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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.

Care of Hospitalized and Boarding Patients

Dr. Rachel Abrams

Join Fear Free Practice Certification Manager Dr. Rachel Abrams for an overview of the path to practice certification and a discussion about preventing and alleviating FAS in your hospitalized and boarding patients.

Fear Free Design Ideas

The built environment affects the mental and physical well being of people and animals. What can you in your Fear Free Certified hospital to further foster a low-stress and healthy environment? In this webinar we will give you tips and tools for implementing Fear Free design into your spaces.

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.

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Do You Hear What I Hear? Noise Aversion Beyond Thunder and Fireworks

Noise aversion isn’t only about thunder and fireworks. Many of your patients are suffering daily from noise aversion to everyday environmental events.

What can the veterinary professional do? In this webinar, sponsored by Zoetis, board certified veterinary behaviorist and Fear Free Executive Council member Dr. Lisa Radosta discusses a variety of treatments that can help patients with noise aversion live happier lives.

Fear Free: Evolving to the Hospitalized, Emergent, and Sick Patient, sponsored by Zoetis

Dr. Tamara Grubb, PhD

In this webinar, board certified veterinary anesthesiologist Dr. Tamara Grubb, PhD, discusses the interconnectedness of pain with fear, anxiety, and stress, and examines therapeutic and diagnostic strategies for both. Topics covered include the relationship between FAS and pain, diagnosing and treating both pain and FAS, reducing FAS in the hospitalized patient, and FAS and pain in the emergency setting. The relationship of pain with fear, anxiety, and stress (FAS) – a relationship that works both ways – is crucial for veterinary professionals who seek to treat their patients’ physical and emotional health. How can the veterinary professional best understand, diagnose, and treat both pain and FAS?

Case Management of Fear, Anxiety, Stress, and Pain, sponsored by Zoetis

Ralph C Harvey, DVM, MS, Diplomate ACVAA, UTCVM

Pain adversely affects the fearful, anxious, and stressed patient. These clinical issues are tightly interrelated, and we best manage them together. In this webinar, Dr. Ralph C. Harvey, a specialist certified by the American College of Veterinary Anesthesia and Analgesia, presents clinical cases demonstrating effective management of this deleterious continuum so as to enhance favorable outcomes for patients, clients, veterinary personnel, and practices.