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By Kim Campbell ThorntonRead part one of this series here.

We all know that cats are tough to decode. They hold their secrets tightly, refusing to share how they feel. Old cats are especially wily when it comes to concealing illness or pain. Being able to see through their camouflage is key to keeping them healthy and serene in their golden years.

In her lecture “It’s Not Just Old Age: Optimizing Health Care for Senior Cats,” presented earlier this year at the Western Veterinary Conference in Las Vegas, Susan Little, DVM, board-certified in feline practice, shared some of her secrets for questioning owners and examining cats to get at the truth within.

Get All The Info

Dig deep. Owners might not mention certain things because they assume changes they see are normal in an old cat instead of realizing that they could be related to disease or pain.

One study found that 55 percent of owners don’t know that cats can have kidney disease without appearing sick, and 38 percent don’t know that senior cats can develop osteoarthritis. Subtle signs of sickness that owners might attribute to old age or fail to connect to illness include not using the litter box, being less social or less active, eating or drinking poorly, weight loss, a change in sleeping habits, and bad breath.

We often hear that it’s important to ask open-ended questions to gather details, but Dr. Little recommends a combination of open- and closed-ended questions because so many variables influence the answers, including the cat’s age and the owner’s level of experience with cats. She likes to start with open-ended questions and then narrow her focus with closed-ended questions.

Phrase questions to elicit specifics

“I’m still learning to take a good medical history,” Dr. Little says. “It’s an art; it’s a real skill.”

For instance, instead of asking, “Have you noticed any changes in your cat’s litter box use,” say “Tell me about your cat’s litter box use.”

That’s a good way to get detailed comments about urine output, stool quality, and litter box behavior that owners might not think to mention. If the owner says, “He forgets where the litter box is,” maybe he didn’t forget, Dr. Little says. Maybe the litter box is downstairs in a dark basement and it hurts to go down the stairs or it’s too dark in the basement, and he can’t see very well anymore. These types of questions can give you a bigger, better picture of what’s going on with a senior cat.

Visual Aids And Other Feedback

It’s a cliché that a picture is worth a thousand words, but the fact remains that pictures help. Show owners a fecal score chart with actual pictures of poop, not just line drawings, and ask them to point to the one their cat’s poop resembles.

“Not all owners know what is normal, especially if the cat’s stool is like that all the time,” Dr. Little says.

Know how much the cat eats. Many owners don’t measure food; they just keep the bowl topped up. For free-feeding owners, ask them to weigh the bowl of food morning and evening for a few days or even a week. The difference tells you how much the cat actually eats.

Before owners come in, ask them to complete a questionnaire on their cat’s pain levels. This should be done at home so the answers can be thoughtful and not rushed. One to consider is the Feline Musculoskeletal Pain Index, available from North Carolina State University.

It’s also a good idea to ask owners to fill out a diet history form at home or ask them to use a smartphone to photograph the bags or cans for everything they give their cat.

“People always forget what they feed the minute they walk in the vet’s door,” Dr. Little says.

Other useful assessment tools to give owners, in advance if possible, are the free downloadable brochure How Do I Know If My Cat Is In Pain?, free nutritional and other health guidelines from World Small Animal Veterinary Association, and checklists from the Indoor Pet Initiative, including a health history questionnaire and environmental needs for senior pets.

In the next post, how Dr. Little conducts successful exams with senior cats.

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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In this one-hour module, client service representatives will learn how to quickly assist pets entering with FAS, educate clients about Fear Free in person and on the phone, guide them in preparing their pets for future visits, provide resources and referrals, organize community outreach activities, and create protocols for the whole team to follow.

This module is open to all professionals that are already signed up for the certification program.

The Vital Role of Client Service Representatives is divided into five lessons:

  • Lesson 1: Communicating with Clients
  • Lesson 2: Creating a Welcoming Experience
  • Lesson 3: Advising Clients on Transporting Pets
  • Lesson 4: Reducing FAS in Other Pet Activities
  • Lesson 5: Getting Involved in Community Outreach

This course is approved for 1 hour of CVPM CE

In this one-hour module, you will learn what natural functions scratching serves for cats; common owner responses to scratching and the problems associated with them; and the potential fallout from declawing cats. Most importantly, you’ll come away with several safe and effective alternative solutions to the problem of unwanted scratching, and a made-for-owners handout to help guide them in the right direction.

This module is open to all professionals that are already signed up for the certification program, and is RACE approved for 1 hours in the category of Scientific.

    Feline Destructive Scratching is divided into five lessons:

  • Lesson 1: Feline Scratching Defined (The Good)
  • Lesson 2: Scratching as a Problem for Owners (The Bad)
  • Lesson 3: Common Responses (The Ugly)
  • Lesson 4: Why Not Surgically Declaw Cats?
  • Lesson 5: Safe, Effective Alternatives to Declawing
By Kim Campbell ThorntonPet owners, and people in general, tend to ignore problems until they become too troublesome to ignore. It’s human nature to put off dealing with things if we’re not sure how to proceed or think it will be too much work. If you live in an area that’s prone to thunderstorms, though, you can help clients stave off pet fears and phobias before they become serious.

“Veterinarians should routinely ask clients about their pets’ responses to storms,” says Pamela Perry, DVM, a behavior resident at Cornell University College of Medicine in Ithaca, New York.

Ask clients what happens during a thunderstorm. Does the cat hide? The dog tremble? Those mild fears can worsen over several thunderstorm seasons. Waiting to treat them can make the problem that much more difficult to manage. Be preemptive and recommend treatment promptly, while signs are still at the subtle stage.

“They might be coming in for something totally unrelated to storm phobia, but they mention that the dog is fearful during storms or that their other dog at home has storm phobia,” says veterinary behaviorist Lore Haug, who practices in Sugar Land, Texas. “I’m like, ‘You need to get on top of that right away.’”

Suggestions can be as simple as suggesting setting up a safe room or getting the pet a snug-fitting wearable that may have a calming effect.

Know how to advise clients on setting up a safe room. It can be a small guest bath or closet with no windows, a basement, or something as simple as a crate with a cover thrown over it. Their pet may choose his own safe space, such as inside the bathtub. Wherever it is, it should be ready and available at any time.

Clients should encourage pets to go there by placing a stuffed Kong or treat-filled puzzle toy in the room daily so the animal knows that good things happen in that room. Remind clients never to close the pet in the room or crate, which can create a feeling of being trapped. If owners know a storm is expected during a time they won’t be home, they should prepare the room by putting a long-lasting treat or favorite toy in it, turning on a white noise machine or other noise blocker, and plugging in a pheromone diffuser.

Be familiar with product options for pets fearful of storms. Calming clothing includes Thundershirts, Storm Defender Capes, Anxiety Wraps, Mutt Muffs, and Calming Caps. Depending on the product, they fit snugly on the body, providing soothing pressure; reduce storm-related static charges; or limit the pet’s exposure to scary storm-related sights and sounds such as lightning and thunder. Recommend drowning out storm sounds with white noise machines, the whirr of a box fan, or relaxing music such as Through A Dog’s Ear or Through A Cat’s Ear. Certain nutraceuticals and pet foods contain soothing ingredients such as l-theanine, caseins, L-tryptophan, and B vitamins and are marketed for pets with storm-related fears.

“Resources like that are easy for owners to implement and don’t require a huge behavior modification program,” Dr. Haug says.

Finally, be familiar with the client’s lifestyle and environment. If medication is needed, that information will help you determine the best choice for that particular animal.

“Make a choice about the effect you want to have happen, what medication fits with that, and how it can work in the owner’s lifestyle,” says veterinary behaviorist Lisa Radosta, who practices in West Palm Beach, Florida.

For instance, some owners are in and out but have a flexible schedule that allows them to premedicate a pet if a storm is in the forecast. For that owner, Radosta says, “I’m going to send her home with Sileo because that works fast and she’s generally going to be home to administer it.” For owners who are gone all day, she might suggest long-lasting clonazepam or gabapentin.

“Make a choice,” she says. “Don’t just throw a drug at it because you like it.”

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 Dr. Marty BeckerSince I published the story of my personal struggle with depression and a family history of suicide–including my father, who killed himself with a shotgun–in Veterinary Economics last year, I’ve heard from hundreds upon hundreds of my fellow veterinary professionals who have faced the same struggles.

As Thanksgiving and the holiday season draw near, I can’t help but think of all of us in veterinary medicine who are feeling anything but thankful, and are overwhelmed not with feelings of good cheer, but of darkest depression.

My personal journey to becoming a veterinarian began when I was 7 years old, growing up on a dairy farm. The family vet came out to treat a fallen cow who, after one injection, rose up.

Even though my desire to be a veterinarian was sparked by that happy recovery, that memory and many like it are frequently overwhelmed by memories of death, terrible suffering, and the mistakes that we see happen in our profession every single day, year-in, year-out.

My experience of practicing veterinary medicine ranged from getting the Twin Falls, Idaho, City Shelter to shut down their gas chamber by agreeing to euthanize the animals myself; fighting to keep some kind of barrier between me and the pain of seeing animals I cared about suffer, or die–and seeing the devastating grief of their human families at their loss; the steady drumbeat of “suck it up” and “don’t think about it” and “don’t focus on all this emotional stuff” I heard so often from my bosses and colleagues.

I got the message loud and clear: Unlike physical suffering and illness, their mental and emotional counterparts were shameful, trivial, and unworthy even of acknowledgement, let alone treatment.

It was the Thanksgiving season that followed the horror of 9/11 when I first became seriously depressed. I was in my late 40s, and had just finished working on my book The Healing Power of Pets. I was sad and wanted nothing more than to sleep all the time. I was in darkness that no amount of awareness of my family history, or will power, or stern self-lectures, or prayer could lighten. That took the care of a physician and the prescription of an anti-depressant. Five years later, I needed an additional medication to keep the darkness at bay.

While clearly my family background contributed to the likelihood I’d suffer from depression, so did my profession. A recent commentary in the Journal of the American Veterinary Medical Association (JAVMA) cited a CDC survey of more than 10,000 practicing veterinarians that found we are more likely to be depressed, to suffer serious mental illness, and to attempt suicide than the general public.

In fact, frighteningly, 14.4 percent of male and 19.1 percent of female veterinarians have considered suicide, nearly three times the national average for the general population. And these numbers are consistent with those in studies of veterinary professionals around the globe, not just in the United States.

I did not found Fear Free to address the epidemic of depression and suicide in our profession; I did it to help animals. But what I found is that it also has the power to help us.

Consider these words written by the authors of that same JAVMA article I mentioned above:

Some of the reasons for the high rates of mental disorders in veterinarians include work-related stress, a lack of early detection of mental problems, access to lethal drugs associated with euthanasia, and the adverse effects of performing euthanasia.

A qualitative, interview-based study of veterinarians who had attempted suicide revealed contributing factors to be adverse relationships at work, concerns about career, issues related to patients, long hours, and heavy work-load. A cross-sectional study of work conditions for veterinarians found that the number of hours worked and professional mistakes were the chief stressors that accounted for anxiety and depression.

How much of the soul-killing stress that afflicts veterinarians and veterinary nurses is caused by working all day on patients who fear us, even hate us? How much is the result of seeing the animals we love and feel such compassion for shiver, drool, even lose control of bladder and bowels, as we try to help and heal them?

I know I became a veterinarian because I felt so connected to the soul of animals. I thought I was doing what was best for them, and it was not until the fateful day when Dr. Karen Overall ripped the bandage off the wound of my compassion that I realized I was in fact harming all the animals I thought I was helping. That horrifying realization sharpened my senses, opened my heart, and inspired the creation of Fear Free.

And it was in hearing from so many of the almost 25,000 of you who have so far enrolled in certification that I realized it isn’t just our patients who need healing through the practice of Fear Free veterinary medicine; it’s us, too.

Of course, Fear Free is not a form of therapy or medical care. Depression and suicidal ideation are real medical issues and require the care of qualified professionals. But as the JAVMA article pointed out, work stress is a massive risk factor for mental health problems and suicide in veterinarians.

Look at it this way: If I think of myself as a cup, I’m half-full–maybe even three-quarters full in my case–of risk factors related to genetics and my upbringing.

Why fill that cup the rest of the way with insufficient sleep, a lack of connectedness to my family and community, guilt, unwillingness to face my problems, and stewing every day in the fear, anxiety, and stress of the pets, pet owners, and staff I interact with professionally? Why crank up the already dangerous pressure I feel by burying feelings of burnout, compassion fatigue, depression, or worse?

After almost 40 years of veterinary practice, I still feel blessed to be part of the greatest profession on earth. I am endlessly grateful for the opportunities I have to lecture to veterinarians, veterinary nurses, and veterinary students, and to speak on behalf of the veterinary profession through the media.

But this Thanksgiving, I also know tremendous gratitude that I’m able to share this gift with each of you: That the practice of the medicine we love on the animals we love can be a healing gift to us both, and not a source of fear or suffering. That we’re part of the largest transformational initiative in the history of companion animal practice, part of healing animals, the people who love them, and ourselves.

God bless you, and have a Happy Thanksgiving, my friends.

Author’s note: If you’re experiencing depression or are contemplating suicide, please call the National Suicide Prevention Lifeline (800-273-TALK; 800-273-8255; suicidepreventionlifeline.org). It’s available 24 hours a day, 7 days a week. Whatever darkness you are facing, the good people who staff these phone lines care and will help you.

Sedation can play a vital role when it comes to creating a Fear Free veterinary visit, but knowing when and under what circumstances to bring sedation into the picture as it relates to the fear, anxiety, and stress (FAS) a pet may be experiencing is critical for the both the pet and success of the visit. In this podcast, featuring Fear Free Executive council member Tamara Grubb, DVM, PhD, DACVAA, and Sharon Campbell, DVM, MS, DACVIM of Zoetis, we discuss the physiological and medical impacts of stress on a patient, how that can play into properly assessing pain, when on the FAS scale to start implementing sedation, and the benefits of doing so.

While Fear Free can often seem as though it’s only about animals’ emotional wellbeing, Fear Free is passionate about the science of animal care as well. Gary Landsberg, DVM, DACVB, DECAWBM (CA), Head of Research at Fear Free, brings you behind the scenes to tell you how Fear Free is advancing research in the field of veterinary medicine.

Achieving a Fear Free Practice Certification might seem like a daunting task, but with a little planning and a strong will to implement, your hospital can make it happen! Marcy Hammerle, DVM, owner of the world’s first Fear Free Certified Practice, shares her journey from Fear Free implementation to Practice Certification, with tips for setting yourself and your staff up for success.