Low-Stress Handling in the Veterinary Clinic

PRESENTATION

BROCHURE

Low-Stress Handling in the veterinary eBook clinic available This book is intended as a practical guide to enable small animal clinical veterinary surgeons and their teams to improve various aspects of their everyday practice: how they understand and relate to patients and clients, how they manage their work, the handling of animals during different procedures, and the implementation of programmes to deal with behavioural issues. These aspects will have a highly positive impact on the wellbeing of the patient, the client, and the veterinary and support staff, with the implementation of smoother and effective procedures.

TARGET AUDIENCE:

✱ Small Animals vets.

Animal behaviour RETAIL PRICE ✱ Veterinary nurses ✱ Veterinary students FORMAT: 17 × 24 cm.

NUMBER OF PAGES: 152 NUMBER OF IMAGES: 150 BINDING: hardcover PUBLISHING DATE: September 2020

€49

Authors ROSANA ÁLVAREZ BUENO Degree in veterinary medicine, food science and technology, master’s degree in apllied animal behavoiur and AVEPA-certified in behavioural medicine.

GERMÁN QUINTANA DIEZ Degree and PhD in veterinary medicine, master’s degree in small and exotic animal medicine. He undertakes his clinical activity in the Internal Medicine Department of the A Marosa polyclinic, focusing on animal behaviour and dermatology.

KEY FEATURES:

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Includes videos of the most relevant procedures.

Contains the main handling techniques.

Has a large number of images.

Explains the ethological basis of low stress management.

Low-Stress Handling in the veterinary clinic

Presentation of the book Low-stress handling provides a new approach on how to address veterinary clinical practice to reduce stress and to make procedures more efficient. The idea is to provide an environment where animals feel comfortable and secure, while we clearly communicate what is expected of them.

For animals, a veterinary practice is a stressful and threatening environment because: • It is not a natural or familiar environment.

• Typically, due to lack of time or knowledge in learning theory, our patients are not habituated to the procedures to be performed, producing a negative emotional burden that may gradually increase over future visits.

• The clinic itself has numerous stimuli that are threatening to the animal, the majority of which are unknown or unforeseeable.

Low-stress handling seeks to reduce threatening stimuli and attempts to maintain the wellbeing of animals during their time at the clinic, making their visit more pleasant and resulting in feelings that are less negative.

The less-negative perception and processing of their experiences will result in a change in the animals’ behaviour, reducing fear, aggression, and avoidance behaviour. In addition, other organic parameters will also improve: immunity, blood parameters, pain threshold, and stiffness on examination. Tension in the owner, the professional, and the team will also be reduced.

Concepts, techniques and theories such as dominance, forceful restraint, the alpha roll, restraint cages, confinement, and use of force for animal handling must be removed from our daily clinical practice. A single negative experience can condition a fear response ad eternum to the clinic, resulting in restlessness, flight attempts, or aggression at subsequent visits.

The benefit of low-stress handling is not only seen in the animal, but also in the owner and in the clinic: • Increasing the animal’s and the owner’s trust in the clinic.

• Promoting an understanding of animal language, the science of learning, and the use of protocols to make animals feel more comfortable at the clinic.

• Increasing the safety of the veterinary and auxiliary team.

• Increasing the efficiency and proper flow of all work processes.

• Improving client relationships and communication.

• Establishing a stable and positive working environment that encourages teamwork.

The authors Rosana Álvarez Bueno Degree in veterinary medicine and food science and technology from the University of Córdoba (UCO) in 1997 and 1999, respectively.

Master’s degree in applied animal behaviour and welfare from the University of Zaragoza (UZ) in 2013. AVEPA-certified in behavioural medicine in 2013. Member of AVEPA (Spanish Small Animal Veterinary Association), of its animal behaviour group (GrETCA) and of the European Society of Veterinary Clinical Ethology (ESVCE).

Director of Etolia, a company that provides veterinary services specialising in dog and cat behavioural medicine, in Málaga since 2006. Rosana Álvarez currently provides consultation services at the Bahía de Málaga referral veterinary centre and makes home visits.

Instructor of cat and dog behaviour and dog training courses nationally and internationally. Speaker at various seminars and workshops. She is the author and coauthor of publications in scientific journals and papers at Spanish congresses in the field of applied animal behaviour. Collaborator in various scientific and nonscientific blogs and publications.

Low-Stress Handling in the veterinary clinic

Germån Quintana Diez Degree and PhD in veterinary medicine from the University of Santiago de Compostela (USC) in 2002 and 2013, respectively. Master’s degree in small and exotic animal medicine from the USC in 2004, master’s degree in applied animal behaviour and welfare from the Complutense University of Madrid (UCM) in 2009.

He completed an internship in animal medicine and surgery at the USC Rof Codina Veterinary Teaching Hospital from 2003 to 2005, and was a visiting fellow at renowned national and European clinical institutions.

He undertakes his clinical activity in the Internal Medicine Department of the A Marosa polyclinic, focusing on animal behaviour and dermatology.

hkeita/shutterstock.com

He is the author and coauthor of publications in scientific journals and papers in Spanish and European congresses in the field of applied animal behaviour, dermatology, and internal medicine.

Table of contents 1. Veterinary behavioural medicine The advent of animal behaviour studies Behavioural medicine The role of the veterinary professional How to identify a behavioural problem What is a behavioural problem?

2. The emotional world of cats and dogs and agonistic behaviour Identifying emotions Fear and anxiety Agonistic behaviours

3. Communication In dogs In cats

4. Nonassociative learning Habituation Sensitisation Exposure to new stimuli

5. Associative learning Classical conditioning Operant conditioning

6. Behaviour modification techniques Systematic desensitisation Classical counterconditioning Operant counterconditioning Extinction Flooding

7. Travelling to the clinic Home treatment Training to use a carrier The car journey Handling on the lead Placing a muzzle

8. The reception and waiting room Entrance Reception Waiting room

9. Consultations Consultation room Equipment Protocols

10. Hospitalisation The hospitalisation area Intensive care unit (ICU) Rest Visits from owners

11. Pheromone therapy What are pheromones?

Pheromone release sites Pheromone therapy

12. Psychopharmacology Anxiolytics Antidepressants Mood stabilisers Antipsychotics α-2 Agonists Practical sedation protocols

13. Handling techniques Guiding or luring Venipuncture Examining the head Towel techniques Syringe extension Ninja technique

Appendix BIBLIOGRAPHY

Plaza Antonio Beltrán Martínez, 1 Centro Empresarial El Trovador planta 8, oficina 50002 Zaragoza, Spain

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+34 976 461 480

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LOW-STRESS HANDLING IN THE VETERINARY CLINIC

The veterinary clinic represents a stressful and threatening environment for the animal.

Low-stress or pet-friendly handling involves an approach to veterinary activities that reduces stress for patients and therefore increases procedural efficiency (see Video 9 in the Appendix). The underlying principle is to create an environment where the animal feels safe and comfortable, while clearly communicating what is expected from them.

The main aim of any pet-friendly procedure is to obtain the patient’s voluntary collaboration, thereby circumventing insofar as possible the need for rough, uncomfortable, or painful handling manoeuvres.

Guiding or luring This technique consists of using a reward or reinforcer to lure the animal. It can be used to convince the animal to move or adopt certain

postures which can be reinforced, so there is a great chance they will repeat them in the future.

Touch or target This involves teaching the animal to touch a surface (e.g. the palm of the hand, a piece of paper, or a stick) and subsequently using this skill to guide the animal.

Sitting Persuading an animal to sit is a basic and very easy skill to achieve during consultations using operant conditioning and the luring technique or gentle handling. A sitting posture affords greater control over the animal during examinations or other procedures (Box 1) and represents a starting point for further pet-friendly handling techniques.

When animals are sat down they are more static and comfortable than when standing, thus reducing the examination time and amount of handling. For example, there is less chance of having to take a blood sample more than once in a seated animal than with one that is stood up.

However, avoid making animals sit down if they may find the position uncomfortable.

Box 1. Examples of different examinations and procedures that can be carried out in a sitting position.

Examination

Procedures

Ear ■ Eye ■ Mouth ■ Weighing

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Drawing blood from the cephalic vein Peripheral intravenous catheter insertion ■ Ocular tonometry ■ Vaccinations or microchipping ■

Handling tecHniques

To ensure the animal remains seated, first use luring by placing a piece of food between the fingertips (Fig. 1a) or, in the case of impetuous cats and dogs or ones with poor control over their bite, hold it between your fingers but nearer the palm (Fig. 1b).

Give the animal several tasty rewards in order to capture its attention, then guide it towards the desired posture by placing the lure in front of its mouth and moving it up and backwards over the animal’s head.

The animal will tend to sit down when this method is used, which is when they should receive the reward (food) or reinforcement (by saying “good boy”, for example) (Fig. 2). Animals that stand up immediately after receiving the reward should be constantly given more treats as long as they remain seated, in fact, the owner could do this while the vet carries out the examination or procedure.

Problems can arise while using this method, so you should have some strategies ready to deal with them (Fig. 3).

Some dogs will have such a high level of stress or fear that they will not be interested in the lure no matter how tasty the reward, how suitable the tone of voice, or how friendly the handling may be. In such cases, gentle, painless physical handling should be used to persuade the animal to sit down. To do this, the veterinary surgeon or

a

b

Figure 1. Reward placement strategies.

nurse should position themselves to the side of the standing dog and place one hand on its chest and the edge of the other hand behind the stifle joint. Lightly push the chest backwards while holding the edge of the other hand still, so the stifle bends with very little force and the animal will sit down (Fig. 4). For small dogs, just place one or two fingers behind the stifle joint.

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LOW-STRESS HANDLING IN THE VETERINARY CLINIC

a

b

c

d

Figure 2. Application of the luring technique to encourage a dog to sit down.

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Figure 3. Examples of potential problems while trying to persuade a dog to sit down. With impetuous animals, or if the reward is held too high, the animal will tend to jump up (a); this can be avoided by placing the lure closer to its head. Some animals may bite the hand holding the lure (b); this is discouraged by using less appealing rewards or holding it between the base of the fingers, close to the palm.

Handling tecHniques

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b

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Figure 4. Persuading a large dog to sit using a petfriendly, physical handling technique.

Lying down Lying down is another basic posture and very easy to achieve in a familiar, relaxed environment using operant conditioning and the luring technique, but it is hard to attain in new, unfamiliar, and hostile surroundings. Therefore, it is not very useful in consultations, except with animals that lie down readily, feel comfortable in this position, or have learnt the skill at home and do it voluntarily.

This position does not hold much advantage over a sitting position; however, it represents the starting point for other postures that are helpful during a physical examination such as lateral recumbency.

If the animal is comfortable and relaxed, a lying position does not pose any risk. On the other hand, if the animal is frightened or in pain, this posture will enhance its perception of being trapped, causing it to be tense, stressed, and vigilant. This will have an adverse effect on the examination and diagnostic tests, increase the risk of aggression, and contribute to a negative emotional state that will complicate future appointments.

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Alternative ventral examination

When the vet needs to examine the ventral area and the patient is uncomfortable in lateral recumbency, it can be carried out as follows. With large animals that accept rewards, they should be guided towards the examination table by an assistant or the owner and encouraged to raise their forelimbs onto the edge of the table to obtain the rewards (Fig. 5), thereby allowing the vet to examine the ventral area and perform the necessary procedures. In the case of small animals, the ventral area can be examined by gripping the patient under their axillae and lifting, while trying to ensure their hindlimbs are supported by the table (Fig. 6a) or the vet’s body (Fig. 6b) so the animal feels comfortable. As a general rule, dogs feel more comfortable in this position rather than when being forced to lie down.

Figure 5. Ventral examination of a large dog that is reluctant to take up a lying position.

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b

Figure 6. Ventral examination of a small dog that is unwilling to remain lying down.

Handling tecHniques

Lying in sternal recumbency To persuade a dog that is not familiar or used to the position to lie in sternal recumbency first get them to sit down. Then hold a piece of food in front of their mouth and lower it to the floor in a position caudal to the dog’s head (Fig. 7). The reward is given once the dogs is lying down or in successive approximations until it eventually lies down.

If the dog is reluctant to lie down, try to find another means of performing the examination;

a

notwithstanding, it is a good idea to show owners how to train their pet to adopt this position for future appointments and as part of their education. There are a few tricks to help encourage dogs to lie down, such as squatting or creating an arch with one leg and luring the dog underneath, hence the animal will lie down as part of a playful activity in order to earn its reward (Fig. 8a).

Instead of a leg, objects such as chairs can be used for large dogs (Fig. 8b).

b

Figure 7. Luring a dog into the sternal incumbency position.

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Figure 8. Using a lure and aids to coax a dog into sternal incumbency.

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Exercises performed in the first few consultations will save effort, time, and resources, and reduce risk in future appointments.

To return the animal to a sitting position and continue the exam, hold a reward above its nose (Fig. 9a) and slowly raise it until the dog assumes a sitting position, then hand over the reward (Fig. 9b). Do not lift the lure too high or the animal might jump up.

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Figure 9. Changing from lying to a sitting position using the luring technique.

To get an animal that is comfortable in sternal recumbency to adopt lateral recumbency, the veterinary surgeon should position themselves to one side (Fig. 10a), place the reward close to the side of the patient’s mouth, and rotate it so the dog’s head follows (Fig. 10b), hence the animal’s body will turn and it will lie on its side (Fig. 10c).

If the dog is not interested in food rewards or is uncooperative, the vet could opt for physical but friendly handling techniques. They should position themselves on the floor beside the animal and, while the owner gently and firmly holds the dog’s head, the veterinary surgeon or nurse passes both arms over the patient’s back and takes hold of both limbs on the side nearest to them. The professional then pulls the dog’s legs to unbalance and roll it gently (Fig. 11a) on top of their lap, before sliding the dog down into lateral recumbency on the floor in front of them (Fig. 11b). If the animal is aggressive or wary, it should be muzzled (it must already be habituated to a muzzle) during the manoeuvre or sedation could be considered in order to carry out the examination or other procedures.

Knowing how to maintain the animal in lateral recumbency is just as important as performing the technique correctly (Fig. 12). The veterinary nurse or owner should firmly yet gently hold the patient’s legs that are in contact with the floor and place their forearm over the neck area to prevent the dog from lifting its head. If the owner is not assisting, they should remain in the dog’s view and even stroke their pet to help relax it.

Handling tecHniques

a

a

b

b

c

Figure 10. Using a reward to lure a dog into lateral recumbency.

Figure 11. Persuading a dog to assume lateral recumbency on the floor using pet-friendly, physical handling techniques.

If the animal is nervous and the examination becomes complicated the vet can choose to perform it in the absence of the owner or even recommend sedation, provided that it is compatible with the animal’s state of health.

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