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How to Make Exam Rooms Fear Free and Friendly for Cats

Julie Liu, DVMSeveral years ago, when I was still a staff vet, I would routinely walk into the doctors’ office in the morning to see one of my associate-mates typing away at her computer with the overhead light turned off. The exterior wall to the office was a large window that faced east so there was always some early morning light coming through, but still, I didn’t get it. Wasn’t it always better to have more light? Why toil away in the dark like a cave creature?

After a few mornings, I started getting used to only having natural light in the office and noticed that I felt a lot calmer. If another doctor turned the light on, it felt way too bright and jarring. I realized that something as simple as decreasing the intensity of the light source in my environment could magically decrease my stress levels without me even noticing.

When it comes to our feline patients, many of the surroundings in a vet hospital can seem similarly disruptive, and may even lead to fear, anxiety, and stress (FAS). By reimagining the veterinary environment and catering to the feline senses, we can promote relaxation and a less stressful experience for both cats and humans. Here are some simple, budget-friendly tips for creating Fear Free feline exam rooms.

Provide a Safe Place

In 2022, the AAFP/ ISFM released an update of their guidelines for a Cat Friendly Veterinary Environment, in which they reference the 5 Pillars of a Healthy Feline Environment. While you may not be able to achieve all 5 Pillars in every exam room, being mindful of them will go a long way towards keeping your feline patients calm.

Pillar 1, “Provide a Safe Place”, is paramount. So what makes cats feel safe? When cats are experiencing FAS, hiding becomes a major way in which they cope. Think of all of those patients you’ve seen hiding under their bedding or overturned litterbox in the treatment area, or hiding under a chair in the exam room–they’re trying to cope with the stress of being in a scary place. Ensuring that every exam room is stocked with towels and a cat bed with high sides will facilitate hiding and comfort during the visit. You can even go next level and place a towel warmer outside the exam rooms. The thermoneutral zone for cats is 86-100.4℉ (30-38°C), so grabbing a warm towel as you’re heading in will allow your feline patient to feel even cozier.

Cats also feel safer when they can be elevated. If the cat chooses to explore the exam room, non-slip cat shelves, perches, and cat cubby holes mounted onto the wall will allow them to survey their surroundings from a height while also remaining hidden. Just ensure that any cubby can be opened easily to access the patient for their exam, as removing a cat from their “safe” place will increase FAS. Along the same lines, if budget allows, replace any exam room chairs with a bench that extends to the floor so cats don’t have to be pulled out from their hiding spot when it’s time for handling.

It can also take several minutes for cats to acclimate to a new area, so if you’re taking all feline appointments to “the back” where it’s noisy and full of dogs to collect samples, expect their FAS levels to escalate. Instead, treat each exam room like a private, “safe”  treatment area for that kitty and stock it appropriately with everything you might need for samples: tubes, syringes, smaller gauge needles, butterfly catheters, slides, and EMLA cream to reduce the pain of needle pokes. If your team members aren’t comfortable collecting samples in front of the cat parent, I’ve found that most clients are more than willing to hang out in the waiting area and drink a coffee or play on their phones until you’re done.

Considerate Approach

As Fear Free professionals, we should always use Considerate Approach with our patients, which means we want to consider how our felines are experiencing their environment during care.

  • Touch. Exam tables are slippery, cold, and uncomfortable. To provide stability and extra warmth, ensure all exam tables have a non-slip surface such as a yoga mat to act as a base under your warm towel. Every room should also have a non-tippable cat scale with a non-slip surface, which could be a Feliway-sprayed towel that you “tare” prior to weighing the cat.
  • Taste. Does your clinic have treats for dogs, but not cats? While many cats will be too fearful to eat treats, others can readily be distracted by catnip, Temptations, Churu, squeeze cheese, tuna, whipped cream, and other delicious snacks during interactions. Also be mindful of taste the next time you’re dousing your feline patients with alcohol to collect samples–unless you wipe the alcohol off of their fur with a damp washcloth, you’re contributing to their negative experience when they groom themselves after the visit. Consider using water instead of alcohol.
  • Visual. Photorealistic depictions of cats or other animals may cause cats to react, so abstract art often works best. If you’re lucky enough to have a quiet exam room with a window, consider making that a feline-only room. Many cats will explore the room and gaze outside during a visit, which works great as a distractor. Cats are also better able to see in lower light than people, so try installing a dimmer switch to decrease the light intensity.
  • Auditory. Vet clinics are loud. Dental scalers, cage doors slamming, and dogs barking can significantly increase FAS during a feline visit. Installing soft closers on cabinets and doors and hanging a “Shhh….feline appointment in progress!” sign on the treatment area side of the door will remind team members to use their inside voices and keep environmental noises low. You can also hook a speaker up to the exam room computer and play soft, cat-specific music. A 2019 study published by the Journal of Feline Medicine and Surgery found that cats listening to cat-specific music in a veterinary clinical setting had lower cat stress scores and lower mean handling scale scores than cats that were exposed to silence or classical music.
  • Olfactory. Pets leave behind lots of scents during visits, and smelling them may increase FAS, particularly if a dog was just in that room. Having a cat-specific exam room helps prevent olfactory stressors, and Rescue will allow you to disinfect and remove traces of the previous patient while minimizing harsh smells from scented cleaners.
  • Pheromonal. When your cat rubs their cheek against your leg or the furniture, they’re depositing the feline facial pheromone that marks an area as “safe”. Feliway Classic mimics this pheromone and comes in user-friendly diffusers that can be plugged into every exam room. You can also pre-spritz your scrubs at the beginning and middle of each shift and room towels with Feliway spray at least 15 minutes before your first appointment, then reload for afternoon kitties since it wears off in four to five hours. Don’t forget to label your diffuser with some client education so cat parents see the Fear Free value.

The exam room can be a scary place for many cats, causing them to experience FAS even before handling. Adding some Fear Free tools and considering the feline senses will help turn your exam rooms into kitty havens.

Resources 

https://fearfreepets.com/cat-friendly-exam-room/#:~:text=Avoid%20chairs%20cats%20can%20get,Choose%20light%20colors 

https://fearfreepets.com/top-10-treats/

https://fearfreepets.com/helping-our-feline-friends-feel-fear-free-with-dr-tony-buffington/

https://fearfreepets.com/providing-the-optimum-environment-for-cats/

https://fearfreepets.com/creating-a-comfortable-environment-in-the-clinic/

JFMS: https://journals.sagepub.com/doi/full/10.1177/1098612X221128763

JFMS: https://journals.sagepub.com/doi/10.1177/1098612X19828131

Cat music: https://www.youtube.com/watch?v=vGyElqvALbY

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

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

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Words Count: The Language of Fear Free

Julie Liu, DVMLast year, I watched a great webinar on Fear Free Pets by Dr. Tony Buffington called “Helping Our Feline Friends Feel Fear Free.” He shared a number of helpful tips on helping reduce stress for feline patients, but one of the points he made really resonated with me. He talked about going to an exhibit hall at a conference and seeing a booth selling signs that can be clipped onto the front of the cage, including a red sign that said, “Caution, fractious cat.” He asked if there were any signs that said “Caution, fearful cat,” because when he saw “fractious cat” his instinct would be to take care of himself to prevent injury, whereas if he saw “fearful cat” his instinct would be to take care of the cat.

Based on that conversation the company started making “fearful cat” signs, but it got me thinking about the language of Fear Free and the terms I routinely hear vet professionals use for pets exhibiting FAS (fear, anxiety, and stress): “fractious,” “angry,” “spicy,” “CAUTION!!!”, and of course, a variety of R-rated terms used only in the treatment area. And I totally get it. No one wants to get bitten, scratched, snapped at, or injured, and it seems like these terms will keep us safer when approaching stressed patients. So why could this language be problematic?

Well, I’ve noticed that when there’s a patient alert such as “fractious” for a cat, people tend to approach the pet in an adversarial way. They put on their cat gloves, take a deep breath, and go into the exam room ready to do battle with their patient, which usually includes scruffing the cat to immobilize them. Unfortunately, this approach often has the opposite desired effect. Cat gloves can cause fear in patients, and scruffing is painful and takes away the cat’s sense of control. The “fractious” cat’s FAS levels then escalate, which increases the chances of getting injured.

Changing our language so that it describes and advocates for the emotional health of the patient can keep us safer. Instead of “fractious,” what about, “Fearful, keep in carrier until doctor is ready, prefers hiding under towel for exam and vax”? It’s rare to see these types of patient alerts, yet they take only a few seconds to update in a medical record.

Terms like “fractious,” “angry,” and “&#%!@” also shut down the empathy we should strive to bring to our patients, both feline and canine, and joking that a pet is “spicy” trivializes their emotional experience. Instead, see how it feels when you use patient-focused language such as “fearful,” “anxious,” and “stressed.” Just as most of us felt at least one of these emotions during the pandemic (or even all three at the same time), most of your patients are feeling at least one of these emotions during their vet visit. In fact, many of these “spicy” patients are utterly terrified and completely justified in their emotions considering all of the scary things they experience at the vet. Using terms like “fearful” and “anxious” also contributes to a Fear Free culture and sets the tone for how we’d like fellow team members to approach their patients–with empathy, not as adversaries.

As Fear Free professionals, we have the tools to identify, prevent, and alleviate FAS. Modeling Fear Free language is another important step we can take to bring compassion to the patients in our care.

Resources

https://fearfreepets.com/helping-our-feline-friends-feel-fear-free-with-dr-tony-buffington/

FAS Spectrum Handouts

https://serona.vet/collections/cage-tags-signs?page=1

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

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

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Taking Cats to the Back: What the Science Says

Christie Keith
Are pets calmer and less stressed without their owners present during veterinary exams? A recent study partially funded by Fear Free sheds some light on this often-controversial subject.

There’s a lot of disagreement among veterinary professionals on how to interpret the emotional cues displayed by pets when removed from their owners. Many pet parents also object to having their pets taken away to a treatment area. While this practice was extremely common during the COVID pandemic, it was a normal part of many veterinary visits before lockdown became a household word and continues to be today as well.

The reason many veterinary team members offer for the practice is that pets seem calmer and easier to handle when separated from their owners. Others say this isn’t because their fear, anxiety, and stress (FAS) are reduced but because the pet is shutting down out of fear and/or in a state of learned helplessness. What exactly is the effect of separation from owners and transport to a different room during a veterinary visit on a pet’s FAS?

In a study published in the Journal of Feline Medicine and Surgery, researchers conducted a prospective non-blinded randomized two-period two-treatment crossover trial with 21 healthy adult cats. Each cat received an initial examination with their owner present to establish a baseline, and then they were divided into two groups. The cats were chosen from patients of a university veterinary teaching hospital’s wellness and dental care service and had previously been seen without any history of needing “undue restraint,” sedation, or anxiolytics to be examined.

The first group of cats received an examination in a treatment area without their owner, and the second received an examination in an exam room with their owner present. The actual order of the exam itself was randomized, and handling techniques described as “low-stress” were utilized. All veterinary team members had completed Fear Free certification to standardize handling and assessment.

The examining veterinarians recorded heart rate (HR) as measured by auscultation and also established a FAS score for each cat. The baseline HR for cats in the study averaged 176 beats per minute (BPM). For cats examined in the treatment area without their owners, mean HR was 226 bpm and 195 when measured in the exam room with owners present.

The most frequent values when measuring FAS scores were 3 at baseline (moderate stress), 4 in the exam room with owner present, and 5 in the treatment area without owner.

The authors wrote, “Results from this study indicate that minimizing transfer between examination areas and including the owner during wellness examinations can reduce some of the more overt signs of stress in cats during clinic visits. The data also suggest more proactive owner education measures may be of benefit, such as methods of owner habituation of their pet for transport and handling ahead of scheduled clinic visits.”

Note: This study was partially funded by Fear Free, which had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Christie Keith is a journalist, editor, and communications consultant with an exclusive
focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate
and Elite Fear Free Certified professional.
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5 Steps to Heartworm Disease Awareness

By Jennifer Merlo, DVM, CVBMC, Fear Free Director of Veterinary AffairsWe mention heartworm prevention to pet parents during almost every veterinary visit. So how is it that more than 1 million pets in the United States have heartworm disease1? American Heartworm Society (AHS) study data collected in 2022 shows that rates of heartworm disease continue to trend upward in both recognized “hot spots” and in locations where heartworm disease was once rare.2

Due to the increased incidence of travel and remote work career options, the United States is experiencing spread of heartworm prevalence throughout the country. Despite our best intentions, our pet parents are still unclear on the severity of the disease and the importance of maintaining proper heartworm prevention.

Here are five ways to help increase your client compliance and decrease the incidence of heartworm disease in your area:

  1. Discuss heartworm prevention at every visit for every pet.

Veterinarians and veterinary staff recognize the importance of discussing heartworm prevention at puppy appointments. However, often we forego discussing it during adult and senior canine patient visits. The AHS reports that only 37 percent of the U. S. canine population is on heartworm prevention!3 This is a staggering number, and it is our job to educate our clients on the importance of prevention for every pet, year-round. We must make it a point to have this discussion with them at every visit and reinforce the importance of prevention rather than treatment.

  1. Cats get heartworms, too!

Too often we neglect to have this important conversation with our feline pet parents. Fewer than 5 percent of cats are on heartworm prevention3. Most feline pet parents do not think about their cat being at risk, since most of them are indoor-only pets. It is important to have open discussions with cat owners about the spread of heartworms. Educating them that even “indoor” cats are still at risk for mosquito bites and heartworm disease can help reduce the incidence within our feline population. Pet owners may not be aware that there are multiple options for adequate heartworm prevention in cats that do not include giving an oral medication; something we know that causes lower compliance rates in cat owners.

  1. Heartworms travel and so do our pets.

The last few years have seen an increase in the number of remote workers, as well positions that require travel across state lines. Our pet owner population now looks at their dog companions as part of the family who often travel with them. As veterinary professionals, we can no longer rely on heartworm incidence maps as they relate to our direct location since our patients are traveling on a regular basis. Heartworm disease has now been diagnosed in all 50 states and without proper education our pet parents may not be aware that they are unintentionally putting their pets at risk. Be sure to ask questions about travel, including vacations as well as work travel, and be sure that pet owners understand that all pets, in all states, are at risk for contracting heartworms.

  1. Ensure that pet parents are regularly giving heartworm prevention.

When I was in practice, I was always in awe of the fact that most pet owners had an ample supply of heartworm prevention at home, yet our records indicated they should need to buy more. This is often because most pet owners only give their pet’s heartworm prevention one-third of the time. With the numerous options available on the market today, there is an option available for every pet parent to become compliant with their pet’s prevention routine. Discuss different prevention options and gauge what your client feels they can be most consistent with. By opening the conversation and talking through what works best for them, you increase your veterinary-client bond while simultaneously reinforcing the human-animal bond.

  1. Recommend heartworm testing annually.

 Despite everyone’s best intentions, sometimes doses of prevention get missed, and it’s our job to help our pet parents provide the best medical care for their pets. Recommend yearly heartworm testing to ensure that their pet is free of heartworm disease. Make obtaining the blood sample a Fear Free experience by using a Considerate Approach through positive rewards such as delicious treats or petting and using small-gauge needles to minimize discomfort. My staff was great at using insulin syringes to obtain the minimal amount of blood necessary to perform this annual test while the pet parent offered the patient treats. Most of our patients did not even realize venipuncture had occurred! Remind owners that unless we test, we won’t know, and that it’s just as important to monitor for heartworms as it is to prevent them.

It only takes one bite from an infected mosquito to transfer heartworms to a cat or dog. Let’s join with our pet parents to ensure that all our canine and feline patients are well protected.

Resources

  1. American Heartworm Society, 2023; https://www.heartwormsociety.org/
  2. American Heartworm Society Incidence Map, April 11, 2023
  3. The Truth About Cats and Dogs, American Heartworm Society

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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How Clients Can Train Their Birds for Transport and Reduce Travel Stress

Barbara HeidenreichBefore you can care for avian patients, clients must first get them to your clinic. Often, that’s easier said than done. Most companion birds are not used to leaving their home or riding in cars, and it can be frightening for them.

Reducing or eliminating distress for the avian companion starts before the patient arrives at the veterinary clinic. This is because transportation to the clinic can be a critical part of the process. Most avian companions rarely travel outside of the home. This means travel may have the potential to be challenging. Training birds for transportation in advance can give clients peace of mind and make it more likely that avian patients will receive regular annual examinations and necessary medical attention in a timely manner.

Transport Container Selection

Training for transport first requires finding an appropriate container. Some manufacturers have designed small travel cages, crates, and backpacks specifically for companion birds. However, other products such as plastic kennels or wire crates designed for dogs and cats can be adapted to work well for birds. Buyers should examine these products closely to ensure that the materials are safe and suitably indestructible, depending on the species identified for training.

An ideal container is comfortable, inviting, and easy to train the bird to use. This may require that the client add and position perching of the appropriate size for the species in training. Birds with long tails, like macaws, may require perching to be placed closer to one end to allow them to sit comfortably in the crate or cage. The container should have enough space for the bird to easily turn around.

Some containers provide more than one door, large doors, or unobstructed openings that make it easier for birds to enter voluntarily. This can facilitate training the bird to willingly enter a container for transport.

While it is tempting to put many toys inside a travel container, be careful to avoid hanging toys that can swing into the bird during car movement. This can create an unpleasant experience. Alternative options to consider include small foot toys that can be placed on the bottom of the crate or items that can be secured to the sides that won’t move.

Training to Enter the Transport Container

Training the bird to enter the travel container involves a series of steps. The first step is to give the bird time to habituate to the new crate or portable cage. This involves giving the bird time to see the travel container without any requirement to engage with it. This can be done by placing the crate or cage within viewing distance, while making sure the bird is calm and relaxed in its presence.

The next steps are to encourage interaction with the travel container. The initial interaction can be started by luring. Luring involves placing preferred items in a trail from outside that leads to inside the travel container. This can include food items and toys. For some birds, providing attention can also work.

If the bird knows how to orient their beak toward an object, like a ball on a stick or the tip of a chopstick to earn desired outcomes (also known as targeting), this behavior can also be used to guide the bird into the crate.

Subsequent steps include reinforcing for allowing the door to be closed for short increments of time. This is followed by reinforcing for allowing the container to be picked up with the bird in it. Over time, the container, with the bird inside, is moved for short distances.

Another important step in the shaping plan is to practice driving the bird in the container in the car. It is recommended to start with short trips around the block. Placement of the container may be important to prevent motion sickness for some individuals. Being able to see where they are going can help. If possible, advise clients to place the carrier in the front seat, raised so that the bird can see out the window. They shouldn’t cover the carrier or place it on the floor or in the back of the vehicle.

If clients report regurgitation, advise them on options to prevent motion sickness. Additionally, driving prior to feeding a meal can help reduce nausea.

Addressing Fear Responses

If the avian companion shows a fear response to transport containers due to prior experiences, another strategy is to use distance as a reinforcer for calm behavior in the presence of the travel container. This is done by starting far enough away from the container that the bird’s behavior is relaxed and calm.

Rather than getting closer and closer to the container, the client should approach the container only to a point at which the bird remains relaxed and comfortable, and then retreat from the container. This teaches the bird that calm body language at that distance results in moving away from the container. This is repeated and the distance between the bird and the container is decreased with each approximation.

Eventually the bird is very close to the container, showing relaxed behavior, and the procedure is switched to the steps utilizing the approach previously described. Learn more about how to use distance as a reinforcer in the Fear Free course Addressing Fear & Aggression in Avian Patients: A Constructional Approach.

Training for transportation is a behavior that can be taught even if a bird doesn’t know how to step up on hands or is not entirely comfortable with people. It is an important first step toward making an avian veterinary visit Fear Free. More details about training for transportation and how to train other behaviors to facilitate caring for avian patients are available in the Fear Free Veterinary Certification Program – Avian.

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

Barbara Heidenreich is an animal training consultant specializing in exotic animals. She consults worldwide working with zoos, universities, veterinary professionals, and conservation projects. She has worked onsite with over 80 facilities in 27 countries. She is an adjunct instructor at Texas A & M University. She has authored two books and contributed to four veterinary textbooks. She is a coauthor of two Fear Free® Avian Certification Courses. Much of her work focuses on training exotic species to cooperate in medical care. Barbara is an advisor for the Animal Training Working Group and the Parrot Taxon Advisory Group for the European Association of Zoos and Aquariums. She has provided her expertise to conservation projects The Kakapo Recovery Program and The Borneo Orangutan Survival Foundation. Her goal is to leave behind a legacy of kindness to animals by sharing her expertise.
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4 Ways to Talk to Clients About Vaccines

By Kim Campbell ThorntonWhen clients think about vaccinations for their pets, they often associate them with their own feelings about needle-sticks. And most people don’t have positive associations with vaccinations or blood draws. As a veterinary professional, though, you know that vaccinations are essential to your patients’ good health. The conversation you have with clients can not only address the importance of protecting dogs and cats against disease, but also explain why vaccinations don’t have to be the painful experience that they think it will be for their pets.

Here are four conversation starters to help clients see the benefits of vaccinations, not only for their pets’ good health, but also how vaccinations can contribute to a positive and Fear Free experience in the clinic.

The risk of contagious diseases hasn’t gone away.

Canine parvovirus, canine distemper, and infectious canine hepatitis are highly contagious and frequently life-threatening.1 In cats, herpesvirus, calicivirus, panleukopenia, chlamydia, and feline leukemia are all widely distributed diseases that cause significant morbidity and mortality.2 Rabies is fatal in both species. Young animals are at highest risk, but any unvaccinated pet can acquire them. All of these diseases are preventable with vaccinations, and multiple combination vaccines are available for any protocol.

Combinations Are Key to Comfort

To prevent anxiety, reduce stress, and keep visits Fear Free for patients and clients, you can offer combination vaccines that contain only half the volume of most vaccines. That means not only fewer needle sticks but also shorter duration of the injection. For clients who are familiar with Fear Free techniques, those things are important.

Disease risks are changing.

Bacterial diseases such as Lyme disease and leptospirosis are increasingly seen in urban and suburban dogs and in areas where the infections were previously not considered to be a problem specific to leptospirosis.3 The Companion Animal Parasite Council reports that tick-borne diseases4 such as Lyme are spreading across much of the United States, in particular to the South and West, carried by deer, rodents, and migratory birds. A warmer climate, contributing to longer periods for tick reproduction, is also a factor. Adult ticks are active year-round any time the temperature is above freezing.

Climate change and increasing human and domestic animal contact with carrier wildlife have contributed as well to a greater incidence of leptospirosis. Dogs who previously were considered to be at low risk for these diseases, in particular city dogs and dogs weighing 15 pounds or less, are now the ones more likely to be exposed to them.

Lyme disease is spreading rapidly, and leptospirosis is now found in most areas.5 A combination Lyme and lepto vaccine provides protection with a single injection and less vaccine volume.

In addition to vaccinations, be sure to provide client education about vector control and exposure risk reduction through topical or systemic insecticides.

Clients with indoor cats may believe their pets don’t need vaccination for feline leukemia virus, but a single unsupervised escape outdoors can lead to exposure to the disease. All kittens should receive vaccination(s) for FeLV, followed by a booster when they are one year old.6 They can receive a lower volume 1/2mL FVRCP-FeLV combination for a more comfortable vaccination experience.

Vaccinating cats against FeLV has contributed to a decrease in the prevalence of the disease. Test for FeLV prior to vaccination so that cats who test positive aren’t vaccinated unnecessarily.

Technology designed to reduce the likelihood of vaccine reactions.

Unwanted proteins are associated with injection-site pain and swelling. Highly purified 1/2mL Ultra vaccines, using Purefil Technology, are designed to decrease vaccination reactions associated with unwanted protein and debris, reducing proteins by up to 75%. Their efficacy and safety have been demonstrated extensively in real-world studies.

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

Kim Campbell Thornton is content manager for Fear Free Pets and is an Elite Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985 and is a recipient of multiple awards from the Cat Writers Association, Dog Writers Association of America, and American Society of Journalists and Authors. When she’s not writing or editing, she’s snuggling with Sparkles, her Cavalier King Charles Spaniel.

TruCan, TruFel, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates.  Other company and product names are trademarks of their respective owners. ©2023 Elanco or its affiliates. PM-US-22-2260

References

1 2022 AAHA Canine Vaccination Guidelines. https://www.aaha.org/globalassets/02-guidelines/2022-aaha-canine-vaccination-guidelines/resources/2022-aaha-canine-vaccinations-guidelines.pdf Accessed on December 13, 2022.

2 2020 AAHA/AAFP Feline Vaccination Guidelines. https://www.aaha.org/globalassets/02-guidelines/feline-vaccination-guidlines/resource-center/2020-aahaa-afp-feline-vaccination-guidelines.pdf Accessed on December 13, 2022.

3 White, A., et. al. “Hotspots of canine leptospirosis in the United States of America.” The Veterinary Journal, 222 (2017), 29-35. https://www.sciencedirect.com/science/article/pii/S109002331730059X Accessed on December 13, 2022.

4 Companion Animal Parasite Council (CAPC) 2022 Pet Parasite Forecast. https://capcvet.org/about-capc/news-events/companion-animal-parasite-council-releases-2022-annual-pet-parasite-forecast/ Accessed on December 13, 2022.

5  Smith, Amanda M., et. al. “Potential Drivers for the Re-Emergence of Canine Leptospirosis in the United States and Canada.” Tropical Medicine and Infectious Disease (2022).  https://www.mdpi.com/2414-6366/7/11/377/htm Accessed December 13, 2022.

6 Little, Susan, et. al. “2020 AAFP Feline Retrovirus Testing and Management Guidelines.” Journal of Feline Medicine and Surgery, Vol. 22, Issue 1 (2020). https://journals.sagepub.com/doi/full/10.1177/1098612X19895940 Accessed December 13, 2022.

This post is brought to you by our sponsor, Elanco, the maker of TruFel Ultra Vaccines.

Can Trapping Cats Be Fear Free? Find Out Here

Bernadette Kazmarski
We think of Fear Free techniques for handling pets in shelters, at veterinary visits, and in our homes. But some cats need to be brought to those places in a most stressful way—being caught in a humane trap. Fear Free techniques can help relieve stress even in these situations.

Most cats are trapped for TNR—neutering, vaccination, and return to a colony. Young kittens and somewhat friendly cats will often be kept for socialization and adoption. Lost cats often need to be trapped, as well as cats in hoarding and humane cases. All of those circumstances are already very stressful.

Being Trapped Violates a Cat’s Instincts

So if cats find boxes irresistible, why would walking into a wire box be frightening to them? Cats will seek and tuck themselves into small spaces for safety and as part of their predatory behavior to both inspect to find prey and hide to ambush prey. But a cat doesn’t want to be ambushed herself, and she needs to feel a sense of security about the space and see a safe exit in order to explore it.

Knowing that, we set up a wire tunnel with one way in and no way out and we expect a cat to walk into it? Yes, we do. They need to be handled, held overnight or longer, and sometimes treated while in a trap too. It’s an immense amount of anxiety and stress for any cat.

Fear Free for Community Cats

This is one area of cat handling where, knowingly or unknowingly, Fear Free techniques have long been used because following a cat’s cues and overcoming her anxiety is the only way to trap successfully.

“Working in TNR/community cat care, I think Fear Free is extremely important,” said Sterling “TrapKing” Davis, founder of TrapKing Humane. “The purpose is to prevent and alleviate fear/stress/anxiety in pets and for our community pets.”

No trapping happens without a plan and preparation for each step of the process, so the cat is treated humanely and experiences the least amount of stress: set the trap in a safe location, use high-value food as a bait, monitor the trap, and when the trap closes behind the cat cover the trap immediately to calm her and eliminate visual stimulation. Then, at each move minding the cat’s comfort and security, carry the trap and transport to wherever the cat needs to go for the necessary services and care.

“It’s things like making sure you have newspapers/pee pads in the trap beforehand. Making sure to cover the traps to calm the kitty and during transports, having a decent temperature and keeping vehicle windows rolled up as wind noise can be really scary, especially with everything going on,” Davis says. “TNR kitties will be a little confused/stressed until you return them back to their colony so Fear Free and understanding it can be extremely helpful.”

Familiarity in the Midst of Chaos

Though there are protocols for trapping, a cat rarely walks into the trap on the first attempt. All cats react to a change in routine with some amount of distrust, and you’re about to put a big change in their routine. Plan the process around familiar elements and adjust as necessary. Here are two examples from my own experiences.

Adding something new to any cat’s environment can create stress. If a cat seems particularly fearful, I’ll often start by conditioning her to the trap: set up the trap, sanitized and sprayed with pheromones, secured open so it can’t accidentally shut, and the cat can walk in and out, rubbing her scent on it. Feed her in the open trap until she seems comfortable, and when ready set the trap so it shuts when she confidently walks in for breakfast.

If the cat has a regular caretaker, they can participate to keep the cat’s routine as familiar as possible. In trapping a colony of 10, I made the plans, set the traps, then left to remove my scent and activity while advising the caretaker in messages. He opened the garage door, greeted them, then sat down with his coffee as he always did. We trapped them all in two days with very little stress because they were confident enough of their circumstances and caretaker to walk into the traps for their food.

Stacy LeBaron, host of the weekly Community Cats Podcast, agrees. “Incorporating some Fear Free techniques into a good trapping plan could benefit both the cat and the trapper during the trapping, surgery, recovery and release stages. Being calm, quiet, and relaxed are bedrocks to successful trapping and colony management,” she says.

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

Bernadette E. Kazmarski is a self-employed commercial artist, writer, graphic designer, illustrator, and fine artist whose portfolio includes hundreds of commissioned pet portraits as well as landscape and wildlife artwork. She is author of the award-winning daily blog The Creative Cat featuring feline and pet health, welfare, adoption, and rescue, plus humor, poetry, and lots of cat photos. Bernadette has been rescuing and fostering cats since 1980 and works with her local TNR organization to TNR or foster/socialize. Her current feline family includes a mom and litter of five incredible house panthers and five former feral rescues in training, plus two rescue fosters from her neighborhood.

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Fear Free Practice Builds Trust With Patients and Clients

Sandra Toney

When she was 12 years old, Karina Salvo, DVM, CTPEP, CVFT, CVMMP, volunteered to work for a one-doctor practice. Cleaning cages, doing laundry, and walking dogs led to watching her first surgeries. From that point, she knew that her career path would lead to veterinary school.

But one thing she and the veterinarians she grew up working for—and later, with—didn’t learn was how to make exams easier on pets. When she became aware of Fear Free®, though, it made sense to her that veterinary visits should be less frightening and more fun for patients.—not to mention for veterinarians and technicians themselves.

“The one thing that I noticed in each and every practice was the frequency in using force to hold a patient,” says Salvo, now an Elite Fear Free Certified® DVM who also has certifications as a palliative and end-of-life practitioner (CTPEP) and in branches of Traditional Chinese Medicine (CVFT and CVMMP). “Some of the staff wrestled what I thought were highly aggressive dogs down to the ground in order to give a single vaccine or draw blood. The end result was someone got hurt, scratched, urine and feces everywhere, and a dog that was left splayed out and panting on the floor in exhaustion or cowering in the corner. This was the ambience of the veterinary field I grew up in.”

As she learned more from Fear Free, she found that in-clinic exams became easier.

Now she owns her own practice, AcuVetDoc Veterinary Reproduction & Animal Care Wellness Clinic, in Royal Palm Beach, Florida, where she treats not only pets but also wildlife. That allows her to see only one patient at a time.

“I can practice 100 percent the way I choose to. I intentionally do not have a receptionist or a technician,” Salvo says. “Patients are scheduled on the hour instead of every 15 minutes. This allows me to work one on one with the patient and the owner. My ‘team’ in my practice is the owner, myself, and the patient. By working together, all of us can better understand the patient and the medicine. Practicing this way has allowed me to build trust in my patients as well as owners because both are comfortable.”

Salvo greets clients and patients at the door so she can watch how the animal walks into the building. If owners have given permission beforehand, treats are on the carpeted floor as they enter.

Animals who have previously had poor experiences at veterinary clinics may be directed into an exam room that resembles a living room—with carpet, a bookcase, leather sofa, chair, and hidden treats. While Salvo sits on the floor, pockets filled with treats, and talks to the owner, patients can explore, approaching when they’re comfortable. If they need more time, Salvo may simply hand out treats during the visit, holding off on an exam. She discusses this possibility with clients beforehand so that they’re aware the first interaction may be a “meet-and-greet,” with the exam portion on a subsequent visit.

Many of her patients enjoy “playtime,” a rewarding exam in which Salvo uses tasty treats to get patients to move on their own but in a fashion that allows her to examine them. For instance, she might get them to sit or turn their head so she can look inside ears or examine the mouth.

One patient who stands out in her memory was a 12-week-old Cockapoo puppy whose first experience at a veterinary clinic had involved being held on an exam table while he screamed, attempted to bite, and urinated and defecated. The veterinarian told the owners that their puppy had mental health issues and should be returned to the breeder. This time they were hoping for a better experience.

Salvo met the owners outdoors, where she had set up chairs and some treats. They sat down, talked about how the puppy was doing at home, and handed out treats to the puppy. Salvo assigned homework: to find tasty, high-value treats that could be dropped on the floor any time visitors came to the home and to be used as rewards during training. She suggested walking the puppy in areas far enough away from people that strangers wouldn’t want to pet the dog but close enough that he could see people, other dogs, and vehicles such as carts. Offering high-value treats during these walks would contribute to forming a positive association with the experience and a connection with the owners.

At the second visit a few days later, Salvo again met the owners outside and had tasty treats already on the ground for her new friend to gobble up. Eventually, the puppy approached her and she was able to perform an exam and give an oral vaccine as the puppy sat next to the clients and received treats.

“On subsequent visits, we sat next to each other outside, and he came and laid on my lap and became more interactive with me and less afraid of the environment,” says Salvo. “With a cheese and Cheerio trail to lead him inside, we made it to the scale and an exam room!”

Three months after that first visit, the puppy frequents farm fairs, Home Depot, and PetSmart, and comes running into the clinic to greet Salvo.

“This is an amazing story with very patient owners who were willing to take their time to understand and provide their dog with what he specifically needed when he needed it, redirection to something positive, protection from being thrown into the middle of a chaotic situation, and to slow introduction to the world around him,” she says.

Fear Free continues to make a difference in her practice. “The best feeling is when the owners are ready to leave and the patient stays behind and makes eye contact with me waiting for another fun treat,” Salvo says, “or when they return and they are pulling their owner into the building.”

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

Sandra Toney has been writing about cats for over 25 years and is an award-winning member of Cat Writers Association and Dog Writers Association of America. She has written for many print and online magazines about cat health and behavior as well as authoring eight books. She lives in northern Indiana with her cat, Angel.

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How to Make Dentals Fear Free for Pets, Clients & Yourself

Jan Bellows, DVM, DAVDC
Wouldn’t it be wonderful if you could approach dentistry without fear, anxiety, or stress?  It can be done and it’s not all that difficult.  Let’s dissect the touchpoints of dental fear and how to replace dread with confidence. 

Client Fear

1. Fear of Anesthesia

This is generally your client’s number-one trepidation. Fortunately, modern, safe anesthesia procedures include (1) evaluating the patient with physical and laboratory exam beforehand, (2) tailoring medication protocols to the patient, and (3) constant monitoring while anesthetized and during post-anesthesia recovery. Sharing these safety measures with your clients goes a long way to alleviate their fear.

2. Fear of Tooth Loss

Often clients will ask “How will my dog eat if you extract so many teeth?” The reply should be “Better than ever before because by removing the diseased teeth, the mouth will now be pain-free.”

3. Fear of Expense

This concern is often shared by both the client and veterinarian. To mitigate this fear, concentrate on what needs to be done to provide the pet with a pain-free, healthy, “happy” mouth. When asked “What is this going to cost?” early in the exam, answer that you will discuss fees “before we leave this room” and “cost is going to be part of the good news.” This can help set the client’s mind at ease and allow them to focus on their pet, the exam you’re performing, and the expertise you’re sharing. Once you’ve established an optimum treatment plan, you can work together to find the best way to make it happen, including payment.

Keep in mind that clients are used to going to their own dentist and are familiar with dental costs. Fortunately, most veterinary practices offer financing, such as the CareCredit healthcare credit card,
 as a payment option. This allows clients to pay for their pet’s dental care over time in budget-friendly monthly payments rather than the entire cost upfront.

Functional vs. Optimal Care

There are bound to be challenges on the path from the basic dental care to optimum care. Most clients want to do the very best for their pet, but cost and time commitment with after care can be barriers. Our job is to provide them with solutions that make the best care possible—budget-wise, time-wise, and health-wise.

Root planing, local antimicrobial administration (LAA), 
and laser periodontal surgery are often recommended for optimum care, but these simply may not be in the financial comfort range of some clients. This is where payment options can help to pay for the care they want for their pet or they can choose functional care.

Some pet owners may be unable or unwilling to provide needed follow-up care. In these cases, multiple extractions are usually necessary to create a pain-free, functional mouth. It may not be gold standard, but the pet will receive great basic care that supports quality of life.

Perhaps the most important thing to remember is that moving clients from fear to acceptance for their pet’s dental care is possible when we take the time to communicate the value and not just the cost. 

Veterinary Fears

1. Oral Surgery

While the goal in veterinary dentistry is to save teeth, it often becomes necessary to remove some or all of the teeth. Indications for extractions include fractured teeth, advanced periodontal disease, non-functional orthodontic disease, and chronic ulcerative conditions. Oral surgery fears include excessive bleeding, inability to remove the entire tooth, jaw separation, and dehiscence. Fortunately, these worries are easy to change into happy opportunities.

  • Excessive bleeding can be mitigated through avoidance, realizing that in the maxilla the most troublesome area surrounds the infraorbital artery, which exits the infraorbital canal just above the maxillary third premolar. In the mandibles the area to avoid is the mandibular canal. When either of these are breached, bleeding occurs, which can be minimized by elevating the head with towels, applying a hemostatic agent (Vetigel®), and gauze pressure.
  • Inability to remove the entire tooth through root separation can usually be prevented by examining intraoral radiographs before the procedure, large exposure, and gentle luxation with a sharpened luxating elevator.
  • Jaw separation, occurring usually secondary to advanced periodontal disease, is rare.  Consultation with a veterinary dentist is recommended.
  • Dehiscence is also rare and, in most cases, should be left alone to self-heal.

2. Not enough time

This proven workflow can eliminate time fears.

A client calls to schedule a teeth-cleaning visit due to oral malodor. The client care coordinator shares that your practice provides more than teeth cleaning. The client will be scheduling an appointment for oral prevention, assessment, and treatment (Oral PAT). This is the time to be sure clients understand the value of complete oral care:

  • There is a dental cause for their pet’s halitosis.
  • This will be diagnosed during the initial oral examination, pre-anesthesia testing, as well as a tooth-by-tooth examination under general anesthesia.
  • Recommended treatment for the cause will be discussed, and it can be performed during the same anesthesia, time permitting, or at a later time.
  • The doctor will make plaque and tartar control suggestions the client can perform at home to support overall oral health.

Here’s a timeline example…

9 a.m. The owner brings their dog or cat into the exam room. Review the history and previous laboratory results, examine the pet, and focus on the oral cavity. Discuss owner willingness and ability to provide daily plaque control. Share the value of the services, then discuss fees for  initial diagnostics and dental scaling and radiograph imaging before the client leaves the exam room. The client agrees in writing that they understand:

  1. Anesthesia will be performed, and they have been informed of the associated risks.
  2. There will be additional fees if extra care is needed to treat the cause of the malodor.
  3. Payment options are discussed openly.

Next, inform the client what to expect from the day and arranges a time (1 p.m.) to speak to the owner while the pet is still anesthetized after the cause of halitosis has been determined.

9:30 – 11 a.m. The staff acquire pre-anesthetic test results to share with the veterinarian and prepare the patient for anesthesia.

11:30 a.m. – 12:45 p.m. The patient is anesthetized, teeth are cleaned, intraoral radiographs are exposed and placed in
 a template for the veterinarian to examine chairside. The veterinarian is handed a dental probe to conduct the tooth-by-tooth examination and treatment plan, dictating results to an assistant who creates the dental chart. The assistant tabulates additional fees and creates a report or takes cell phone images, which are emailed to the client.

1 p.m. Talk to the pet owner to review what was found and describe optimum treatment and why it is important for their pet. Fees for the additional care are discussed, along with payment options.

3 p.m. Therapy (e.g., extraction of multiple teeth and application of a locally applied antimicrobial to stop bleeding on probing points) is completed.

5:30 p.m. The client meets with the doctor to review the diagnostics and therapy. A follow-up appointment is set to evaluate healing and create a daily plaque prevention program tailored for the pet.

3. Proper Assistance, Equipment & Instruments

An assistant goes far to lessen the load on the veterinarian during dental treatment.

Proper instruments and equipment are also important:

Elevators: Because there are a variety of sizes of teeth, one needs a variety of sizes of dental elevators. Generally, select the elevator that best fits the contour of the tooth to be extracted. The Heidbrink and Miltex 76 are root tip picks useful in elevation and for extracting retained root tips. They also can be used to cut the gingival attachment off the tooth prior to displacement with dental elevators.

Extraction Forceps: Smaller extraction forceps have been designed for dog and cat teeth. They have more parallel jaws, increasing the surface contact and are much more effective than the human incisor forceps formerly used in veterinary dentistry.

Magnification & Lighting: One frustrating aspect of oral surgery is the limited access and poor visibility. These problems may be decreased using magnification (2.5-3 power) and head lamps.

Sterilization of Equipment: Since extraction is a surgical procedure and the instrument penetrates tissue sterile instruments should be used. While it is true that the tissue surrounding the tooth is already infected, it is inappropriate to add different species of bacteria to the infection. Chemical disinfectants may be effective, but they take time to work, and must be thoroughly washed off prior to use.

Hemostatic Agent: Vetigel® is used to syringe over a bleeding area. Within a minute the bleeding generally stops.

Flaps: Surgical extractions are performed by making releasing incisions on the mesiobuccal and distobuccal line angles between adjacent teeth. These releasing incisions are joined by an intrasulcular incision that follows the gingival margin. The periosteum and gingiva are elevated off the bone with a periosteal elevator, to create a full-thickness gingival flap. The buccal plate of bone over the tooth is removed with a water-cooled high-speed bur.  The root is removed, and the flap is closed without tension over the alveolar socket.

Postop

Radiographs taken postoperatively allow the practitioner to verify that the entire tooth has been extracted. Radiographs create a permanent record of the procedure. The possible pain to the patient caused by the disease condition or the procedure creates the need for consideration of pain medication administered by injection of a local anesthetic, parenteral injection, and oral pain relief medication.

Complications

  • Tooth roots may become separated during the extraction procedure, creating non-extracted root fragments. The preferred treatment in this situation is to create a buccal flap over the fragment for removal.
  • Collateral damage to other oral or extra oral structures including perforation and orbital contusion of the eye with sharp dental instruments.

Using proper instrumentation and extraction technique makes the extraction simpler, safer, and easier on the patient and practitioner. Multirooted teeth should always be sectioned prior to extraction to prevent the likely hood of fractured root segments. Difficult extractions can be accomplished by gingival flap surgery to facilitate atraumatic elevation of the root in a buccal direction. Pre- and postoperative radiographs and pain control help document what has been done and provide the patient with a relatively painless procedure.

Pet Fears

Let’s not leave out the patient, who is our most important consideration. Fear Free practices such as use of nonslip surfaces and techniques such as considerate approach and touch gradient contribute to the success of dental procedures.

Creating a Fear Free dental practice is achievable. I am always happy to help. Please email any questions (dentalvet@aol.com) or call on my cell 954-465-4200.

References

  1. DeBowes LJ. Simple and surgical exodontia.Vet Clin Small Anim 2005; 35:963–984.
  2. Gunew M, Marshall R, Lui M, Astley C. Fatal venous air embolism in a cat undergoing dental extractions.J Small Anim Pract2008; 49, 601–604.
  3. Holmstrom SE, Frost, P, Eisner ER. Exodontics. In:Veterinary Dental Techniques for the Small Animal Practitioner. 3rd ed. Philadelphia: Saunders, 2004, pp. 291–338.
  4. Kapatkin AS, Manfra Marretta S, Schloss AJ. Problems associated with basic oral surgical techniques. In:Problems in Veterinary Medicine. Dentistry. Manfra Marretta S ed., 1990; 2: 85–109.
  5. Reiter AM, Brady CA, Harvey CE. Local and systemic complications in a cat after poorly performed dental extractions.J Vet Dent 2004;21: 215–221.
  6. Reiter AM. Dental surgical procedures. In:BSAVA Manual of Canine and Feline Dentistry. Eds. C. Tutt, J. Deeprose, D. Crossley. BSAVA, Gloucester (UK), 2007, pp. 178– 195.
  7. Scheels JL, Howard PE. Principles of dental extraction.Sem Vet Med Surg 1993; 8:146–154.
  8. Smith MM, Smith EM, La Croix N,et al. Orbital penetration associated with tooth extraction. J Vet Dent 2003;20:8–17.
  9. Van Foreest A: Exodontia (tooth extraction in dogs).EJCAP 1993; 3:35–42.
  10. Verstraete FJM. Exodontics. In:Textbook of Small Animal Surgery. Philadelphia: WB Saunders, 2003; 2696–2709.

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

Dr. Jan Bellows received his undergraduate training at the University of Florida and Doctorate in Veterinary Medicine from Auburn University in 1975.  After completing a small animal internship at The Animal Medical Center in New York City, he returned to south Florida where he still practices companion animal medicine surgery and dentistry at ALL PETS DENTAL, in Weston Florida. He is certified by the Board of Veterinary Practitioners (canine and feline) since 1986 and American Veterinary Dental College (AVDC) since 1990  He was president of the AVDC from 2012-2014 and is currently president of the Foundation for Veterinary Dentistry. Dr. Bellows’ veterinary dentistry accomplishments include authoring five dental texts – The Practice of Veterinary Dentistry …. A team effort (1999), Small Animal Dental Equipment, Materials, and Techniques (2005, second edition 2019) and Feline Dentistry (2010, second edition 2022).  He is a frequent contributor to DVM Newsmagazine and a charter consultant of Veterinary Information Network’s (VIN) dental board since 1993.  He was also chosen as one of the dental experts to formulate AAHA’s Small Animal Dental Guidelines published in 2005 and updated in 2013 and 2019.

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How to Conduct a Fear Free Pain Exam for Cats

Michael Petty, DVM, CVPP, CVMA, CCRT, CAAPM/strong>The approach to a pain exam in a cat barely resembles what you might do with a dog, who you can take outside on a leash and trot around, and who are usually more accepting of a physical exam for pain. Instead, I am going to describe the team approach to diagnosing pain in cats.

Owners often report that their cat has become grouchy or will even growl and strike out while being petted or picked up. The underlying cause could be that the cat is in pain and doesn’t want to be touched out of fear of causing more pain. It’s much the same as a person with a painful wrist or shoulder; they understand how to move that arm without causing undue pain, but a well-meaning handshake from another person can cause excruciating pain as the person with the painful arm loses control of the movement.

This leads us to the beginning of the pain exam: discussing with the owner behavioral changes they have either observed but dismissed (often as “old age” or some new quirk) or behavioral changes such as elimination outside the litter box. Indeed, a 2020 study published by Daniel Mills et al. in the journal Animals called Pain and Problem Behavior in Cats and Dogs found that it is estimated that almost 80 percent of behavioral issues can be related to various painful conditions; not only musculoskeletal, which is the focus of this discussion, but also other sources such as gastrointestinal pain. Hence it is crucial that every member of the veterinary staff plus the owner be involved in order to properly diagnose, treat, and evaluate the progress of any therapy. Otherwise, the mental snapshot of the animal in pain might be as jumbled as a jigsaw puzzle dumped out of its box.

The pain exam starts with your customer service representative, maybe the most important person in the diagnostic team. They are going to hear the owner say things that an educated customer service representative might recognize as a sign of pain, such as not using the litter box, suddenly fighting with other animals in the house, or hiding in another room. The receptionist then has the ability to ask the owner to video the cat walking across the floor, using a step, or jumping to a favorite spot. The receptionist can also ask them to visit websites, for example www.catredflags.com, to set the stage for a pain discussion once in the clinic.

The pain exam continues with the technician who, clued in by the receptionist that there might be a pain problem, can ask about videos. If the client did not visit any of the suggested websites, the technician can have them do so on a clinic tablet or laptop.

At this point, it is important to ask about behavioral changes: has the cat’s world become less vertical and more horizontal? Does the cat hesitate to jump or jump up in stages using a chair, for example, to reach a windowsill? Does the cat socialize less with humans or other animals in the household? There are more examples on the website mentioned in the previous paragraph. All of these inquiries help to “soften up” the client for the message that their pet may be living in a constant state of pain and has been telling them all along through their actions.

The pain exam concludes with the veterinarian, whose success in diagnosing pain depends heavily on the events and education preceding the examination. Without them, the owner might not see the cat through the eyes of someone trained to recognize pain in cats.

I always start my pain exam by letting the cat wander the room, keeping an eye on how they move and jump. Cats should move like a tiger gracefully moving through the jungle, with a fluidity of movement. Of course, some cats do nothing but hide under a chair during the visit, so this is the importance of asking the owner to take videos: This is my number-one diagnostic tool to know that “somethin’ ain’t right” with the cat’s musculoskeletal system. Pointing out what we see to the owner brings them a new sense of enlightenment regarding the cat’s condition.

Once I know something is wrong, I finally put my hands on the cat to locate the problem. The physical starts with stroking the cat from head to tail, in a gentle pattern. For many cats in pain, this will relax them and build a trust that will allow you to do slightly more potentially painful manipulations. You can also look for areas of sensitivity at this gentler touching. When these painful spots are found, there is no longer any need to revisit them; what more can you ascertain or achieve, besides increased stress in the cat?

The next step is to focus the exam on suspect areas. By this time, you may have an idea as to the general body area where the pain is located. If so, depending on the cat’s FAS score, I may examine only those joints, as the exam is over when the cat says it is over, and further manipulation may result in a heightening of their FAS score, indistinguishable from a response to pain. I find it easier to manipulate the cat’s joints when they are in lateral recumbency.

Manipulation of the elbow in a recumbent position. Please note, this is my daughter’s cat Alvin who is very compliant. This cat is not being scruffed; his head is only being held in place.

However, some cats will not allow that to happen. The exam can also be done with the cat in a standing position.

Examination of the lumbosacral joint in a standing position.

Each joint needs to be gently extended and flexed to look for resistance, but not to the point of causing undue pain. Again, if you are trying to persuade yourself or the owner that there is an issue, this is not the way to do it. For videos on how to do a complete pain exam on a cat, visit https://www.zoetisus.com/oa-pain/feline-exam-videos.aspx to see Dr. Duncan Lascelles demonstrate.

This brings us to radiographs. Some cats have either a demeanor or pain level so high that a physical exam should not be performed. If we are convinced that the issue is pain, it is now become less important to know the exact location, thanks to the approval of frunevetmab, an anti-NGF monoclonal antibody that is distributed to all of the OA joints in the body.

However, if we are not convinced, or we hope to do directed therapy such as acupuncture or rehabilitation therapy, then radiographs are a must. These should always be performed with something to reduce the cat’s anxiety and pain during the radiographic study. I prefer butorphanol as it gives 15 minutes of mild to moderate pain control as well as an additional few hours of somnolence, which can help ease the cat’s anxiety while waiting to go home. Just remember, the pain control lasts only about 15 minutes or so after injection; don’t confuse any sleepiness on the cat’s part past 15 minutes as pain control. And a final word on radiographs. Many cats with OA actually form areas of calcification distant from the joint. If you haven’t brushed up on diagnosing OA on radiographs in cats, you may want to explore that further.

Notice the distribution of calcification in this cat with knee OA. There is a typical lesion on the left knee but both knees have areas of calcification proximal to the joint. Sometimes they will even be seen floating in an adjacent muscle. Another reason to consider that cats might actually be aliens.

Utilizing the team approach and minimal hands-on interaction can greatly diminish the FAS in our painful feline patients who are going to be resistant to touch. Now that we have examined that cat with input from the entire veterinary staff, along with the owner and the cat itself, we no longer have a jigsaw puzzle, and can move forward with the therapeutic phase of their OA treatment.

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

Michael Petty, DVM, a certified veterinary pain management expert and veterinary acupuncturist, is author of Dr. Petty’s Pain Relief for Dogs: The Complete Medical and Integrative Guide to Treating Pain (Countryman Press, February 2016). He owns Arbor Pointe Veterinary Hospital and the Animal Pain Center in Canton, Michigan, and is past president of the International Veterinary Academy of Pain Management.

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