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New Ways to Do Old Things in General and Emergency Practice

Most dogs, cats, and pet owners don’t like visiting the veterinary hospital. Their experience is far from spa-tacular! From vaccinations to X-rays, healthcare providers and pet owners are desperate for gentler, more enjoyable ways to perform common procedures. In this webinar, Jonathan Bloom, DVM, goes beyond theory and philosophy and explores innovative Fear Free-based techniques used in practice to create the best experience imaginable for pets, pet owners, and healthcare providers. Sponsored by Elanco.

Puppy and Kitten Socialization Bingo

The socialization period of puppies and kittens is extremely important in the formation of a happy, healthy, and well-adjusted pet. Help your clients take full advantage of this in a fun and engaging way with these socialization bingo cards!

By Deb M. Eldredge, DVMWe have all been there. The embarrassed client who pokes her head in the door and asks if we have a hose to clean her dog off. The carrier with the yowling cat and the fetid odor with an owner who is embarrassed and says her cat “might need a little cleaning and could the carrier be cleaned too?”

Plan Ahead

Even before you work on the stress aspects, think about how to physically minimize chances of stress diarrhea. Ideally these pets are scheduled early in the day for their office appointments. That way the owners can skip the pet’s morning meal – and maybe even the evening meal of the night before if need be. Less in means less out. Obviously doing this depends on the health of the pet and how the owner manages feedings but it might be a solution.
There may be dietary changes that help with a specific pet. Think plain canned pumpkin for fiber to help keep stools firm. Advise owners to avoid any special or extra treats for a day or two before the appointment.

Travel Trauma

A careful history can enlighten you about the cause. Is it the car travel? Some pets just don’t handle car rides well. Or is it only when the pet actually senses and anticipates a veterinary visit? Sometimes it is both factors. The important thing to realize is that Fear Free procedures must be instituted ahead of the veterinary visit to help these animals.

If it is the car travel, consider dispensing anti-nausea medications ahead of the visit (yes, vomiting often accompanies stress diarrhea). Look at calming combos that help with travel anxiety such as Travel Calm, an essential oil combo for dogs who get carsick. Send clients home with canine or feline pheromone products—wipes or sprays—that the owner can use in the carrier and car to and from the clinic. For patients who have a history of travel-related diarrhea, offer to prescribe PVPs—pre-visit pharmaceuticals—such as gabapentin or trazodone to help them relax.

Encourage families to give the nervous dog an extra-long walk and possibly some playtime early on the morning of the appointment to try and stimulate bowel emptying before the dog gets in the car or enters the clinic. Playtime at home for a cat might help as well.

Counterconditioning

Long term, especially if the diarrhea is specifically associated with arriving at the veterinary clinic, you can try some counterconditioning techniques to help put a stop to loose stools. Encourage owners to take their pet for short trips ending up in the parking lot of the veterinary clinic. Then dogs can get out and get some special treats or, even better, some playtime with a favorite toy such as a tug. Cats can get favorite treats. Then happily turn around and take them home. Pets will come to associate trips, even trips that end up at the dreaded vet clinic, with some good things.

As pets deal with a clinic utilizing Fear Free practices, the fear and panic they previously showed when traveling to or arriving at the clinic should subside. As fear and anxiety decrease, so should episodes of stress diarrhea. Everyone will be happier!

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

By Linda LombardiDo you have clients asking about using nutraceuticals for their pets’ behavior issues? Here’s a primer on what they can—and can’t—do.

The term “nutraceutical” is a mashup of “nutrition” and “pharmaceutical.” Beyond that, because they’re unregulated, there’s no legal definition, and every journal article you read will likely start by spending several paragraphs grappling with this fact. For practical purposes, nutraceuticals are food-derived substances that are claimed to have an effect on health. For example, alpha-casozepine, derived from milk protein, affects neurotransmitters in a similar way to benzodiazepines and may help reduce anxiety.

Looking at a list of these products, their claimed effects, and how they’re sold, it can be a little difficult to see how they are different from drugs–after all, some drugs are derived from nature, too. Lisa Radosta, DVM, DACVB, of Florida Veterinary Behavior Service in West Palm Beach, says, “They are really in my mind not that much different from drugs, except they’re unregulated, but in the mind of the consumer they are different because they are ‘natural,’ and that is something that a lot of people are looking for.”

The desire for something “natural” can be based on misconceptions both about nature and about drugs. “Natural” doesn’t necessarily equal “safe”: the natural world is chock-full of poisonous substances. In some cases, clients may simply need some reassurance about the drug options.

“When clients are thinking of behavior meds, they’re thinking of sedatives that will ‘turn their animals into zombies’ and change their personalities,’ says Jill Orlando, DVM, DACVB, of Carolina Veterinary Behavior Clinic in Raleigh, North Carolina. “When they think of a supplement, they don’t think it’s going to affect their animals as strongly as what they perceive a behavioral drug does.” She also notes that people may unconsciously project the stigma of human mental illness–and the associated medications–onto their pets.

But there can be reasons to consider these products beyond client psychology, if only because there are so few approved medications for fear, anxiety, and stress in animals. The trick is to sift through the research to figure out the safe and effective choices.

Dr. Radosta prefers to use the term “supplement” to also include products derived from herbs– essentially all the products clients may find on the internet or at high-end pet stores and bring in to her with questions–and they all require the same careful consideration, first, for safety.

“A lot of these supplements haven’t been given to a group of dogs to see what they do to the liver, to the kidneys; nobody knows,” she says. “So that’s kind of scary. On the other hand, we shouldn’t throw the baby out with the bathwater. The research does show that some of them can offer benefits for fear, anxiety, and stress in animals. We don’t want to throw things away just because they aren’t a drug, but we also don’t want to assume they’re safe.”

Consider the source of a product. “What I tell my clients and veterinarians is, we try to use supplements from companies that we trust–as much as you can trust a company. We try to use supplements made by pharmaceutical companies. It’s not that I love pharmaceutical companies, but it’s that I can hold someone responsible.”

Whatever the source, read the research and evaluate the evidence yourself. Given the lack of regulation, you first need to know if a product has been properly tested for safety in dogs and cats. “For me, that’s key. Did someone give this to a bunch of animals? What is the LD50? Do we know? We shouldn’t be playing around with an animal’s life.”

Regarding evidence for effectiveness, methods of studies can vary widely. One thing to consider, says Orlando: “Is the research done on the actual product, or is it done on the functional ingredient in that products? That’s not to say that that information isn’t useful, but it doesn’t necessarily prove that product is effective.” Other factors include but are not limited to the following:

  • Species used in the study: was the research done on dogs and cats or only on rats and mice?
  • What condition was studied? If a study was narrowly focused on, say, separation anxiety, the substance may not work for other types of anxiety.
  • What was evaluated? Actual behavior or physical measurements such as stress hormones? Both types of studies have strengths and weaknesses.

If you’re still not sure, Dr. Radosta says, consult a veterinary behaviorist—that’s why they’re there!

Once you’ve decided on a product, Dr. Radosta says, make sure clients have reasonable expectations about efficacy. The common expectation that “natural” means “won’t affect the animal as strongly” is correct; it means it’s not going to have as strong a beneficial effect as a drug. Where you might get a 50 percent effect on a behavior from a drug, you can expect about half that from a supplement. “That in my practice is considered a positive outcome, and the day the client takes the supplement home I make that very clear,” she says. “If you say your dog is 25 percent changed, that’s a success.”

Because effectiveness is reduced, more than one supplement may be needed. One of Dr. Radosta’s clients whose dog has an extreme storm phobia now administers 11 capsules a day, a regimen that might add more stress for some owners and pets. These products also tend to be more expensive than their pharmaceutical counterparts, a cost that can add up quickly.

Finally, with either supplements or medications, the ideal solution relies on more than just pills; it should also involve behavioral modification. Realistically, though, this isn’t always going to be possible. Not everyone can afford a skilled trainer, and sometimes life is just too overwhelming to add another burden on clients’ time. “I meet a lot of people here in south Florida who are taking care of elderly parents and I do discuss that with them, but I have empathy,” Dr. Radosta says. “I say straight up: your life looks really stressful to me, how are you feeling, can you do this?”

But nearly everyone can handle some simple changes such as crating a fearful or aggressive dog in another room when company comes to avoid exposing a pet to triggers.

“Behavior modification can’t always happen,” Dr. Radosta says, so sometimes we do what we call medication and management: supplements or medication–something that changes neurochemistry–and managing the environment so the behavior can’t occur.”

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

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.

dog being examined by vet
By Deb M. Eldredge, DVMOne of the tenets of Fear Free is that pets should also be as pain free as possible. A pet in pain will be fearful, potentially defensively aggressive, and clearly not happy. Before pain can be treated, however, it must be identified and, to a certain extent, quantified.

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.

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By Kim Campbell ThorntonDo you talk to your clients about whether their pets are in pain? It can be a difficult subject to discuss, in many instances because it just doesn’t come up. Sometimes pet owners overlook subtle changes in behavior that can indicate pain or assume that those changes are a normal by-product of aging. You may need to bring up the subject yourself, especially if you are seeing a senior pet or one who resists examination.

“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.

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

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By Tamara Grubb, DVMIn human medicine, postoperative nausea and vomiting are among the most prevalent and concerning of all postanesthetic complications. The conditions are so common and have such an impact on human health care that they have earned their own acronym from the National Health Library, PONV.

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.