Hello, Anthony Chadwick from the webinar. Vet. Welcome to another episode of Vet Chat.
We're in the beautiful cathedral viewing room. You can't actually see it, but we've got a big cathedral, just in front of us. And, I'd like to welcome Doctor Sarah Heath who's gonna be talking to us about all things behavioural as usual.
This episode is sponsored by Forte Healthcare, the marketing authorization holders of Reconcile. So, Sarah, . Do you think behaviours like a veterinary topic, then do you?
I love the way you wind me up, Anthony. Yes, veterinary behavioural medicine is very definitely a veterinary discipline. Something we've been working very hard to establish over a number of years.
There are now specialists like myself and, Daniel and, Rachel Casey, who are recognised by the Royal College of Veterinary Surgeons for being specialists in this field. So I think we have actually got to the point where it is recognised as a veterinary discipline. That's great, cause I remember of course we were in a dermatology conference many many moons ago, and you very much brought this up as a concept, which I think in our heads we kind of understood but hadn't maybe thought about it obviously as deeply as you had about.
Animal disease, there's a physical element, but there's also very much an emotional element, a cognitive element as well, isn't it? All diseases sort of connected, it's not just physical, is it? Yeah, and I think this is really important for our profession to think about the fact that healthcare has got these three equally important dimensions, because at vet school, we all know we concentrate so much on physical health, and we have to, there's an awful lot to learn.
5 years never feels quite long enough to do the physical disease parts. But we do need to remember that health also has an emotional and a cognitive component. That those parts of what's termed the health triad are equally important to each other.
And you can't actually treat one without the other. So, if you're gonna do better veterinary care in terms of physical disease, better diagnostic procedures, more accurate clinical examination, you need to consider the emotional health and the cognitive health of the patient as well as the physical. And again we were both at ISFM which sort of coincidentally was in Rhodes, that was no reason why we were there cos I know we both love ISFM as a conference.
I'm very much, again, very central stage wasn't it, and diseases like whatever you want to call it, FIC stressed bladder, but it's interesting, some of those conversations are going on now about even how we define the diseases. Yeah, absolutely. I think Danielle Gilmore's been quite vocal about the fact that she wants to bring the word stress or emotion or into the title so that people actually realise that something like what we currently call FIC is a physical disease.
But it has to be treated taking into account emotion. And if you don't do that, you'll only get partial recovery. You'll get flare-ups of the disease ongoing, and the welfare of the animal is best served by looking at this from a more sort of rounded healthcare approach.
And sometimes this just means rehoming the cats because it doesn't like living with 10 dogs and 15 cats, does it? Yeah, I, I think what we need to think about is, are we optimising the environment for these individuals and obviously IA care ISFM, the American Association. Feline practitioners work really hard to produce these very, very good guidelines.
One of those is on feline environmental needs, and it really talks about the fact that it's where the cat is, and is that optimal for them as a species. And again, for us as vets, when we think about behavioural medicine. I think about the animal in the whole of the animal, so obviously behavioural medicine very strongly linked to the brain and how the brain functions and how, your emotional systems influence your physical health in, in that way that links between.
Gut and brain through the gut brain axis, for example, but it's also about thinking about the species, you know, if it's a cat, if it's a rabbit, if it's a parrot, if it's a reptile, is it living in an environment that actually meets the needs of that species? And it's fascinating when you give them the chance to show their proper behaviour, you know, the, the cat that adopted me and my wife during the pandemic, buddy who I like, I know you know I like to talk about, he very much decided. To leave home because home was too busy for him.
Yeah, he just wanted a retirement home too many people around. Yeah, so rather than being in buddy's case, rather than being with a busy family with lots and lots of activity, moved down the street to live with you and your wife where it's nice and quiet. But obviously.
That was in, you know, the, the caregivers of him knew that was what had happened. So we're not recommending taking in other people's cats and feeding them. But this was something that was done with the cooperation of the caregivers who he had, he realised that he was struggling and he was actually happier, in a quieter environment.
So speaking about the triad of health, obviously I think as vets we all understand physical health because it's what we spend, as you say, most of our time at university studying and then. Clearly we've now begun to look more at emotional and cognitive, but Can you explain what you mean by emotional and cognitive for me? Yeah, so emotional health is to do with those systems identified by PANSA that are about how behaviour is motivated, how behaviour is generated, which is using the amygdala, the limbic system part of the, of the brain, and it's about how that, those different ways of motivating an individual result in different behavioural outputs.
Cognition is about how you process information in terms of things like learning and memory. So let's take an animal who comes to the veterinary practise, who's got, for example, a disturbed gastrointestinal tract, so comes in in abdominal pain, maybe with a history of diarrhoea. So here we have a dog who has got a physical health problem.
He's got diarrhoea and abdominal pain. May well have an emotional problem on many levels. The pain is an emotion as well as a physical sensation.
The gut brain axis means that there is a relationship between disturbed gut function and serotonin levels, and that can mean that you have more protective emotion. You're more likely to be protective in your behavioural responses. And then, whilst in the veterinary practise, this animal makes an associative.
Learning link between being in pain and being in the veterinary practise and is learning from that and developing in an association cognitively, which may then mean that when they next come to the practise, even though their gut doesn't hurt, they have an expectation because of their learning that this will be somewhere where I feel unwell or where things will be unpleasant. So that's their cognitive health. And we can be cognitively very well.
So in the dog world, a really, a dog who has very good cognitive health could be a champion agility dog or a champion obedience dog. So can learn brilliantly and can function in a cognitive way very, very well, but be emotionally very ill. So may actually be very, very anxious or become very frustrated.
When they're in that context, so they go to their show or their agility and they perform very well, but then they show behavioural disturbances at home, because emotionally, they're not very well. So, you can be unwell in any of the parts of the triad independently. You have good physical health, with poor emotional health and good cognitive health, or any combination of those, can happen, which is why they need to always be looked at together.
How do we deal with that dog that comes in with the gastrointestinal problem and then is gonna associate that with the vets, is there any tricks, tips that you can give us to try and lessen that association? Yeah, absolutely. So we can think about obviously if there is discomfort using pain relief more promptly than perhaps we sometimes do for things like gastrointestinal disease.
We also can think about, how we set up the environment that the animal's coming into so that we can favour more engaging emotions because emotions are like a balancing scale, and as one, if one is high, you can then elevate the other one. It doesn't mean you've got rid of this one, there's still pain and discomfort, but if you can increase their positive in relation to it, then that can help with the learning process. If the dog is really struggling, then we can give medications that will block memory formation to stop them from having, you know, unwanted association.
So there are lots of things we can do, but I think one of the most important things is dog friendly practise, which is run by BVBA and Dogs Trust or cat-friendly practise run by iC Cat Care. Those two schemes are vital, and I would urge. Every practise in the country to get in touch with both of those schemes, cat friendly and dog friendly, and get more information about how you can get on board with having an approach which is species friendly and takes into account their behaviour.
Because I suppose also what you're saying, you know, you've got the gut pain, but then you're aroused because there's several dogs around you as a cat or as another dog. You get even more anxious and of course that just exacerbates the problem, doesn't it? Yeah, absolutely.
So keeping it calm. Yes, and that's where the dog friendly practise, as I say, and the cat friendly practises really work on, it's not it's also, it's not just the way we interact, it's also about the environment. I know ISFM and AFP have got some new guidelines coming out in November, so watch out for those, that'd be a great, addition to your practise.
Library, for cats and then they say BVBA and Dogs Trust have now got the dog friendly practise scheme, which I would urge people to find out about. And I think that must be quite new because I think I remember us talking about there is a cat friendly practise, why isn't there a dog friendly, so it's it's BVA live in June, so just this year. Yeah, fantastic.
How do you think it works with obviously vets? Referring cases, that's obviously something that you've built your business on and has obviously got busier and busier. But sometimes people also, you know, lay people, but also vets get confused between veterinary behaviourists and and people who are doing behaviour but perhaps haven't got a veterinary degree.
So how do we differentiate, and where do you think we can use behaviourists who aren't vets? I think this goes back to the health triad. If you think about healthcare for humans, there are doctors, there are specialists and consultant doctors in hospitals, but there are also a myriad of other professions involved in delivering healthcare for a human animal.
And healthcare for our species, our veterinary species, is actually just the same. So, for example, maybe we're more familiar with this in things like osteoarthritis. So, osteoarthritis is a physical disease, of course, it must be diagnosed by a vet and any medication necessary for treating.
Disease would need to be through a veterinary surgeon, but it's really crucial that they also have supportive therapies, physiotherapists, for example, I would say are crucial to the management of an OA case, and we don't use them enough. So behavioural medicine is similar. That in terms of behavioural medicine as treating emotional disease, that is a veterinary job and we need to have veterinary behaviourists who can diagnose the fact this animal's disease process is actually abnormal.
This is all to do with, you know, without getting too tech. Technical, it's the neuroscience of emotional motivations and how they're generated and this link with physical disease. So of course, you need a veterinary surgeon involved in that.
But there are also elements of behavioural change which are cognitive, which are learned. And there's also elements of behavioural change which are emotional because of the environment. So they're living in suboptimal environments and their emotions are not abnormal, as in the animal is not ill, but their emotions are challenged by the environment they're living in.
Those cases, then very definitely well qualified, people working in clinical animal behaviour are vital to that team approach, of healthcare. So, I think, think about the triad, you immediately think, this couldn't all be done by one profession. And just as, say, human healthcare is not only done by doctors, veterinary healthcare also needs to be multi-disciplinary in nature.
And this is also where. We base a lot of our time on prevention with vaccines and of course preventing some of the some of the emotional disorders comes from good training and and bringing up at the right time, doesn't it? So behaviourist but also potentially a place for nurses within that vital, I think the nurse contribution, and when I talk about veterinary professionals, I mean that nurses and vets, we're a team, and veterinary nurse contributions are absolutely essential in behavioural medicine.
And certainly can be a, a massive part of the in-house preventative behavioural service and also the identification behavioural service. So actually understanding there is a problem, then veterinary nurses play an absolutely crucial role. And many veterinary nurses are very, very interested in behavioural medicine.
Many of them go on to also do additional qualifications in companion animal behaviour as well. And Bristol have recently had their first. Cohort of graduates of veterinary nurses who've studied behavioural medicine or be animal behaviour as part of their veterinary nursing degree, so they're a nurse with a clinical animal behaviour, bent at the point of qualification, so yeah, definitely.
And puppy parties again, something that really developed, probably over the last 2025 years, how sort of, how much are you seeing those in practise? Is that something that, When you're coming in, a lot of prac practitioners are offering that service now, or do you think that's still it's a difficult one, isn't it, because, puppy parties have kind of evolved, and the old idea of puppies just arriving at veterinary practise and having a free for all in the waiting room, that's not useful. So what we're now looking at much more is the veterinary practise.
Role in preventative behavioural medicine, which is about controlled exposure to a veterinary experience in a positive emotional bias, so that we can create these very important emotional associations. You know, we can still call them puppy parties, but it's not the idea that puppies just come, you know, run around with a load of other puppies and have half an hour of madness. Because then what we're actually doing is creating very high arousal associations with the veterinary practise, which actually is counterproductive.
So I think we've moved, we've moved a long way in preventative behavioural medicine and it's far more science-based, it's far more, sort of rooted in neuroscience of what is actually happening to the brain of these puppies at this age and what can we do to actually make that. Beneficial for their welfare, very importantly, and also for them being sort of acceptable members of society, because being a domestic dog is actually very hard work. And to being a domestic cat also, because there are some clashes with your natural behaviour, potentially.
So there's a lot of preventative education that veterinary practises can be doing. It's all very difficult in that 1015 minute consult, but you know, I know we've spoken a lot and I, I've been really, I learned so much when I talked to you, as you know, but. Looking almost before the puppy even comes into the household, I know how much care and attention you took when you were getting your new dog.
It wasn't something that you looked in the paper one day and decided to buy the dog and the next day it was there. So perhaps tell us a little bit, how do you think we can as vets bring that into the practise, because often the first time we see a puppy is, you know, when somebody rings up and said, can he come in for his first vaccine, so how can we change that around? Getting access to prospective caregivers is really hard for veterinary practises.
However, there is now a world of, social media. People who know me will be laughing now because I personally am struggle with social media, but I do realise that it's incredibly useful in that it's a way for veterinary practises to get access to people who are not yet caregivers. And that's really, I think, where we can, as a profession, really, Explain how important it is that when you get a companion, whether it's a dog or a cat, or, or, or even deciding on which species you're going to get, as basic as that, that there are lots of things that we need to be considering.
When I was getting Jamie, last year, I actually made multiple 4 hour trips up to Northumberland to, first of all, see mom before she was pregnant, then go and meet dad before the mating had happened to see. Whether they were, you know, suitable, then talked a lot to, the caregiver who was actually involved in the breeding and all of those things so important to invest that time. But if people don't know that, then they, they don't understand the importance of it.
And of course, recently the the COVID pandemic rather challenged that. But yeah, I think it's a profession, we can get our news out to people through websites. Social media, etc.
The people who don't have a pet. I know one of your good veterinary friends is called Jamie and I, I, I can remember how crestfallen she was when she realised that you weren't naming the dog after her, but after one of your favourite football players, Jamie Carragher, has she forgiven you? Is she talking?
I think she still tells people that Jamie is named after her. She's very definitely named after Jamie. She's she's still in denial that's a problem, .
So how do we select the right professional to send, how do you think we get to that, you know, when somebody like, you know, I see an animal in the practise. How how's that selection process going on to whether we send to veterinary behaviourist or somebody else? So the, the whether you need a veterinary behaviourist or or a clinical animal behaviourist really depends on whether the animal has emotional illness, and you may not know that at the beginning.
So sometimes practises actually select who they refer to as to who they know and who is in their area. And then obviously if you're referring to a very, Good, well qualified clinical animal behaviourist. If they, see the animal and realise that actually this animal is emotionally ill and for example, may need medication, that's the time to then say, actually, we need a veterinary behaviourist involved in this situation, or the vet in the general practise if they are confident to diagnose emotional illness and dispense medication accordingly, then of course, they can do that as well.
In terms of who do you look for, qualification is important, and accreditation and belonging to reputable organisations who have a code of conduct, who have a disciplinary procedure, who have standards. In terms of membership. These are all things that I think we need to be really careful of and look for.
And there there are some guidelines for that in the UK, but it's not regulated legally. So there's still a bit of a, you know, a loophole there. However, if we think about things like the Fellowship of Animal behaviour clinicians, FABC or the Association of Pet behaviour counsellors, APBC these are organisations that do have that sort of structure.
And then we have an umbrella organisation of the ABTC, the Animal behaviour Training Council, which has registers of people who belong to reputable organisations. Also looking for accreditation, so ASAP have the certified clinical Animal behaviourist accreditation will give initials or postnominals of CCAB again, something to look for when you're looking for somebody to refer to. I think you need to meet them.
It should be someone you actually have physically met and had a conversation with. Yes, if you've checked. Who are you working with?
Because if you're a vet referring to a non-vet, you retain duty of care. So this has to be somebody you really trust with your patient, their welfare and health, your caregiver, but also your professional reputation, because you retain duty of care. And it shouldn't be a one way process.
So you refer a case, you should then have a dialogue, an ongoing relationship with that person, that professional who's a co-professional. And you should be able to have a professional relationship. So, if you refer and you never hear from them again, I would be very worried.
You, you really want them to be feeding back because sometimes we don't understand it is illness until we know a bit more, and they need to then be asking for veterinary input, or they need to ask you as the general practitioner to But for physical health conditions that may, may be involved, because they may not be detectable at the first consultation. Maybe only as the clinical animal behaviourist works with the case, they realise that maybe, for example, pain's involved and they need a dialogue relationship. So this should be, you know, two professionals working together for the benefit of the patient.
Finally, we're hopefully coming out of the pandemic, how do you think the animal population has has dealt with COVID from the perspective of emotional. Wellbeing and so on, has this been a good time cause people have been home, or is it now becoming worse because people are now going back into work? So how is, how, how, what's your take on all of that?
It's been challenging, and I think it's been very, very challenging for human animals as well. So we need to remember that the households that domestic pets are living in are often quite challenged, and the pandemic obviously is important. That caused a lot of changes in routine, a lot of changes in, you know, more patterns of behaviour that can be challenging, and, and it can, it can be challenging both ways when it, when they were at home and when they go back to work, both of those things are challenging in different ways.
And now we have the Economic crisis, which also puts a strain on the emotional health of the human animals and thereby creates potential, challenges for the non-humans living with us. So difficult times. And again, going back to thinking about that triad, that that the health of everybody, whether they're human or non-human animals is both physical, emotional and cognitive.
And we want all of those things to be optimised for good welfare. Sarah, thank you so much. We've gone 2025 minutes without actually without talking about football apart from Jamie Carrier, so we've done quite well.
Thanks very much. You're welcome. Thanks everyone, take care, bye bye.
