.
This course has been approved by the PACCC for 5 CEU
A recent PubMed search of PONV garnered almost 10,000 hits. For the human patient, PONV is unpleasant and results in dissatisfaction with perioperative care (Gan et al. 2014). Humans would pay extra to prevent PONV (Gan et al. 2014). Unfortunately, PONV is more than just an annoying occurrence. Vomiting itself can cause other postoperative complications, and PONV has been called “distressing” by humans who experience it (Gan et al. 2014).
As all veterinarians and veterinary technicians can attest, PONV also occurs in veterinary patients, and we should ask ourselves this question: is PONV distressing to our patients? Could PONV lead to or add to fear, anxiety, and stress (FAS)?
The author of a recent review of nausea and vomiting in veterinary patients makes a strong argument that these conditions could cause or compound FAS and could be considered an animal welfare issue (Hay Kraus 2017). The point is made in the review that Brambell’s Five Freedoms of animal welfare include freedom from discomfort, pain, and distress. PONV likely causes discomfort, could contribute to pain, especially in patients with preexisting abdominal pain, and could potentially be distressing.
Maybe we can’t definitively know whether an animal experiencing PONV is “distressed” or not, but we can argue that reduction of PONV is medically beneficial to our patients. Potential adverse effects of PONV include dehydration, electrolyte imbalances, esophagitis, aspiration pneumonia, exacerbation of pain, and elevated intracranial and intraocular pressure. In addition, PONV is likely to cause anorexia and may even contribute to agitation in the recovery phase of anesthesia.
Fortunately, we have drugs, such as maropitant, that decrease the incidence of PONV and the associated adverse effects. Numerous studies describe the anti-nausea and anti-emetic effects of maropitant in both dogs and cats (Hay Kraus 2017). One study also showed that dogs receiving maropitant returned to normal food intake postoperatively more rapidly than dogs not receiving maropitant (Ramsey et al. 2014). At 20 hours post-anesthesia, 93 percent of the dogs receiving maropitant versus 46 percent of the control dogs had returned to normal feeding. This could aid in alleviating dehydration, electrolyte imbalances and any nutritional deficits that might affect healing.
In the same study, dogs receiving maropitant had a better quality of recovery than control dogs. This could be due to decreased PONV and could add support to the theory that PONV is distressing to veterinary patients. In human medicine, administering sedatives that also decrease the incidence of PONV is recommended for treating emergence delirium in children (Dahmani et al. 2014).
Finally, reduction of PONV is not only medically appropriate for the patient, it is also important for maintaining the human-animal bond and pet-owner satisfaction with perioperative care. Nausea, vomiting, and anorexia are major concerns for pet owners, and presence of any of these conditions generally leads to owners assuming that their pets are experiencing diminished quality of life. As in human medicine, pet owners are concerned enough about PONV to pay extra money for its prevention (Hay Kraus 2017).
The bottom line is that PONV can be a medical concern both on its own and through complications caused by the act of vomiting or the vomitus itself (i.e., aspiration). PONV can exacerbate pain. PONV may contribute to FAS. Owners are concerned about PONV. We have drugs with high safety margins that effectively alleviate or eliminate PONV, and one of those (maropitant) may even play a role in analgesia. So why wouldn’t we treat or prevent PONV, regardless of the motive?
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 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!