Hello, my name is Hayley Walters, and I have been veterinary nursing for 23 years. I started my career, in mixed animal practise in Buxton in Derbyshire, and from there I moved on to work with moon bears, or Asiatic black bears in China and Vietnam, rescuing bears from the bile farming industry. From there, I then moved to Edinburgh to work at the The Dick Vet School in Edinburgh for the Jean Marchique International centre for Animal Welfare Education, and this involved teaching in low to middle income countries in in the vet schools over there to the students and also to the lecturers.

So I've got lots and lots of different experiences in referral hospitals because I was also an anaesthesia nurse for Edinburgh. And also in the charity sector and also first opinion and ECC. So hopefully, with this, all this experience and also all the people who've contributed to this lecture, there'll be something in here that I can share with you to help maintain or improve welfare standards for your patients when they are hospitalised with you and also when they just visit the clinic for a consultation.

So there's lots to get through, so I will crack straight on. Here are your learning objectives. By the end of this lecture, hopefully you'll be able to understand how patient welfare is compromised in the practise from the moment the patient walks through the door.

Appreciate what causes patients to behave the way that they do when they're in the practise with us, and recognise the practical steps that you can take to improve patient welfare with very little extra effort, whether you are an animal care assistant, a veterinary technician, a veterinary nurse or or a veterinary surgeon. There are lots of little things that we can all be doing to make that experience far better for the animal. And also be able to understand what adjustments can be made in consulting rooms, in the prep room, in theatre and kennels to improve patient welfare.

And then a quick slide at the end that recognises the additional needs of our long term inpatients. OK, what is good animal welfare? Well, I'm sure you all know animal welfare is ensuring that the physical and psychological well-being of an animal is being met, and it really is as simple as that.

The two go hand in hand. You cannot have good animal welfare without both of those needs being met. So often in in training it to be a vet or a vet nurse, and when in the clinic, we focus on the physical health alone, but thought must be given to the animal's emotional well-being.

And the word welfare used to be met with a bit of eye roll in the past and was often seen as a bit hippyish or namby pamby, or those in the school of pin it down and get the job done, they weren't meaning to be thoughtless to their patients, but they were only considering one side of what good welfare meant. And I've used this picture because every physical aspect of this, tetanus dog's care has been considered. It's got a fan on it to keep it cool, very well padded underneath because this dog was rigid and couldn't turn or move itself.

A urinary catheter has been placed and urine has been collected into a urinary bag. It's got incontinence pads underneath its bottom and also underneath its mouth as if it's struggling to swallow. Central line has been placed.

There's a syringe driver in the cage with it, for this CRI it's constant rate infusion of analgesia, and esophageal feeding tube has also been placed. But there was also thought given to its emotional needs or psychological needs. So the nurse that was looking after this dog was told that this dog was very frightened of other dogs, and this dog was in a glass-sided kennel.

So she simply hung sheets up so it couldn't see the other dogs, even though it was completely recumbent and barely conscious, she still had that thought for that attention to detail, to think about that dog's emotional needs. And this is the reason why I took the picture, because it was a busy, noisy ICU ward, and sleep is of huge importance, a massive important part of getting better, and also for mental wellbeing, she put earplugs in the dog's ears. And it's that level of care and attention to detail that we should all be striving towards.

When we look at how to measure animal welfare, we can break it down into 4 categories physical state, phys physiology, environmental resources, and behaviour. And if we consider the animal's experience at the vet, we can see that their welfare is compromised in every single category. Physical state.

It goes without saying that they are usually physically compromised, but also physiologically too. Cortisol levels can rise temporarily during situations such as hunting or mating and so raised cortisol on its own is not always detrimental to an animal's health, but chronic stress and prolonged periods of raised cortisol levels can affect an animal's stress. And stress can originate when an animal experiences a reduction in predictability of events, which obviously happens when they are in the clinic.

Environmental resources, environmentally, they are completely compromised. If you've ever been hospitalised and you've forgot your phone charger, you may have a small idea what it's like not to have the stuff you need and the stuff and, and the people around you that you like and and need around you. And behaviorally.

They are challenged, to when they are kept in a barren, unfamiliar environment with people that they do not know and around animals that they do not know. So despite us being the good guys, our patients are often in a poor welfare state, physically and mentally, when they are in our care, and we need to be considering every category in order to make their experience with us as positive as it possibly can be. So what can we do to help the hospitalised inpatient?

Well, I decided that I would divide the the clinic up into these areas. I've skipped over waiting room because there was so, so much to include. So we're looking at general good welfare practises in the clinic and then we'll move on to what we can do in prep, then in theatre and recovery and then in in kennels.

There's a lot of information coming. And you will probably only remember about 20 to 30% of it. So if you've got a notebook with you, I would suggest, jotting down some notes of the good ideas that I come up with.

A lot of this might be very normal in your practise. I might be teaching you stuff that you already know, but there might be some gems, some nuggets in here that you think, Oh, I can, I can use that in my practise. Now, this lecture is based on the latest sign.

Scientific evidence, but it's also things that I've seen done in referral, charity, emergency and first opinion practises, and it's also combined with the knowledge of around 30 experienced vets and nurses. They all contributed to this lecture, to improve patient welfare. I was really inundated with information, so you're getting a nice package presentation of all the information I've had to sift through.

OK, first impressions to the veterinary clinic, they count, and they're normally extremely negative. And an animal first comes in to see us. It's a cute little puppy, it's or a kitten, it's vaccinations.

And the next one, it's vaccinations and usually microchipping, and then the next visit after that is often neutering. So this can have lifelong negative effect on how an animal feels about the clinic. And fear can result in the animal having to be carried or dragged into the clinic, muzzled for examination and forcefully restrained.

It's pretty miserable for a lot of them. It's unpleasant for the animal, but it is often cited by owners as a reason for not bringing their pet in and may result in delayed treatment or poor owner compliance with treatments. So often these negative welfare experience can be mitigated by building a welfare bank account.

Some of you may have heard of this already. If not, then we can consider an animal's relationship with the veterinary clinic to be like a bank account. So each animal starts its relationship with the clinic with a balance of zero, neither positive nor negative, in terms of its welfare experience.

However, each time the animal has an aversive experience, we make a withdrawal from that that bank account. So vaccines, microchipping, neutering. the more aversive the experience, the bigger the withdrawal.

And additionally, if a significant debt is accrued, it can be difficult to enter into positive equity, even with repeated positive experiences following that awful aversive experience. So animals that are constantly overdrawn in their relationship with the clinic are much more likely to experience poor welfare in the clinic and display those behaviours which we find difficult to deal with and they're problematic for clinic staff to manage. However, Those animals which have built up their bank accounts through a series of positive experience deposits with clinic staff are much more likely to behave positively and to trust staff within the clinic so that when a withdrawal or aversive experience is necessary, there is a positive trust balance and the experience is less likely to negatively affect the patient clinic relationship, or to result in those unwanted or dangerous behaviours that make our job extremely tough.

And patients difficult to deal with. And you can see, the picture of this dog, that is the exact same dog. One, the exact same dog.

She's having, an awful time due to so many negative experiences in the picture on the left, and there she is looking a lot more relaxed in the picture on the right, due to some great experiences. OK, so the ladder of aggression, understanding dog behaviour and how dogs communicate with us when they're anxious or they're fearful, can make a huge difference to how we handle them, and therefore how they experience their time with us. So the ladder of aggression, which I'm sure many of you have heard of, is an illustrated summary of the gestures a dog may use when they are feeling stressed or threatened.

And the gestures are designed. The the dog uses these gestures to avert threat and so to avoid escalation towards aggression. So if we start at the very bottom of the ladder.

We can see in those green arrows there, a dog that is nervous will, will yawn, outside the context of being tired and lick its nose outside the context of food on its face or or of eating. And we can see this little Chihuahua here, is turning its head away, which we call gay averting. He's lifting a paw, that little front left paw there, which lots of us think is cute, but is actually a sign of anxiety and worry.

We can see the whites of the eyes. This is called whale eye, and we can see the ears pulled back on this little chihuahua as well. So all of those, those signs there from this dog are saying, I'm very, very worried, I'm very anxious, .

And the dog is not going to launch at us in this exact moment. It's giving off all these signals to say I'm super, super worried. But you can see there this dog is already about halfway up the ladder.

Now, if we don't respect what this dog is very clearly telling us, then the dog has to start becoming a bit more proactive in taking action about what is happening around it and to it. And so we then see more threatening behaviours. So we'll see them stiffen up and stare.

We'll see the growl like we're seeing with this little dog here. This little dog just took a few seconds for this dog to go to. Oh, I'm very worried to, oh, please stay away from me.

If we ignore the growl and the growl is a gift, we should never punish the growl because the growl is communication. They can't talk. All they can do is growl.

It's not naughty. You don't need to dominate a dog that's growling. It is telling you, stay away, or I might have to bite you.

And often they won't even go straight for a bite. They'll do a snap. And when, if they snap and miss, they meant to miss.

That was your final warning. And if you still ignore that, then you, you are often bitten. Understanding the meaning of these gestures mean we can better read our patients and cater for how they are feeling.

Now, not everybody knows about the ladder of aggression, but many of you will. And I, and you a nurse. Who wants I worked with who every time a dog would yawn at her, or yawn in her presence through anxiety of being in the clinic or being too close to her, she would stick her face in the dogs and say, am I boring you?

Not a great way to behave around dogs. We need to recognise what they're communicating to us. Now, small dogs, little dogs like Chihuahuas, they get a bad rap, and because of their size and the fact that we can overpower them because they're so small, we often do not listen to their message of Please stay away, I'm frightened because we find it cute or we find it not very threatening, and we know we can overpower them.

So they have learned that the lower level behaviours do not work and therefore tend to escalate up the ladder much more quickly than those bigger dogs, often missing out many of the signs altogether and going straight to the bite, because they've learned it's effective. I'm sure we have all been bitten by little dogs, but fewer of us are getting bitten by American bulldogs or Akitas because when one of those growls at me, I sure as hell listen to them. But as I say, the little dogs, because we know we can overpower them, we tend not to listen to them as much, so they have learned they need to go up the ladder quicker.

OK, so I didn't mention the middle section of the ladder, which is the lying down leg up. And that is often mistaken for a tummy tickle when a dog does this, especially in the clinic when you approach it in its kennel, it rolls onto its back, and you're like, Oh, bless you, you're asking for a tummy tickle. But we need to be able to tell the difference between a dog that is asking for space, which is what lying down leg up.

Is like this visor on the right here, got very tight eyes, ears pulled back, tail between the legs, paw raised, a dog that's looking very stiff. Now that dog is asking for space. Please don't come near me.

It's the equivalent of us, maybe in a pub, approached by someone who looks like they're about to attack us, and we raise our hands and we show our palms and the wrists and we go, whoa, whoa, whoa, I don't want any trouble. That's what That dog is doing, it's an appeasing gesture. Please stay away.

Dog on the left, the black and tan one, however, is asking for a tummy tickle. At some point, it laid on its back, maybe in an appeasing gesture, got its tummy tickled and and learned, Oh, right, when I lie like this, my tummy gets tickled, and they'll invite a tummy tickle. You can see this dog's tail is relaxed, its tongue is lolling out of its open mouth and its eyes are relaxed.

So, Knowing the difference is super important. The other thing to remember is that people have often thought incorrectly that this appeasing gesture meant that the dog was being submissive, saying, OK, you're the boss, you're dominant over me, you're the alpha. That's not the case.

. Thinking that a dog is being submissive to you may lull you into a false sense of security that now you can do anything to that dog because that dog is now respecting you and and seeing you as the alpha dog, not the case. This dog is over halfway up the ladder and may need to escalate to a bite if you continue to not listen. So ask yourself as well when you're looking at an animal in the clinic, is it a dog?

Is it trying to create distance between you and it? Or is it allowing you to come close? So just have a look about.

What they do when they're in the waiting room with you or in the consulting room. Does it really want you to stroke it? I know as veterinary professionals, we often think that if we just get close to that animal and just touch them, they'll see that we're OK.

We're a kind person. That's not necessarily the case. It actually may just want the reward of you moving away and staying away and doing as little as possible with the with with them.

Try and listen to what they are saying. Whatever you need to do, could it be done another day? Could it be done under sedation?

Could you be using anlytics? Could they have some trazodone and gabapentin cocktail before they come in for whatever procedure it is you're needing to do to them? That is certainly something to consider rather than battling with these animals.

I took, I speak to so many nurses in my current job now, as I visit student nurses in their clinics and check they're doing OK with their training. And so many of them talk about when a dog growls, I'll, I'm, I'm quick to get a muzzle and, and get staff to help me hold it. Do we have to be fighting with all these animals, with all these dogs?

Could we be thinking a bit more about, about anlytics for these patients? The walking sedation, if you decide that the procedure does need to be done and the animal does need to be sedated, then a walking sedation is a really great idea. So somebody walks the dog down a corridor, the dog is usually muzzled.

This is if the dog doesn't want to be touched or restrained to receive the intramuscular injection for sedation. Somebody muzzles the dog, walks down the corridor, and somebody who's experienced in intramuscular injections, hides around a corner or in a doorway with the drawn up dose. You'll need to use a wide bore needle and make sure that it's securely attached to the syringe.

And as the dog has walked past, the dog thinks it's leaving or going somewhere else, it's not focused on you at all. You give the injection. Usually lumbarpax seals is a great place to give it, give it very quickly and then place the dog in the kennel or let it sit quietly with the owner.

And in this way, the dog gets sedated, you get to do the procedure, but it hasn't been held down or pinned down. I know of some practises that we're still trapping heads in doorways or getting more and more people to lie on an animal, fighting with them. To get these using dog catching poles, worst places I've seen net graspers.

So a walking sedation is a really great way of, making the welfare experience far more positive for a patient that does need to be sedated but does not want to be touched. Trigger stacking. OK, so we've all had bad days, I'm sure.

Perhaps you sleep through your alarm. In the morning you find that the milk's gone off in the fridge, then the bin bag bursts as you take it out to the, to the wheelie bin, and someone cuts you up in traffic on the way to work, and then you're trying to get a cat out of its cage and it holds onto its vet bed when being removed, and it drags out its water bowl and its litter tray and it all goes over the floor and you just explode. And aggressive reactions seem to come out of nowhere, sometimes with people certainly, but also with animals, and the animal's response to what you do to it seems to be disproportionate to the situation, like simply touching it to put a stethoscope on it.

This is known as trigger stacking, and when numerous stressful events occur. Simultaneously or within a short period of time, this decreases an animal's coping tolerance. And I said, this is called trigger stacking.

It's not unique to human beings. So when we perform a benign procedure, often an animal has experienced so much stress prior to that moment, it simply cannot cope with one more thing, and it bites. And we see it, don't we?

Those animals that come in like, Whoa, I was only saying hello, and it snapped at you. We've no idea what's gone on leading up to that moment that the animal came into the consulting room or even just into the waiting room. All of these stresses or triggers they add up, and many animals can cope with just 11 trigger.

And if they're given time to relax, they can shrug it off. But when several stresses stack on top of each other, what are deemed out of character reactions may occur. We must remember this with our pets, the visitors, especially for the dogs that never ever get put in the car to go for a walk, but only to come to the vets.

Those dogs know what's happening to them. And are usually pretty stressed by the time they get to even to the car park. Low stress handling.

So it is a bit of a buzzword right now. So maybe you've heard low stress handling or fear free handling. It's basically what we should all be doing, holding and positioning animals with gentle restraint and using food rewards and making it a positive experience.

It reduces reducing, helping to reduce the amount of anxiety the animal experiences in the visit. And also makes us think about what, the animal is seeing from its perspective. When we're using low stress handling techniques, it should be long, slow strokes, gentle hand movements, a calming voice, because sometimes we get those patients into the clinic, don't we?

And they're often hyped up and excited to be there, so we ramp them up as well with high pitched, vigorous movements and high-pitched voices. And then we ask them to sit still, and it's pretty tough for them. So the other thing with low stress handling is we need to not get into the habit of holding animals so tightly that the animal anticipates something aversive will happen.

Everything should be smooth and with food rewards if they're allowed it, and calm and slow and gentle. Really gone are the days of pinning animals down. I really hope it is like that for you in your practise.

Just no more fighting with them. They often, we often think, well, if I, if I don't dominate this animal, it will think it's one. But the animal didn't even know it was in a competition with you.

Towelling over scruffing with cats always if you go in rude and grumpy with a cat, you'll get rude and grumpy back. Cats are only scruffed naturally for 3 events, 3 events in their life. Number one is when they're carried as a kitten, and they are much, much lighter when this happens to them, and it's only done in an emergency when the mother needs to move them, to somewhere safe.

When they are mated. And also when they fight, so not a great experience to be scroffed. It's stressful for them, and it also removes the cat's ability of choice and control, which is super important to a cat, super important to all of us.

But when you're small, like a cat, yes, you predate on animals, but you're also small enough to be predated upon. Having no choice and control is not a nice situation for a cat to be in. Scruffing is uncomfortable at best and painful for them at worst.

So creating a cat burrito, or purrito, as some people call it, is one of the best things you can do for a cat that needs to be restrained for whatever reason. If you ever do scruff a cat, then you must remember that it is an absolute last resort, and that's only if you think the cat is going to run out of the room and there's an open door that leads to a road full of traffic. If you think that cat is gonna need scruffing, then you get a towel and you go in with your towel first of all, or you sedate the animal, before you handle it.

Now we often talk about gold standards in practise, but to me, gold standards suggests almost that there is only one way of doing something that works for all patients. So what we should be talking about is bespoke standards or bespoke patient handling. Each animal that we deal with requires something different based on its personality and also based on its previous learning experiences.

So obviously we need to think of each animal as an individual, and I use these examples because they show how each animal was treated differently. So the cat on the left. I was always a big fan of taking animals out of their cages to do any, any procedure to them, blood samples, IV cannulas, bandaging, whatever, because their cage should be their safe place where they, where they can sleep and relax.

However, this isn't going to work for every patient, so this was a cat that needed a blood sample. I took it out of its cage and tried to hold its head up so someone could blood sample it, and it just kept pulling its head down. And every time I got the head up, it would pull it down, incredible neck muscles, and I found I was fighting with this cat, but I'd remembered that when it was in its cage, it was super smoochy and much happier.

So we did the blood sample in the cage, and the person who's holding on to its chin. Gently to raise its head. No one else is restraining this cat.

She's actually got the camera in her left hand to take the photo. That is how unrestrained the cat needed to be in its own environment, in the cage. It's not going to work for every cat.

So it's about bespoke patient care. Little Chihuahua needed, just needed examining, I think this one again, we didn't want to muzzle it. It's, it's face is so small.

So just using a towel to wrap around it's. Neck like that to prevent it from hurting you is a great technique. Again, it didn't like being on the table, tried to climb up you when you did that.

So just holding it in that position was a great way to do what we needed to do to that dog very, very quickly. This little cat was in for repeated chemo, and she just likes sitting in her litter tray. So that's where she received her chemo.

She was allowed to stay in her litter tray to receive her chemo. So. She felt a bit happier and and comfier there, so bespoke patient handling, what does your individual patient need?

When examining patients, Do dogs really need to go on the table? When you think about dogs, how often do they go on the table when they're at home? Almost never.

So it's really unnatural for them to then be put on a table in the clinic. It lets them know something awful is gonna happen, tables are off. And bit wobbly, it can be a bit noisy, and obviously they can injure themselves if they jump off it.

So if you've got knees that work, then please, please get down to the dog's level and do the examination on the floor if that is going to make that dog feel more comfortable. With cat boxes now, I cannot stress this enough. If you've got a cat that really doesn't want to come out of the box, and the, the, the lid, the top of the box will come off, then please examine that cat in the base of the box.

Keep it, covered over with a towel and just examine each quarter of the cat as you need it. A cat's natural instinct when it's frightened is to run or to hide. We don't let them run, so let's keep letting them hide.

They'll often be much easier to handle. If you do need to weigh them, then do that as the very last thing, do the whole examination, weigh them and let them go back in, in the box. Whatever works best for that cat.

Use high reward treats, not a sample pack of something that's free. So licky licks for cats, if you can get that in the UK, we'll costock it. It's, it's like magic for cats.

You can blood sample cats, just holding up licky licks and then have access to their jugular. Liver pays for dogs is great. I'll often just open a tin of sensitivity, and they are super happy with that, since so many dogs are fed, dry food, having, wet food is an absolute treat for them.

Although also food bomb the floor as well. So I'll either splatter food on the floor, I'll throw biscuits on the floor, because then the food isn't having to come from you, so that a dog that's feeling conflicted, like, oh, I want the treat, but oh, I'm worried about you. You bomb the floor, you change that dog's mental attitude of you.

It's just like when you always offer someone a cup of tea. Now that dog knows that food is coming from you, but it doesn't have to come so close to you to get it. Do not label animals, do not label animals with derogatory names.

Once we label an animal with a derogatory name. We instil in others, in our colleagues, a way of behaving around them and a way of handling them, and we don't take into account the animal's emotional state. And not only is it unprofessional to label animals with negative words.

So imagine if your grandma in the nursing home or your child at school had a negative derogatory name that the staff used on them. So not only is it unprofessional, but it does not take into account the animals, Emotional state, as I said, it is behaving in a specific way to achieve something, whether it's distance from the clippers, or whether it's to escape the room, or to get the thermometer out of its bottom, or to not go through a door. It is doing that behaviour because of that situation, and we need to ask ourselves what can we do to make it better.

OK, when you're admitting a patient, we need to be asking for, information about their personality and their preferences. We can't break animals down to their biological values. It would be really strange if you dropped your child off at a nursery or with a babysitter and then didn't tell them anything about their likes or their dislikes.

So, So these are some of the questions that we can be asking, our clients about their patients, about their preferences and about their personalities. So are they sociable, are they friendly? Are they are fearful, when they're left alone?

Is are they a nervous animal? Are they noise phobic? Do they prefer to actually be left alone?

What do they like and what do they dislike? OK, we're moving into prep now. So prep, I love prep party room.

It's my favourite place, very sociable, catch up on all the gossip with all your friends at work. But prep is so scary for the patient, as it's no longer with its owner. It cannot hide in its kennel.

It's exposed to an alien environment of strange smells, noises, machinery, and often painful or unpleasant procedures are carried out in prep. If a patient is not being admitted, it does need a procedure that the vet doesn't want the owner to be present for, then please don't take the animal out of the consulting room and into prep. That animal has already had to acclimatise to the waiting room and had to acclimatise to the consulting room, and taking it through to prep with all its noise, and other animals in there can often just be too much for that animal.

Just go into the consulting room, ask someone to come into the consulting room with you. Ask the owner to sit in the waiting room if you don't want them to watch and do whatever procedure you need to do in there if you can. Prep is, is a super stressful place for animals, and if they don't need to go in there.

Please don't take them in. Staying in prep, when you're in prep, really should have beds on tables for all procedures so that it's comfortable. Now the bed, if the animal has been admitted, can be brought through from the kennels, obviously, to save on washing, but it also means that they are, smell on that bed is familiar to them.

Smell is their primary sense and it's important that things smell of them when they're in the clinic. We need to do calm talking and slow stroking, not the high pitch. Good, good, I guess you are.

Oh, and vigorous scratching, nice calm, low stress handling with them. And as I said before, if you are needing to hold tight to an animal because it's not sitting still, once the second it does sit still, release your grip. So as soon as they stop struggling, release your grip, because this is their reward for, in quote marks, behaving.

This is their reward for doing what you need them to do. If they start to struggle, you increase your grip again. Once they start struggling, release it, they very, very quickly get, OK, so if I, if I stay still, I'm not held as tightly.

For animals that are having an anaesthetic. Please think about pre-medicating them before placing the IV cannula. If you know you're going to need emergency IV access immediately to that patient, obviously pop your IVs in first.

But if that animal is a very worried animal and it needs an IV cannula, but it's also having surgery, then please think about pre-meding them first so that they're nice and relaxed, easy to handle, and just, just much less stressful for the patient to have some lovely pre-med drugs on board. Before that IV cannula gets placed. And a top tip when you are placing an IV cannulate, make sure that you have everything open and right next to you as soon as you start.

Once you've picked up that paw, don't let that paw go again because they really often, especially cats, resent that constant hold and. So you clip it, then you swab it and then you let go of the port to open up your cannula and then you pick it up again. And they get a bit super sensitive to it.

So make sure everything's open in advance. It does, it does help them a lot. Staying in prep, try avoid bandaging over joints as as it restricts their natural movement.

So try and stay within the joints so that they can sleep and curl up and be and walk and be as comfortable as possible without having restricted joints. Obviously using a good padding layer and very carefully applied vet wrap cohesive bandage will prevent the swollen pores. I know some people still like to include pores, when they place an IV cannula.

Often the animals really resent this, and then they get wet when they go out for walks, and, it restricts their movement. So a really top tip when you've got little legs like a cat, a top tip for not going over, joints is to, really tuck your, Soft band layer, your your padding layer right underneath that bung. Remember, it's the bung that's gonna dig in once it's bandaged in.

Now you've got that padding layer really beautifully tucked up under the bung there. But now your vet wrap, if you, if you do your vet wrap like this, you're going to go over a joint, and there's no padding layer there. If you do it like that, you're gonna have no vet wrap on that lower padding layer, and the animal could pick at that.

It could get wet. So what I do is I fold over the vet wrap, I nick a little hole in it with scissors, and then I slide it through the bung like that, so that you have got a really beautiful, well padded, smallest amount of bandage you can use. And I find that 99%, probably higher of my patients completely leave their IVs alone when you've placed them as comfortably as this cat's picture shows.

Still in prep now, when this is, oops, so this is just a top tip. I was 15 years qualified before I learned this top tip. I'm sure plenty of you know it.

But if you're taking a jugular blood sample from a dog, if you clip over the neck where the hair grows in opposite directions, you are pretty like. To find the jugular under there. So this is a top tip.

You spend less time clipping, less time having to restrain the animal, less chance of clipper rash, and you're gonna hit the vet, the, vein first time and hopefully look like a legend. And it is perfectly OK to use a blue needle to collect blood. And some animals, especially cats, react less to it.

Excuse me, I'm just gonna take a quick drink of water. I know lots of us will do the Green Needle, the go to Green Needle. The 21 gauge needle, but you can use a blue needle if you need to.

Onto theatre and recovery now. Just want to touch on dehydration and fluids. So dehydration is an extremely unpleasant feeling, but can also lead to hypotension, impaired cardiac function, infections, and kidney failure.

Water can be left in with the animal up until it's pre-medicated or sedated, so there is no need to withhold water for hours, prior to being premedicated or sedated. They can have water up until that last moment. Excuse me.

All general anaesthetic patients should receive intravenous fluid therapy. So try and convince as many owners that have the option of fluid therapy to go for fluid therapy. And this helps to supply normal fluid maintenance requirements, maintain adequate blood pressure and allow for any fluid losses through surgery.

Now being hungry is also an unpleasant feeling, so food should be withheld prior to sedation or anaesthesia for the minimal time possible. Gastric transit time, gastric transit time for dry or solid food is approximately 6 hours. So this is the recommended fasting time for adult dogs and cats.

And research shows that extending the duration of preoperative fasting is associated with increased gastric acidity. So withholding food for longer than 6 hours is unnecessary and can actually be detrimental to the patient as it increases the chances of gastroesophageal reflux, which we are desperate to avoid. So this ought to be taken into consideration when planning your day's surgical list.

So the patients that are likely to be last on the list can receive a small volume of food, 1 teaspoon or a tablespoon, depending on the size of the patients, on the morning of surgery, if they are if they are unlikely to have their anaesthetic until later in the afternoon. So 6 hours for adults, but for puppies and kittens, 2 to 4 hours, absolute maximum, some people even say 1 to 2 hours. Preemptive analgesia, as you know, I'm sure this is using analgesic drugs before the induction of a noxious stimulus or, or surgery.

So it reduces, using preemptive analgesia is, is pretty mainstream these days. But if any of you are working in super old school places, it might be that preemptive analgesia isn't given. But it reduces the amount of nociceptive input to the spinal cord, and it reduces peripheral and central sensitization and therefore also reduces peri and postoperative pain and an awful phenomenon hyperalgesia.

So pain is best managed early and aggressively, it is much more difficult to control pain once it is well established than it is to manage pain before it becomes severe. And if any of you have experienced a headache. Of course, I'm sure we all have.

And you feel the twinge of a headache. If you take your paracetamol and ibuprofen, as soon as you feel that twinge of a headache, it is very unlikely that that headache will develop into a full-blown headache. But if you ignore that headache and allow it to develop, to a full blown headache, then take your paracetamol and ibuprofen.

It's unlikely that headache will disappear completely and you'll still have that low background throbbing pain. So preemptive pain relief is, is highly recommended for your patients, to experience good welfare. Preventing pain should be the goal of the analgesic plan.

Surgical pain is 100% predictable. If you take a scalpel blade to something, it will hurt. So your, an analgesia plan should be in place prior to surgery starting.

Quickly want to talk about why pain is important. Obviously welfare is a major concern, but also painful animals will have an increased blood pressure and an increased heart rate. If they've just had surgery and you've, all those vessels have been tied off, that have been cut, we do not want to see a massive increase in blood pressure and clots being blown off.

Would be disastrous. There's an increased stress response in the body when an animal is painful, which decreases wound healing times through those stress hormones circulating, but also through interference with the patient and it's wound, licking at its wound. An animal that is painful is not as, often as mobile.

And if you've had surgery or orthopaedic surgery, then we do need these animals to be moving, restricted movement. So on leads, but we do need them to be moving so that they can get out and go to the toilets or for cats so that they can groom themselves, or those maintenance things, so they can get to the food bowl, or get to the water bowl. They're so painful, they're not going to be doing these things.

They don't want to eat when they're painful. And with the best surgery in the world. If they're not eating, they're not going to get better.

With our little, with our baby animals, we see poor growth and poor weight gain when they're painful. And then in humans, depression and sleep disturbances have been reported. We can assume the same thing is happening to animals.

And poorly controlled acute pain can lead to chronic pain in humans. This is really interesting. So pure poorly controlled pain at the time of surgery.

Disastrously can lead to chronic pain for people. We didn't used to think this was the case. We didn't used to think it didn't.

We used to think it didn't matter if pain wasn't controlled at the time of surgery, but we now know that these human patients are going on to lead months and months of chronic pain, some years for some of them, if their pain isn't treated properly. Humans are self able to self report because they are verbal, our patients aren't, but we should assume the same thing and therefore we should take that cat spay, that dog castrates pain extremely seriously, so we don't venture into the problems of long-term problems. I want to touch on the difference between light anaesthesia or pain because it's super important that we understand the difference.

So an animal that is experiencing the light anaesthesia. Will have a, if it has got a central eye position, a palpupil reflex that's present, a jaw tone that's present, swallowing, moving, vocalising, and you have an increase in heart rate, blood pressure, respiratory rate, that animal is light and that animal does need more anaesthetic. You need to quickly get some propofol into that animal, if it's swallowing or moving or vocalising or turn up your isofluorine if you think you've got time to do that.

But if an animal is adequately anaesthetized, but painful, then we see this instead. You'll see a ventral eye position because the animal is adequately anaesthetized. You'll see that there's no palpibril or blink reflex present.

Jaw tone is nice and relaxed. It's not swallowing, it's not moving. It's not vocalising.

If you have all of that, and then an increase in heart rate, blood pressure, respiratory rate, that animal is painful. You need to give more. Turning up the isofluorine is not going to help that animal have a nice recovery and be more pain free on recovery.

So if you've got an animal that's had, say, a dose of methadone in its pre-med, 0.2 or 0.3 milligrammes per kilogramme of methadone.

You can add more methadone, another 0.1 mg per gig methadone to that dog, and hopefully you'll see the blood pressure come down and the heart rate and the respiratory rate come down in those adequately anaesthetized patients that are experiencing noseception. So that's where the brain has been told that a painful assault is happening, but because the animals adequately anaesthetized, it can't move away from it.

But with a light. And with an animal that's lightly anaesthetized, give more anaesthetic and potentially more analgesia. But for one that's adequately anaesthetized, but then has an increase in heart rate, blood pressure, respiratory rate, give more analgesia.

So it might be a top up dose of methadone, it might be some IV paracetamol, it might be that you can use some lidocaine or bpivocaine in that animal, especially those dentals. Dentals that aren't blocked, their anaesthetics are often all over the place where we start extracting teeth. So we really should be blocking with local anaesthetic, .

As many patients as we possibly can. Local anaesthesia is usually very cheap, readily available, and is the only drug that will 100% guarantee that no pain gets through to the pain, the brain, and not, and the other drugs can't do that. So really, we should be calculating safe doses and using this stuff, a lot more frequently than we do.

OK, staying in theatre, for a moment, hypothermia needs to be discussed because it is a recognised torture technique. And too often our patients are getting cold, and it's extremely common during anaesthesia and during surgery. But the consequences of, of hypothermia are quite severe.

And they include, include morbid myocardial events, a reduced resistance to surgical wound infections, impaired clotting, impaired coagulation, and delayed recoveries for the patients or what we tend to call, a long waking up time, from the anaesthetic and also postoperative shivering. These physiological effects of hypothermia affect the patient's well-being, and human patients actually often identify feeling cold as one of the most unpleasant aspects of their treatment and sometimes worse than any pain associated with the procedure itself. As I said, hypothermia is a recognised technique in torture.

And shivering is not only subjectively unpleasant, but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. And furthermore, shivering may aggravate pain and hinder wound closure by simply stretching the surgical incision. Now I've, I know, I spoke to one student nurse who had a bear hugger in her practise, but wasn't allowed to use it.

I don't know why, but she was told that if they're shivering, they'll warm themselves up. That to me makes absolutely no sense. Patients should not be getting to the shivering stage and if they do, they should be actively warned carefully.

The other point I want to make, and this is a hangover from the days of using halothane, do not turn off the ISO and CO when the vet is stitching up or when you think you're coming close to the end of the procedure. Often the most painful part, the stitching up suturing of the skin. Animals should be either anaesthetized or recovering.

So in the days of Hall of Fame, there were long recovery times, and turning them down incrementally towards the end of the procedure was the normal thing to do, and it was acceptable. Otherwise, you had a patient that was unconscious for a really long time after the procedure. You had to do this.

But I subfluorine and sevoflurane is extremely short acting. Once it's turned off, the animals become conscious pretty quickly, and it's very unpleasant to be. Becoming conscious in a strange place with painful things being done to you, or hair pulling things being done to you as, as, as things are ripped off, or wet things being done to you as as the patient's being cleaned of all the blood on it.

And then still being semi-conscious as you're moved back to kennels and placed and placed down in a kennel. It's a really awful, awful experience for them. And I do appreciate that practises are extremely busy and the ops lists are very long and that the veterinary profession is extremely short-staffed at the moment.

But please consider the patient's welfare. If you are experiencing very long recoveries with your patients, which means that that nurse can't be freed up to then go back into theatre and and do the next patient. Then, perhaps.

Perhaps the patient got too cold under anaesthetic, which is why you're having such long recoveries, or maybe it was allowed to get too deep in theatre in the first place. Maybe the the meatomidine needed reversing, or maybe the pre-med was a bit overzealous or whatever reason. Please don't turn them down towards the end of the procedure so that you can more quickly.

Get through the ops list. We need to obviously consider the patient's welfare and look at what it is that we're doing that will help encourage them to wake up more quickly in a nice, comfortable, warm, safe environment. If you've ever had an anaesthetic yourself, you'll understand how disorientating and awful it is to, to, to, to wake up.

I know you went to sleep, but to recover from the anaesthetic, Anyway, so let's be considerate for our patients. OK, staying in theatre and recovery, it's important that we, when we look at our patients, that we know the difference between a dysphoric patient and an animal that is actually in pain. So a dysphoric animal can momentarily be distracted.

So those animals that look like they're thrashing and they're howling away, if they're dysphoric, we can momentarily distract them by saying their name or opening the kennel door, but a painful animal cannot be distracted from its, from its vocalising. Or whatever position it's putting itself in to try and get comfortable. Question Buster colours.

They are my pet hates. They are traditionally were traditionally used because animals did lick their wounds because we weren't very good with analgesia in the past, but in the past, but we now have so many choices of analgesia and such a better understanding of pain and pain recognition and how detrimental pain is to a patient that we are better at giving analgesia and therefore we don't. Really always need to be using Buster collars.

And if we put a buster collar on or Elizabethan collar, we've just stopped the animal from alleviating its pain in the only way it possibly can, which is licking it. Lazy vetting, I'm afraid to say, if you do a thoughtful clip with clippers that are sharp and clean and work, and if you do a prep that's not over vigorous with hippy scrub. And you use pre and peri and post-op pain relief, gentle tissue handling and sutures that aren't too tight.

You almost always don't need to then place a buster collar on that patient. And I visit places where the cat is still under anaesthetic, after being spayed and a buster collar is being placed on it. And I just think.

If we don't need to be doing this in this day and age, yes, obviously, if they've had eye surgery or ear surgery, then we certainly do need to be thinking about buster cos for those patients. But it's not, it shouldn't be something we're reaching for with every patient. If you are worried that that animal is going to lick that wound and you're happy with your analgesia plan and your tissue handling, then consider one of the medical shirts, which is far better tolerated by the patient and also by the client.

Also, I like to think that if you had a headache and you were rubbing your head because your head hurts, would you hope that someone would come along and tie your hands behind your back to stop you, or would you hope that they gave you some paracetamol and ibuprofen? I know which one I'd like. So remember that the post-op opioid, so postoperatively, the opioid may need topping up if the, if the non-steroidals aren't cutting it or if it, if it's been a long time since it had the, pre-op, the pre-med, think about giving a top up of opioids.

And everything should go home with analgesia after every single surgical procedure. Obviously, this includes cat castrates and dental extractions for definite. Surgical procedures are painful.

They will need analgesia for several days. OK, very quickly want to touch on recognising pain in dogs. So all of these photos were taken opportunistically.

And as we know, dogs with their body language and their facial expressions are constantly communicating with us and with each other. And so often because of this, it is quite easy to tell when a dog is in pain, but we need to know what that dog's character was like before the painful event happened, so the surgery, so that we can very quickly see if it's painful afterwards. So if they are at the back of the cage, not wanting to be touched and hiding, then we can, and it was at the front of the cage to start with and greeting people, we can assume that this animal is painful and it's trying to avoid being touched.

If it's disinterested in its food or surroundings, so if we see any behavioural changes that can alert us to the animal, being painful, interfering with its wound or guarding its wound. Again, sign of pain. Prayer position.

If anyone's ever seen this, this is not a dog that's doing a play bow and an invitation to play. This is a dog that has, quite severe abdominal pain, and you can tell the difference there because a play bow, the, the tail would be in the air. But look at that dog's face.

It's very tense face, gaze averting, just trying to get comfortable. This dog desperately needs some more analgesia. If the dog is tense and rigid, reluctant or unable to move, that certainly can indicate to us that, to us that the animal is painful, or if you've got that head down, that hang dog expression, also a sign of pain.

Squinting of the eyes, pulled back ears, tense face. All should be ringing alarm bells with us and if you've got an altered posture, that hunched tense abdomen when they've had abdominal surgery. Also a sign of pain, and if they're vocalising, they're crying out, pain score them, see what's happening with them.

Now, pain in cats, as I said, they are predators themselves, but they're also small enough to be a prey species. So therefore cats may appear more stoical and exhibit less obvious, less obvious pain behaviours, but there are still pain behaviours to be seen. So if you've got hunched, that hunched up posture with straight legs, sign of pain.

Slanted or squinty eyes. Should be alerting us recumbent, tense, or rigid, that is not a natural cat position going on there at all. Should be pain scoring these ones and seeing where they're at.

If they're hissing, flinching, or clawing after the, after surgery, and they weren't doing that before surgery, that should ring alarm bells with us that they're painful. Back of the cage and, and hiding, so behavioural changes, whereas before they were happy to be touched again. Sign of pain, vocalising.

It is a very brave cat that vocalises in in a practise and draws attention to itself. So, often vocalising can be a sign of stress in cats, but it can also be a sign of pain as well. If they're disinterested in their food, or in their in grooming themselves or their surroundings, whereas before these behaviours were happening, and pain score these animals, check what's going on.

This cat was brought in by its owner because if you see down its legs, it's, it's all filthy down its legs and around its face. It stopped grooming itself. When we opened up the cat's mouth, it's a big painful tumour underneath its tongue.

So those changes in normal maintenance behaviours, should be alerting us. Altered posture, look at that. That's a really unnatural position for a cat to be in.

If you've got head lowering in a cat as well, where the, where the head is lower than the shoulders, another sign of pain and a cat needing to be pain scored and probably analgesia given. And here on the right, that's, that seems like a normal cat position, but not in the vets, and it was doing it for the whole time it was there, which is why I took the picture, picture after noticing it for a couple of minutes. And sure enough, when we x-rayed that animal, there were two large abdominal tumours in that poor cat, and this was the position it was adopting to try and be more comfortable.

So anything that just doesn't look quite right for a cat, or as a change from a normal behaviour, the behaviour before surgery. Pay attention to. On to kennels now, we're getting towards the end, so pain score all your patients at when you TPR them.

So temperature pulse and respiration really should be TPRPS doesn't take very long to pain score an animal. Yes, it's a nuisance. You might need to print a print, a pain score, or you might need to find the pad and you and someone's moved it.

So laminate a Glasgow canine and feline pain scale. That is the one I thoroughly recommend you use. Super easy to use, and have a laminated copy on each kennel.

Use a whiteboard pen, so there's or just add up twos and ones in your head if you need to. So you don't need to print them out daily, and they are there when you need them. Record your finding on the hospital sheet, obviously inform the vet if you're a vet, a nurse or technician or a.

White and clean after if you have written on them, but even easier still. You ask any vet nurse what they've always got on them. It will be scissors, a pen, and their mobile phone.

So screenshot it, stick it in your favourites. You can see I've love hearted this. I've got over 7000 photos on my phone.

I've only got 28 in my favourites, so I can quickly find my pain scores. I, I, I don't add up you chooses and your ones. There's no excuse to not be pain scoring these days.

We really should be doing it. And once you've pain scored, remember, and it was high, and you give the analgesia, make sure you go and pain score again 20 to 30 minutes later, to make sure your analgesia was adequate. And if it pain scored low, then, make sure it's down for another pain score at least 4 hours later, more if necessary when you're next to your GPRs.

OK, staying in kennels, tries as best you can to have separate cat and dog wards. Patients not facing each other if possible. It's really stressful for dogs and cats to be facing each other.

If you can, have a visual barrier if patients are facing each other, that would be great. If you've got one dog that is reacting to another dog, try and move them as far apart as possible. All very straightforward things that we can be thinking about, use their name.

Their name is familiar with that for them, to them, and it creates a semblance of a relationship. Try your best to not say the ex lap cat or the liver failure dog, use their name. It's the only thing that is familiar to them in the clinic.

And as I said again, bespoke patient care. Take them out of the kennel for treatment or leave them in, whatever works for that patient. If you've got an animal that's chewing at its drip, oops.

Apologies. If you've got an animal that's chewing at its strip, don't just place a buster collar or Elizabethan collar on them. Investigate it.

Has the IV site gone grotty, like in this picture? Maybe the bandage is too tight, the fluids are going subcut. Oh, the amount of times I've gone on to shifts, and the, the fluids, the animal's interfering with it, and it's going subcut and everything is wet.

So please investigate, why they might be interfering with their IV site. And TLC Tender Loving Care, it is a treatment. It's not work avoidance, stroking reduces stress, so please, please take time to, to just stroke those animals or groom those animals or take them out for a, for a walk if you can.

There's a 3 to 1 rule. So for every 1 to 3 rule that we should be trying to apply, for every one aversive thing you do to a patient, you should be doing 3 lovely things to that patient. So that there's, there's a, you're building up, a relationship with that animal.

You're not just going in to take temperatures and to inject, you are doing something nice on the other times as well. Getting through kennels now, take into account their age and their temperament when they are in with you and where you're going to, which kennel you're going to place. If you've got the luxury of several kennels, have a think about which kennel is going to be best for that individual animal.

If they're old or sleepy or shy, put them in the quietest area, put them in the kennel that's in the furthest away. Part of the room, if they're young and bored or highly sociable, put them in a high traffic area so they can watch what's going on. Just be thoughtful about the positioning in the in the ward or the kennel room.

Barking dogs. OK, how often have you seen someone or been that someone who has yelled at a barking dog to shut up or kicked the kennel to make them shut up. They just won't stop whining or barking.

I'm sure we've all done it. I've done it, I've shouted, there's only so much you can take, and after several hours of barking, you just lose your cool. We are only human, but we really need to ask ourselves, why are they barking cause they sure as heck won't be barking continuously or whining continuously at home.

What is motivating that behaviour? What's motivating any abnormal behaviour? Stop and look at it from the animal's point of view.

Assess and then take action. So let's think, this dog behind the blanket, which is always the go to behaviour, isn't it? Hang up a blanket.

How's his day going? Is he living his best life in that kennel right now? Think about what he can see and hear and smell and ask yourself, is he comfortable with other dogs?

Has he been to the clinic before? What happened to him last time he was there? And why is he barking?

Is he excited, frustrated? Is he guarding, bored, scared? Or is it because he can't cope with being on his own?

Is he painful? Does he need the toilet? Is he hungry?

The amount of times those barking dogs then go quiet and then you look in their kennel and they've pooed or they've weed in their kennel and you just feel rubbish because they were asking to go out, poor little loves. Does the dog have what it wants and if it was your dog, what would you do? Because hopefully it wouldn't just be to shout at it.

OK. Kennels for whoops, for cats, they do need a hiding place that's not a luxury, it is a necessity for cats. You can get these brilliant stickers, for the for the lower parts of cages so that it feels like they can hide a little bit, or you can buy the more expensive forts.

You can use bathroom stools, they're great and place a towel over them. They can live in the cage if storage is a problem, just wipe them down each time. Or you can just use.

Stiff blankets or cardboard boxes for them to hide in. Every cat must have a hiding place. As I said, frightened cats will either run or hide.

Let's give them the opportunity to hide. You can use the owner's carry cage. If you look at the picture on the bottom with the red carry cage, that is not the way round to put the carry cage.

That cat is now just on display. It's like a display cat. So make sure you turn it side on so they are still actually physically hiding, able to hide away from view.

If a cat is sleeping in its litter tray, which many of them do, or just huddled up in its litter tray, then you need to give them a second litter tray, because they do need one to huddle up in if that's what they want to do. And they do need one to go to the toilet in. So I remember I had one that had been sitting in its litter tray, took it for its anaesthetic, and, it pooed on the table, and I've just felt so guilty.

And I thought, how long have you needed that poo for? But you couldn't go because you're in your bed. You can offer alternative setups if you want and keep noting preferences.

I was pretty determined this cat wouldn't stay in its literary bi. So I offered another one. Then I thought, no, actually, what do you want?

What it wanted was just a little ledge to rest its chin on. So, it got out of its litter tray and chose that nice soft bed, instead, and had its toilet there when it needed it. Kennels still only clean cages when they are dirty.

So lots of people will disinfect cages every day, but you do not need to disinfect and refresh the bedding every day unless they are soiled. We certainly don't do this at home. I certainly don't disinfect my home every day and wash dog's bedding.

Dogs and cats, as I said, rely heavily on their sense of smell to make them feel secure, so we don't want to be washing away all those smells that are helping them to feel secure. We need a predictable routine for these patients and regular toileting opportunities. If you'd like to use music therapy, then reggae or soft rock or something with a slow tempo, has been shown to help reduce stress for some animals, but you don't want to leave it on all the time because they become habituated to it, so there needs to be periods of no music as well.

Time all your TPRs and pain scores and examinations and drugs to be given all at the same time as possible. So they are given opportunities to rest and sleep. And speaking of sleep, if you can, no entry into kennels, after midnight until 6 a.m., because sleep is so important and sleep deprivation is also a form of torture.

So if you do have patients that require drugs or attention through the night, try and place them. All in the same place and as far away as possible from the other patients that can be left to sleep peacefully through the night. Special nurse, consider having a special nurse, especially for those long term inpatients.

Now a special nurse is a nurse who's designated to be a substitute owner for that patient, and they should only be involved in positive aspects of the patient's care, such as walking and feeding and stroking, and they should never be associated with unpleasant or aversive experiences. Unpredictable carers who are sometimes associated with pleasant experiences, but occasionally also perform aversive ones, can create emotional conflict, resulting in stress and reducing that patient's ability to relax. So if you have the luxury of a nurse that can be the special nurse, then please try and use one.

If you can't have a special nurse, then try and use the 1 to 3 rule. But the role of the special nurse is to create a predictable person who that patient can relax around and therefore reduce the potential for long term stress. Also help support good patient welfare and a speedier recovery.

OK, nearly finished, finishing on long term inpatients, and we'll start with dogs. So in humans, decreased mental health has been reported in long term hospitalised, people, and it would be pretty reasonable to assume that the same thing can happen in animals. I'm sure you've all had that patient, that long term inpatient where this is not very scientific, but you just see.

The light go out of their eyes a little bit, and they just get a bit sadder and a bit more depressed about still being in the kennels. So, in addition to a predictable daily routine and all the requirements that I've described about being in kennels for the short term inpatient, long term inpatients will also benefit from novel experiences and also environmental enrichment. If you can think of some, great ideas, I'm gonna give you a few now.

And think about owner visits as well. So some animals will benefit from regular visits from their owners. So if it is safe to do that, and the animal is not distressed when they leave, then visits from the owners should be encouraged.

So, in terms of enriching their lives, longer walks, longer, much more interesting walks at least once a day, not just out to go to the toilet, but to actually help prevent boredom, maintain their muscle tone, and improve the the dog's overall quality of life, giving them chances to sniff. Sniffing is their primary sense, so please let them go out and smell what they, what they need to to enrich their lives. Scatter feeding.

So dogs that are free roaming or living on the streets will spend a huge portion of their day searching and scavenging for food. This is a perfectly natural behaviour, and it's not afforded to most dogs as they are fed from bowls. So scattering dry food around the kennel or the run area encourages this really natural behaviour.

It makes use of the animal's long time sitting in the kennel. And provides mental stimulation as well. And puzzle feeders like Kongs, or rolled up towels with food in them or cardboard boxes, can all be considered for improving the feeding.

Feeding time experience for dogs. Consider using medications for those patients that are stressed, gabapentin, trazodone, they may all help to alleviate that acute anxiety and to help facilitate their recovery. Again, consider a special nurse for the long term inpatients.

I'm finishing with cats now. So everything described for the short term in patients, but include the following if you can, the largest cage in the clinic should be made available, to allow them for more choice and for more movement. A scratching post needs to be added for their nail maintenance and the performance of natural behavioural repertoires.

Different height options if you can within the cage in the form of, of shelving, if you can, or, or a cat tree even. Extra hiding places should also be included if that's practical for you. Again, feeding.

Can be adapted, in the form of scatter feeding, hiding the food or treat dispensables, or placing the food in various locations and heights around the cage, and this will all help to encourage, mental and physical stimulation. And play time with a fishing rod toy can increase mental and physical stimulation too. Also grooming sessions with gentle brushes, not a ferminator, or a flee comb.

And this can help to improve the bond between, the patient and yourself, and it can also help to relax the cat. So those are my top tips for the long term in patients. And I'm finished.

So there are many practical things that can be done, and all of these tips shouldn't be considered, should, should be considered normal patient care and not extras. None of them are expensive, and none of them are time consuming, and they do save you time in the long run, as patients are easier to handle. And my final word is lead by example, soldier on, even if you are the only one doing it in your practise, because changes will occur, I promise you.

Thank you very much for your time.