Hi there. Thank you so much for asking me to speak. I'm really excited to speak, at this particular congress, and also on a favourite subject of mine, which is cat-friendly clinic.
In this talk, we're going to try and cover a few different areas. I could spend all day discussing it with you. But we're gonna focus particularly on Talking about the background of cats, so I'm going to bring in a little bit of how cats came to be in our lives, and you're probably wondering why that's relevant, but I find it really helpful when I think about the reactions of cats in the clinic.
And we will talk about emotions, and I'm not a behaviourist, but as a medic, I need to know how my cats are feeling, and any of us encountering cats in the clinic, it really helps if you have some understanding of why they're behaving the way that they are. We'll talk about some of the challenges of being cat friendly when you're very busy and time pressured. We'll talk about axiolysis, how to use that, and we'll be going through some environmental, as well as kind of habit changes that can make us more cat friendly.
So hopefully there'll be something in here for you, even if you already work in a cat friendly clinic, but also if it's something you're considering doing for your clinic. But even if you're not, there might be a few tips and tricks that you can take away from this session. So just a bit of background, if you're not aware of what I'm talking about at all, regards the cat friendly clinic scheme.
It's a scheme that's run by International Cat Care and their veterinary division, which is called the International Society of Feline Medicine. And we've been running this for about 10 years because we realised that in comparison to dogs, cats got a bit less attention from the veterinary sort of arena as far as publications and particularly around handling in the clinic, where it was really accepted that cats could be very difficult to deal with, perhaps were heavily restrained, and just were not considered so carefully as far as their mental well-being as well as their physical well-being. So ISFM started this scheme and is now accredited over 3000 clinics all around the world.
A similar scheme is run in the US Our partner scheme is run in the US, which is called the Cat Friendly practise scheme. Now, this scheme has benefits to both cats owners, but also to staff working in the clinic, and I will tell you how to convince your boss that it's also beneficial as far as income generation. It's pretty well known and well accepted by veterinary professionals, and most people I speak to have certainly heard of what we're trying to do with cat-friendly clinic.
But in general, we could do a lot better at marketing it to owners. And I think if you are a cat-friendly clinic or you're thinking of becoming one, then have a look at how you're marketing it and make sure your clients are actually aware, because I think you find a lot of clients are not aware of all the efforts that are being made for their cats, and they'll appreciate it. So because the scheme had been around for 10 or 11 years this year, we decided it was time to update some guidelines.
And so a lot of what I'm going to discuss with you today is in much greater detail in these two particular guidelines. So I can't go through. Everything.
Follow this link or even just Google a cat friendly clinic, cat friendly environments and cat friendly interactions, and you'll find these documents, which I've taken some charts from, and you can refer to for, lots and lots of information and share with your colleagues. So I told you I was going to tell you what a cat is. Well, you're probably thinking, of course, I know what a cat is.
But actually, understanding where cats came from can really help us understand them. And if we were dealing with any other species, maybe that we weren't familiar with, we probably would look at their husbandry, their history, you know, if we were treating zoo animals or something. And actually, I'm going to try and convince you that our cats are still little wild cats.
They are descended from the African wildcat, which you can see on the screen here, which is sort of like a leggy tabby and not too dissimilar from the cats in your consulting room. And we often think about cats in terms of sort of Egypt and being honoured in that way, but they've probably been around and around human settlements for a little bit longer than that. But they're not traditionally domesticated.
They came into human lives because they realised that where there were humans there was farming. Farming meant grain and grain meant mice and rats, and therefore it's a sort of parallel association rather than cats being bought directly into our homes all that time ago. They are excellent predators, which anyone who owns a hunting cat will know very well.
But an important point is that in the wild they're also prey to larger carnivores, and that means that they are a vigilant species. So they're both predators and preys, and that's important because a lot of their behaviour in the clinic, it comes from that fear of larger predators. Therefore, it makes sense to be fearful of large dogs, for example, in a clinic.
These little wild cats are independent and quite solitary. They don't live in groups, and they're highly territorial. And these are characteristics that we see in our modern cats.
And we always use this phrase of cats not being small dogs, which comes from that historic sort of underrepresentation of cats in the veterinary curriculums and the textbooks and the scientific literature, which I'm really pleased to say is changing. So I know I don't need to tell you that cats are not small dogs, but just look at that kind of contrasting. Evolution and contrasting ethology, and you see that dogs are highly inbred.
They've been selected for their character as well as their appearance. And of course we have Chihuahuas, we have Great Danes, and that kind of variation we don't see in cats. They've been bred for jobs, such as rescuing and herding or just looking cute or not cute, whether you think pugs are cute or not, and they don't run around outside generally without us.
Whereas cats, I mentioned this kind of parallel journey into the modern times, and that's because hunting abilities have been really quite prized until recently when we decided we didn't particularly like them bringing mice into the house and eating them. That independent nature is something that we celebrated and in some cases still do. We consider them less demanding pets.
So we like some aspects of their wildness and their lack of domestication, but some other aspects we don't particularly like, and this can cause a real clash between normal behaviour and running a successful veterinary clinic or having a cat that doesn't have behavioural problems. Additionally, cats go outside, certainly in the UK and in lots of other countries, unsupervised through cat flaps, etc. And that means they have different exposures to trauma and parasites, and we need to understand that when we're managing any illness or preventative healthcare.
And we need to think about this little wildcat when we think about stress, because they are susceptible to stress in the home, outside the home and definitely in the veterinary clinic. So what do cats like? Well, they like control.
They like to feel safe within their own territory. They like to choose what they do, and they like peace and quiet. And I think you might agree that that does not describe a busy veterinary clinic.
And so immediately we are starting to pressure some of the things that they find truly important. As I mentioned, they retain some of these characteristics of wild cats, and that includes that hypervigilance. They're very aware of noises, of smells, of sights, and as mentioned of other animals.
And they really are quite cognitive and emotionally complex and much as the memes on the internet and things might simplify them, there's quite a lot going on in there. They do feel a lot. They're also very unfamiliar with going away from home compared to dogs.
So immediately going to a veterinary clinic may become a much bigger deal and much more stressful than the dog that's quite used to going in the car, for example, my dogs love going in the car. They are also smaller, and that means that some of our drugs aren't made for cats, and we have to divide them. They have different physiology, which means different toxicities from dogs as well.
And so all of this we've got to take into account when we manage them. And that's why they really are. They're such a unique species, and we can't treat them in the same way as our canine patients.
So there's a little wildcat, that's my little wildcat. They also have really diverse lifestyles, and that means that our veterinary care might be quite diverse for them. We certainly have feral cats that are going to have, you know, likely minimal veterinary care, and they might need some preventative healthcare and encounter infectious disease and require population control.
And then on the other hand, we've got our cosseted pet cats and our pure breed cats, for example, where they have potentially been bred more for character and tolerance of humans. In the middle we have a group which we call Inbetweener cats, and these are the cats that you hear the clients say, Oh, I really wish they were a lap cat, but actually they don't seem that bothered. And that's the classic Inbetweener where they, they couldn't necessarily survive very well as a feral free roaming cat, but they don't particularly like being contained in a home and cuddled, and there are quite a lot of cats that fall into that category.
So you and I as veterinary professionals need to manage this whole spectrum, which is a little bit different from potentially how we treat other species. So despite all I've said about this and you know that they're wild and they're hunters, they have adapted to being pets and they can cope with living with other animals, and many cats like living with other animals, and they can make excellent family pets, as you can see this picture of a friend of mine's little girl with their cat. So they're very much loved by their owners, and in modern times owners demand excellent veterinary care from us and we'll spend money on them and see them really as part of the family.
And you can see from this particular study where owners were asked how they did view cats that half of them, you know, they don't see them just as a pet, they see them as part of the family and a proportion, 25%, see them as their child. And so a lot of emotions and a lot of attachment involved in that. And so we've therefore got to step up and and understand this this species so we can look after them the best.
So knowing about the species, as we mentioned, helps us understand their natural and normal behaviour, even if that behaviour doesn't fit with what owners want them to do, such as house soiling, for example, it could be a completely normal behaviour, but it's clearly not convenient within a home, and we need to understand their reactions to things that go on in the clinic and consider adjusting the clinic to reduce that fear and anxiety. So other reasons to be cat friendly, which, you know, comes naturally to many of you that are listening, I'm sure. But there are a building, there's building evidence to prove that being cat friendly is a benefit all round.
So we've got data from both the USA and the UK showing less staff injuries from cat-friendly clinics, and that means fewer days off and in the US means less sort of healthcare costs associated with that. Actually increased efficiency, and that might surprise some of you because people may have a perception that to be cat friendly means you have to be really slow, you have to faff about, you can't get the job done. Actually that's not true at all, and the evidence suggests that examination times are shorter and fewer staff are required.
Once we get in a battle with the cat and we're restraining them and we're holding them down and we need more people to hold this bit and that bit to get our samples, then we need more staff involved. In that situation where we've got a cat that's very anxious and stressed, we can't interpret some of our clinical data, and that includes things like heart murmurs, hyperglycemia, so we're going to get inaccurate information. And we know that the quality of anaesthesia is improved when cats are less stressed when they're going into that anaesthesia.
Interestingly, the same true in humans that we want humans to be relaxed going into surgery and we want cats to be relaxed going into surgery might actually even need less drugs for the anaesthesia and therefore less adverse effects. So if I haven't convinced you already, or you need to convince the boss, this recent paper came out just last year which showed that at cat friendly practises, so which are the American equivalent cat friendly clinics, they found that the average Revenue, the average practise income for per cat visit was higher, there was a higher level of diagnostic testing, a higher number of visits, so the cat clients were more. Just more keen to visit the practise, and when they were in the practise, they were, more accepting of further diagnostic tests.
And interestingly, there was a higher number of cats with clinical abnormalities, presumably because they were coming in more often, and they had higher caseloads and they could examine these cats fully. So there's benefits all round really. Another study here looking at stress in cats and their owners at outpatient veterinary clinics, and owners were asked what they found stressful about their about their clinic experiences.
And the most stressful elements they found were travelling to the clinic, other animals in the waiting room, and then the consultation itself. So owners notice, they do notice how their cats are handled in this clinic. And a third of them had seen their cats scruffed, which is obviously something that would be extremely upsetting.
I'd hate to see my cat scruffed. I think that would be, you know, really upsetting, and owners reported that they found these things upsetting. They were aware their cats were stressed and they didn't like it, and that would be a barrier to them coming back to that clinic.
Interestingly, they felt that cat only waiting rooms would be the most effective measure to reduce stress, perhaps because they're sat there waiting, noticing their cat's stress, noticing dogs if they're close to them, for example. So we've got this sort of growing evidence of the of the benefits of being cat friendly. Let's move on to talk about emotions, and why we care about it.
As I say, I'm not a behaviourist, but I've learned a tremendous amount from working in the cat-friendly, clinic scheme and working with some fabulous behaviourists when we were talking about why cats do what they do in a clinic. And the take home really is that the behaviours cats shows are cats show are their response is how they're feeling. And a lot of this really reminded me to being a parent actually, when we talk about the behaviour just being.
Almost a symptom of the emotion. And sometimes when creatures like toddlers or cats have a limited range of ways to behave, then we need to look at what that underlying emotion is rather than just trying to correct or prevent that behaviour. We need to look at why they're doing it.
And cats are emotional creatures like toddlers, and they are also responding to their prior learning. So how often have you seen a cat that was OK on visit one, more challenging visit two, when you saw it again on visit 3, you couldn't get it out the basket. And this is because they're just like toddlers again, they're learning from their experience.
And if they learned that they, the clinic is a place of fear, where they had no control and where they had a negative outcome for them. I'm gonna remember that and learn from that. And so traditionally we've talked about positive and negative emotions, but with the Heath model, using this with permission of Sarah Heath, we've sort of tried to rename them as engaging and protective emotions because it helps us really understand the behaviours that are the result of these feelings.
So because I'm quite a simple, I'm not a behaviourist, I've tried to put this and slightly modify Sarah Heath's diagram to explain a little more. When we talk about emotions, we talk about, she talks about valence, which is this positive or negative, sort of aspect of it. And we also talk about arousal, so how to me simply how, intense that emotion is.
And what we see in cats in this engaging emotions is joy, care, and obviously lust, which won't apply to most of our neutered patients. But these, these positive or engaging emotions are, you know, something that actually can happen within the veterinary clinic and be learned and be learned as a positive thing. And what we might see as far as behaviours as a result of those emotions are exploring the environment, playing for potentially for inpatients, seeking warmth and contact, and so these are all the behaviours that would result from some of that, those, those engaging emotions.
On the other side, the protective emotions of fear, anxiety, and look at pain in there. So pain comes in as an emotion. And that's because a lot of our patients coming in with pain will also have fear and anxiety, and they make each other worse, is my simplistic explanation.
Fear and anxiety can make pain worse and pain can make fear and anxiety worse. So just think about that. If you're in pain, you're much less tolerant, aren't you?
I certainly am. I have a headache, I can't, you know, the children asking me for things is pushed me over the edge. And then also on this side, we have frustration, which we'll talk about a little bit more in a moment.
But the behaviours that we'll see as a result of those protective emotions are going to be the things that you and I do not want. So by repulsion, we mean hissing, biting, scratching, by avoidance and inhibition, we mean those cats that try and hide under the counters or try and simply sit as still as they possibly can, like a statue. And some cats will do appeasement, which is when they're sort of rubbing around you, but they're actually still feeling quite fearful.
So what happens if a cat is feeling an emotion of fear, anxiety, or pain, for example, they can sort of choose their, their behavioural response. But if we don't listen to that, then they can go up, up the ladder of those emotions and those behaviours. And Sarah Heath talks.
About a sort of tree and jumping the branches to to different things. And I see this in children as well. You know, one behaviour doesn't work, I'll try the other one.
Being nice didn't work, I'll, I'll hit them over the head, etc. And similarly, if a cat tries to be inhibited, they try and stay very still, hide their head, Look away from you, and we don't let them, then they might jump to showing repulsion, which we're more familiar with the term aggression, but prefer to maybe call it repulsion because they're just trying to get away. They're not trying to savage you and I.
They're trying to get away. Again, if they can't avoid, so that cat that ran underneath the cupboard that we drag out that then bites us. And again, that cat that's trying to, to appease us, but then we still restrain them, this can very quickly also turn to that behaviour.
And frustration I mentioned, and this is another protective emotion. And, you know, those cats, and I'm showing you a video of it now, who, they don't seem fearful. They disrupt their cage, they turn everything upside down, the litter tray upside down.
It's often young cats that are quite actually bold, temperament cats. And you can see this cat was an absolute nightmare. He's, if you look closely, tied the giving set and the extension set round his neck.
And this is a cat that had had a foreign body, actually had was acetemic and so dehydrated that this cat needed fluids, and a cat like that can be very difficult to handle in the clinic. And they will show repelling or aggressive behaviours if we push and try and restrain them, particularly. And axiolytic drugs may not work because they're not fearful, they are just frustrated, and therefore sedative drugs might be a better choice.
What can we do to try and help? Well, often they want out of that cage, and so providing consistent interactions, putting them in a, a larger cage in a consult room, consistently giving them something to do, brushing and interacting with them to encourage positive emotions. And actually, this cap, we did have to provide some sedation to allow us to continue the fluid therapy.
And the other thing, discharge them as soon as possible so that they can get back to their home environment. Inhibition is the other one I mentioned. And what they're doing while they're so inhibited is that they're listening, they're watching, they're gathering information.
And these are the cats that in hospital, they don't use their litter tray. They actually, if you watch them, they don't sleep. They generally don't, don't eat.
And these cats will often be very easy to handle. You can do things yourself, do anything to them. But if pushed, and again, if we don't give them the choice to hide their head or to hide away, then they can change that into a repelling behaviour.
And these are the ones that say, he was totally fine and bit me out of nowhere, didn't bite you out of nowhere. They were showing and trying their best to tell you that they were so unhappy, but we, we weren't able to detect it. Don't forget pain, I mentioned it as one of these protective experiences and emotions and if we have cats that are older, they're likely to have osteoarthritic pain, and therefore travelling to the clinic can cause them discomfort.
Heavy restraint, hard surfaces, all of this pain will increase their, their level of negative emotions, increase their their decrease their tolerance of us doing anything. So consider analgesia, consider simply not extending elbows too much for imaging or for IV placement and always sort of soft beds, of course. The other thing I want to eradicate from your language of your clinic is this term that cats are evil, naughty, spicy.
They're not any of these things, as we've just said, they're feeling and emotion and they've got to chosen a behavioural response that perhaps has worked for them in the past, that we've, we've taught them. We've pushed them to it. What they're doing is trying to help themselves get back into control and feel safe.
So when they do this, we've probably given them no choice but to behave in this way. And they're basing it on previous experience where they didn't behave like that, but they still had an outcome that to them was not, ideal. And look at this image in the middle.
Look at that cat at the bottom. It's totally possessed and evil. These cats are fearful.
They're fearful for their lives. They think, you know, they think the worst thing's gonna happen. They're going to be hurt.
They're just reacting as a normal little wildcat. So remove that language and describe the behaviour better and then describe what works and what didn't work with that cap because that's much more constructive than just having a flag that comes up that says they're, you know, they're nasty. And when you think about it, it's actually quite surprising we can do anything with cats in the clinic because we have this concept of stressor stacking, which I quite like, and what this really means is that by the time you and I see the cat in the consult room, they've already had a tonne of experiences that means we encounter this cat in the middle, this spiky cat.
So they've been kept in, food withheld, shoved in a carrier, in a scary, noisy car. Horrible waiting room with the dog barking into their face. I'm sure it doesn't happen in your clinics, but, it's certainly can do.
And by the time they reach examination, that stress level. And I always say it's like me with the, the television's on, someone's asking me something, my phone is ringing, something, you're gonna snap, aren't you? And so the same for our cats, so it's almost surprising that, that, as I say, we, we can see cats that are so tolerant when we get them in.
Throw in some previous learning and their background temperament and you end up with a a challenging situation. What can we do? Well, let's be constructive in our advice.
Think about what we tell our owners. Does your clinic provide advice to your cat owners about how they get to the clinic? We'll talk about carrier choice in a moment, but simply things like carrier handling.
And here, I've got a video that I took in my house just showing, if I put my cat in, he encounters my children. Encounters some dogs at horrible low level. Remembered, probably totally unfamiliar with the carrier.
I promise I wasn't swinging it exaggeratedly. This is me just holding the handle. So holding the handle and you have this horrible, traumatising experience before you've even got the clinic.
Just if the carrier had been covered, if the carrier had, been held from underneath rather than by the handle, perhaps you wouldn't have also felt really sick, cause that would lower your tolerance too. You know, these cats that come in drooling, horrible experience. Bringing them in the right carrier.
Have you seen any cats come in in these backpacks? I saw, I was driving down the road the other day and I saw someone walking along with a cat in a backpack. Absolutely terrifying.
this cat in the bottom left here was brought to Sears on the tube, so it'd been on the, on the tube in this, and it's even got a clear bottom. So the cat must feel absolutely like it's got no floor. Imagine.
Terrifying. These, these cloth ones that fold entirely down, so it might feel like the ceiling's coming in. These are horrible choices of carrier, but if we don't educate our owners, then they're gonna fall for the, the online sales and buy one of these.
Actually, what we want, and we've got a QR code here for some information, is a, a carrier that we can remove the top from, that we can cover up. And also, we want to encourage owners to have the basket out. So ban the spidery, cobwebby basket that was used last time and contains a lot of horrible alarm pheromones and actually have it as part of the bed with treats, in.
House so that it's a, a safe space rather than a terrifying, terrifying space. And just me doing a horrible impression here, forgive my face, of how it must feel to be dragged out of a basket. Very intimidating and very frightening before you've even started doing anything.
So those are out. And when you do have clients bring cats in the base with carriers, you can take the top off, you can do a lot. So here's us doing some blood pressure, doing some bloods, doing some ultrasound, all in the base of the carrier, avoiding that handling, which could cause pain and distress.
So, yeah, great deal we can do if we do that. What if a cat is really reluctant to leave the carrier? That's a common situation, isn't it?
And I found this, picture. In a book called Mog Goes to the Vet that my children were reading that you can see, it says, the vet tried to look at her, but it was very difficult. And this is a situation where Mog wouldn't go into the basket at home and now won't come out of the basket at the vets.
And you'll be pretty familiar with that, I have no doubt. And obviously, an unsuitable carrier, this vet is using and shaking Mog out, which means that when we go to examine Mog, she isn't going to be particularly impressed with that. What's better, you know, if we can get clients to choose the right carrier, even with challenging cats.
So in this situation, if we have a cat that we know, is quite fearful in the clinic, and in this situation, what we can do is, particularly using an assistant can help, which I know isn't always available, but we can take the top off and we can slide a towel in. OK? So instead of using gauntlets or anything like this, which, you know, discourage you to use, we can just cover the cat with a towel.
That would allow us to do an examination. Abdominal palpation, etc. Or we can then remove the cat and potentially give an injection of sedation or put into another carrier, for example.
So carriers are important. What we've seen an increase in use of is, anxiolysis. And so we see quite a lot of gabapentin used prior to visiting the clinic, if you're not aware of this, a few nice studies showing reduced fear and anxiety and increased handlability.
Once cats have been treated with gabapentin, usually 2 hours before their appointment or their visit. It is very effective and also pregabalin is another drug alternative, which has got a licence in Europe and in the UK although it's availability in the UK is very limited and so gabapentin is used much more frequently. And this can be really effective if we have a little old cat ins quite poor body condition or with CKD then do lower the dose.
But in general, it's 100 milligrammes per cat, usually works out to be about 20 milligrammes per kilogramme, and that's been studied in also hyperthyroid patients presenting for radioactive iodine treatment. And a really nice paper you can see at the top here showing that oral gabapentin administration can reduce actually the amount of anaesthesia that is required whilst you are doing a procedure. As far as effects on blood pressure measurement, it has been thought that it has very minimal effect on blood pressure, and there's a study showing in healthy cats that that effect is very, very minimal on our clinical parameters, including systolic blood pressure.
But actually, there's a bit of evidence showing that in our chronic kidney disease or older cats, it potentially could lower blood pressure a little, which is not unexpected really because anxiety will increase blood pressure. So we're not sure how much of that is a drug effect abnormally, lowering the blood pressure or if actually it's just removing that anxiety induced white coat hypertension. But it's something we should be aware of.
Trazodone has also been used in this situation too, but trazodone is gabapentin is pretty bitter to give, but trazodone is quite difficult to dose to cats, and so we'd prefer, we have a better wealth of knowledge about using gabapentin or pregabalin. So cat friendly environments, well, those of you who've read our, our guidelines, you might be familiar with these sort of pillar process. And so these, we've got 5 different pillars, and this applies to the home environment, but it also applies to the clinic environment.
And basically, what it means is the things that We need to consider in order to make that environment more tolerable to cats. And it really centres around considering their senses, particularly the extra pillar that was added not too long ago, which is respecting the cat's sense of smell, but also their other senses, providing them with key resources. And that means somewhere to hide as well, in a veterinary clinic.
And opportunities to keep themselves safe and have positive, consistent and predictable interactions with humans. And you can see how some of this goes sort of out the window when we've got to get things done and we've got to have interactions with cats that result in in their treatment. But we need to take it into account and try and optimise these pillars as much as possible.
You'll find this diagram also in our guidelines, so I'll refer you back to have a, have a look at that, that just shows you about a cat's senses and. We always think of dogs as being sniffer dogs, but actually we could have sniffer cats. Their sense of smell is 1000 times better than ours.
I always think, yeah, they just wouldn't choose to do it, would they? But in theory they could go out and find somebody lost. It's just that they, they can't really be bothered, as opposed to to dogs.
But look at that, they feel things, they hear things, they were excellent hearing and sight. And so they are sensitive to, the abuse of those senses. So loud noises, vibrations, slamming doors, and just think about what the cat sees.
I showed you some of my videos, and I'll show you some more of me taking videos from within cat baskets, and it just gives you an idea of what they're experiencing. And a few examples here, what we need to minimise. So, smells, dog anal gland smells, or the horrible bin in the consult room, those cloudy bits of dog hair that have built up.
Actually, just removing some of these scents could lower that, again, lower that stress level, think of that stacking, and then make that cat more tolerant. Some of the sounds of a veterinary clinic can be, you know, horrendous if you're a cat. So you can probably hear that, in the background there.
Horribly traumatic sounds that they can experience. I'll stop it for you here. Even if we've actually tried to keep them dogs away, if they can hear them.
And this is something I've experienced in clinics where they have no visual contact, but they can hear the dogs barking. Those cats can be quite stressed by that. Vibrations, so particularly kind of something like the closing of doors, so here's me putting a cat into a cage in its carrier.
In this situation, you see other cats, so exposure to other cats, which is also extremely stressful, particularly whilst they're contained in a basket and they can't get away. And then just some of the sights that they might see whilst they're being transported. Or whilst they're actually in the ward you can think about, so in this situation, the corridor goes past the dog ward.
And on their way out, they might go past some dogs. All of this causing stress. Oops, a few more noises.
OK, more tips and and things that we need to know, what's out? Well, certainly, cat muzzles, cat bags, clypnosis. All of these are something that we really, really do not want to be using in the clinic.
They cause fear and anxiety. In some cases they will result in a cat showing inhibition because of fear. So that means that we might be able to get the job done, but it means that once we remove that muzzle, the cat's going to be extremely fearful.
We could get bitten, and the next time they come into the practise, they're gonna be very, very challenging. It might mean we can get the job done. But is that good enough?
Is that good enough to justify, very poor welfare during the time that we're doing it? And there is another way. And I don't know if you've seen these horrible bubble plastic cats.
These are available for clippings cat's claws, but the same applies as far as causing loss of control, and fear and anxiety. So what we prefer much more is to use towels, lots of towels, these are an essential part for cat friendly clinic and treats and try and encourage some of those positive engaging emotions. Just a note on using treats.
Some cats love them, and you might be saying to me, Well, I've got treats, but cats never take them. They never take the treats. What you need to do in that situation is look at the clinic and the waiting room and things.
Are they arriving quite stressed? And that's why they're not accepting those treats. And for other cats, it can be that they suffer a little bit of emotional conflict.
So what they mean is they want to take the treat, but they don't want to be anywhere near yours and my hand. And that means we can just put a few dreamies on the table and step away. And then if they approach those treats, we're again just changing it, aren't we?
We're changing that whole situation into something a bit more positive. But don't get disheartened if you feel like cats won't accept the treats that you have. Look at that whole, your whole clinic and see if you can reduce particularly waiting room anxiety.
And then start with kittens. You might find that that you've got a, a sort of technique of working with kittens that involves licky licks and other liquid treats, etc. And then you can start to introduce it to other patients.
And there's a little kitten, well a young cat, one of the first cats we treated with FIP showing that sometimes, you know, those experiences in the clinic can be really positive. The other thing, know your patient, and just a short note and a QR code to show you that if we understand a little bit more about how cats have come to be with their owners and the types of behaviours they've shown before, it can save you time, because you're, you'll go into that situation prepared and knowing that that cat's been challenging to handle previously, and then perhaps would benefit from having gabapentin before they come in. It red flags clients that might need a longer consult, and it saves time taking extensive histories from patients that you haven't seen before.
And you can also send this out to existing clients just to, to really update your information. It's also from a PR point of view, it really shows your clients that you care about their cat and that you care about how they felt previously in the clinic, and understood a little bit more about their pet. I, I have never met an owner who didn't really appreciate that.
I appreciate you've got a short consult time in primary care, and therefore, can this be on the webpage. You can download this from us and you can put your own practise branding on it. We don't mind that at all.
Just keep ourSFM at the bottom. Send that out and you've got all that information, it can be scanned onto a computer. We mentioned the importance of the waiting room in that survey shown to be very important to our owners.
So just have a, have a fresh look at your waiting room. Even if you are a cat-friendly clinic, what we see sometimes is that cat-friendly clinics are beautiful waiting rooms, but people still sit in the dog area, and they still put the carrier on the floor. So that's about client care training to ensure that they're giving that information, or have you got it?
Is it clear in info that's sent out to clients? Is it on the wall? A few pinch points.
One particular is when paying. People tend to put their basket on the floor when they're paying, and that means that all the good work could be undone if they're then sniffed by a dog on the way out because they're still, obviously that, that learning of, of the, scariness of that experience. Some clinics will be brilliant at having towels, even, pheromone impregnated, towels that can be put over the carrier in the waiting room, but then they run out, and whose job is it to replace them.
And in a busy clinic, obviously, we totally understand that. And market it, tell them what you're doing and why you're doing it. Displays about cats, just show people that you really care.
And that survey by Sarah Caney really shows that owners appreciate it and they're very aware of what's going on in the, in the waiting room. So if you have got a beautiful clinic option to have a cat waiting room, great. If you don't, then think about how you can wall off a corner.
But do the other bits like having the towel that can be put over, having, awareness from client care that they should sit in that corner. Here's an example of of use of cat silhouettes, so they look really nice to clients, but if you're that cat in that carrier, you probably might find that quite scary. So just think about think about things like silhouettes and pictures.
What about the consult room? Well, that's also important to the clients, and I'm not going to spend a long time talking about this, but just to say, you know, make it your own, label it as the cats consulting room. If you're the person who tends to see a lot of cats, and have some materials up on the walls and set yourself up for success, have everything that you need.
There and ready to go, so you're not going in and out the door. That's what we really don't want to see. We don't want to see you having to go in and out, and we'd rather, you know, that dogs had not gone in there first if they have, then try and clean up those smells and that hair and just try and make it a more safe and quiet area.
You can do really fancy things and here's a a clinic that very kindly sent this picture in where they've got an area where they can look at how a cat moves in the clinic, so they've got steps. And that's a kind of innovative way of providing an option, for the cat to again have choice about how it moves around the room. You can always make sure that there's somewhere either in the base of their carrier or if not, then a box on your consulting table where they can feel hidden while you do your examination.
Prepping, really important. So having all the equipment that you need, so you're not going in and out, in and out, in and out. And there's something to be said about not moving cats around the clinic.
So for bloods, do they have to go out to the prep room? Can they not be done in the consult room to avoid that kind of transport and exposure to different noises and smells? So just think about what you have, what you have ready, whether there is time, obviously you might have a next appointment.
But if not, can those bloods be done in the room and the equipment brought to the cat rather than the cat taken to a different area? Let's move on a little bit to interactions and how we actually handle the cat. We talked about that a little bit, but we'll talk about it, sort of a little bit more.
What we want to do is really give back the control to that cat and examine them where they are comfortable. OK. So you can see a cat here that's being allowed to move around the room.
And just being examined in stages, listen to the heart. Palpate the abdomen. And then giving it breaks in between and allowing it to move around the room.
Some cats won't have the confidence to do that, and they'll want to stay in their carrier or they'll want to stay on the consult table. If they do, they'll cover their head. Give them the choice to be covered if they want to whilst you examine bits of them and you move that towel around.
You can also see here measuring blood pressure, just sat on a chair in the consult room, examining cats on the floor. This can make such a difference to how that cat tolerates examination. But in some cases we're gonna need to do more, and in which case, if we can't manage to do things by distraction or in the carrier, and there are some cats that you can even take blood from while they're using licky licks.
I know you might not believe me in all situations, but it is possible. But sometimes we are gonna have to do a loose towel wrap, and I think that's acceptable, give the cat the option of hiding their head if they want to. Again, it's about looking at what they want to do.
And then if that's not working, we're gonna have to consider taking a break and sedation, rather than escalating this into a big battle that results in someone getting bitten and that cat learning that the clinic is somewhere very scary. OK, just note also the use of kind of comfy bed and gentle handling, slowly, pheromone sprays. I've got this algorithm, which I'm not going to take you through because it's very long, but I want to just refer you back to those interaction guidelines.
And what this shows is that we're not naive that many cats have already have learned experiences of the clinic, and they will not tolerate being examined in the base of the carrier, and they will not tolerate any of your best cat-friendly interactions. And so for those cats where they have previously behaved protectively, so they've shown the type of aggressive behaviour that we've talked about, we've got this algorithm to talk about anxiolysis, to talk about kind of how to, at what point to intervene with with IM sedation, but also thinking about how you handle these cats after, for example, a procedure. So again, we're avoiding this battle.
Make your own life easier, recover them in the carrier. Now all of this. Obviously, we need to have appropriate observation of our patients after anaesthesia or sedation, but mostly we can do that with the cat in their carrier, and then we don't have that additional step of removing them from the cage and putting them back in their carrier, which can be problematic.
Removing IV lines when it's safe to do so, but before a full recovery again can all make your life so much easier. But this won't be possible if you don't know about this cat's behaviour, and that's why we need to be recording emotions and behaviour in the records so that we can plan ahead for this. You know, your best fracture repair in the world, but if we have to, you know, heavily restrain that cat and get.
The gauntlets out to try and get the IV out. A lot of that good work will be undone, because remember that anxiety and fear can affect recovery. It can just affect everything, as well as when you see that cat back to check that fractured repair, it's gonna be even less examinable.
So consider these preemptive steps and recording what works and what didn't work. And so that can be used again, rather than just, as I said, labelling the cat as, as really difficult to, to handle. So what we said is there are 3 Ps.
If they are a cat that behaves protectively, then plan and prepare and consider what you need to do in order to make that experience. It's got to be done. We're not saying it doesn't have to be done, but let's try and make that experience efficient and minimise any further learning about the bad experiences.
You can find all that info in the guidelines. What about the ward? Well, the ward is somewhere, yeah, lots of clinics do now have cat only wards, which is really brilliant.
That wasn't the case 10 years ago, and I think we've all seen a real growth in in cat wards. And a clinic recently that, I was shown around. They very kindly showed me around their cat ward, and they had a cat ward previously, but it was, was a bit noisy.
It was quite small and the their cages faced each other. And now they had a really nice ward without the cats facing each other and without the cats being examined in front of each other. And they said that they saw they required less sedation and the cats were much easier to handle.
So it really does have an impact on workflow because everything is longer when it's a big battle. So if you've got your cat only ward, brilliant. If you don't, then there are workarounds as far as timing procedures, perhaps in giving a cat a pre-med in the consult room in their carrier, as long as we're regularly checking them, of course, before they're brought to the ward, recovering them away from dogs.
If there's a dog that's noisy, then can that be discharged ASAP. Just work around as much as you possibly can. I've worked in clinics with no cat ward, and that tended to be what we did.
We tried to time the procedures. If we did have to put a cat in the ward where there were dogs there, then certainly they had somewhere to hide that was very covered up, and we sent them home as soon as we, we possibly could. OK.
So just think about what you can work around if you need to. Wherever, whether you have a dog ward or a cat ward or a mixed ward, there must, these cats must have somewhere to hide. It's very well recognised that this will reduce their anxiety, no matter what emotion they're feeling.
Ideally, they could also sit on the top and perch, and you see things like the cat's protection hide in the image here, where they can perch on the top or go underneath. These are quite widely used, but they were designed for shelters. They're quite heavy and they're difficult to get cats that are fearful out from underneath them.
Some people use what you can see at the bottom there, which is just a step, so it's just a, a sort of cheap stool, step stool with a blanket over the top of it. It does the job, but there are other solutions that I'll, I'll show you as well. So this is a bucket turned upside down with the front cut out.
I quite like that. Again, you've got an option to sit on the top. A cat's own carriers can be used, and that obviously provides some sense of security because of the scent from home, which can be quite valuable, and they can then be taken, you know, just put back straight back into their carrier and discharged, for example, or taken to other areas of the clinic.
These structures, I, I bought these, they were, litter trays, actually covered litter trays, and they're not perfect for, for the job because the IV line can still get sort of caught up. But they're not bad. And again, the cats seem to like them.
And what about a cardboard box? Well, I would say if there's a cat in a cage without anywhere to hide, that's not acceptable, and anyone can find a cardboard box, tip the drip bags out, use those, use anything, but they must have somewhere to, to be able to be hidden. And we might argue, well, what about observation, but I think you'll agree with all of these solutions, we can still see the cat, we can still do our monitoring, and so it allows us to see, for example, respiratory patterns, take respiratory rates, but without .
Than being so exposed and feeling so open. Here's a few more examples, some fancy cages here. These are really nice, aren't they?
I'm not expecting everyone to have these, but aren't they lovely from one of our ISFM cat friendly clinics. They've got a little curtain. So you can do very fancy things, but these cages that have portholes between them are lovely to provide separation.
These beds are quite sweet. Another cardboard box. So have a look, even if you are a cat friendly clinic, just make sure that every cat is having a bed.
And then just think about again that experience of the cat in the ward. So I did one of my videos. Can you hear that noise?
Really noisy, isn't it? You probably can't hear me very well. It's really noisy.
And so in these situations where we have cats in cages and we have a work environment in the middle of the ward, so we have places to examine or treat cats that's in front of their cages, or even sitting and writing notes up in front of their cages. That's not. The best thing in the world, and you could hear from that, a ringing phone, people talking.
Take the conversation out of the ward is the first thing that I would say. So ward rounds, shoo the vets out, they need to have that discussion outside, not in front of the cat. Covering the front of the cage, at least partially.
So that will give the boulder cats the choice of looking out if they want to, but the more frightened cats of hiding away. So there are ways of, of covering this, and I've got a few examples for you here. So if you have a ward where you have the table in front of the cats, here's, one in the bottom corner here with a curtain that comes across, which I really like.
In the middle, a movable screen on wheels, that covers the front when they're examining a cat. And just make sure that you, you close the cages, very quietly. You can put some stoppers on the metal cages to stop them being so noisy.
And in this type of situation where we have cats that cages that look onto other cages, try not to use one side, and try not to, when you're bringing cats in, expose them to visuals of other patients. So you can see here, try and use just one side, not both sides. Hospital sheets.
Well, again, I've got one for you. I've sold this for you. You can use ours.
We, did a bit of work on altering the hospital sheets from a clinic that I was working at, and they very generously allowed us to use them. You can label this with your clinic, and this isn't going to be for your day patients. This is going to be likely for an inpatient because of the detail that it has.
But I do think hospital sheet recording is very important. . Providing things like their nutrient requirement, their nutritional requirements, their just their preferences, and recording urination and defecation and food intake.
And so have a look on our cat friendly clinic environment guidelines and you'll see that you can download these hospital sheets. And just consider that every hospitalised cat is an individual. And I really love this photo I've shown it before in talks, where one of our, fabulous nurses has really identified a lot about this patient.
So they've written a note on the cage, and what you can see, they've written, I like chin rubs and a gentle voice. Please don't give me a castle's, I panic when you lift it off me. So This cat was actually quite challenging to handle, but what you can see is that from that information we can engage in some positive experiences, which has the knock-on of making our lives easier.
We also learned that giving this cat one of those grey cats protection castles could be challenging because when it's lifted off, the cat feels very fearful. So in that small bit of information, we've really learned how to handle this, this cat. Also for inpatients, and if you are a clinic that's hospitalising cats, I really want you to to have a think about your protocols for kind of TPR so temperature, pulse essential monitoring.
It's quite easy to get into the habit of doing full TPRs, for example, twice a day. And yes, you're absolutely right, that could be valuable clinical information. But I would argue that a lot of surgical patients, in general, patients that are improving, do they need to have rectal temperature taken twice a day?
That in itself can be something that's really, you know, scary and upsetting for a cat. So just look at the checks, and I'm notorious for going into the clinic looking at the sheets and crossing off lots and lots of checks. It doesn't mean we don't monitor these patients, but we can do a lot of what we used to call at uni over the box door checks.
So, from when we did equine, but looking in and looking at the patient's demeanour, measuring their respiratory rate from a distance, for example, rather than getting them out, getting them, you know, into a stressful situation, doing a rectal temperature and then everything being much, much more difficult. Timing is important, so if you do need to do a temperature, could you do it an hour after they've had analgesia so that when being taken out is less uncomfortable for them. Medications.
Have we got oral meds at 9 and at 12? Is it not possible if they're twice a day that we could combine those medications in a, a gelatin capsule and give them all in one go, so that that cat's not being pilled multiple times in a day. And are they all needed?
Polypharmacy, it has negatives for many reasons, but also for this again, recurrent medicating, multiple times. Could we give some of those meds IV while they're hospitalised? And then consider discharging them as soon as possible.
I am quite a control freak and I like to see the patient, and maybe I want to see them urinate. Maybe I want to see them eat, but sometimes we have to bite the bullet, communicate with our client and discharge them. And it's rare that I've regretted that.
Yes, it's possible that then they don't urinate, then they don't eat, they have to come back in. Everyone's annoyed. But in lots of cases, there are cats that have, you know, such a temperament that they will not urinate, they will not eat while they're in.
Feeding tubes are fabulous for us not having to worry about some of these things, and I'll talk about them as my final slide. Other bits of cat friendly equipment, I think that pocus and or TFA safer, so this kind of rapid scanning and ultrasound, if you have that available, is a very cat friendly thing to do. We allow cats to adopt a natural position, don't restrain them, and we can identify free fluid, wet lungs, all sorts of things, and particularly great if we can do it with any form of portable scanner and and do that on the ward.
So pocus in general is a really useful and cat friendly skill that can be introduced. Measuring blood pressure with minimal restraint and with headphones, using ELA cream where possible. So are you always applying ELA when you're doing, in advance of placing IVs, using things like ease off to to remove bandages, and not using horribly adhesive bandages that are very difficult to get off.
Feeding tubes, warming devices, all things that are very, very species specific. Soft buster collars rather than hard ones if we don't need to use the, the hard ones. I had a, a schoolm friend the other day and the cat had been discharged, it had a small bite wound been discharged with a a hard collar and the cat hadn't moved for about 12 hours.
It was so distressed by the the plastic Elizabethan collar, whereas actually a fabric one, they can push backwards and they can just allow a little bit more normal behaviour. And again, you know, if you are hospitalising lots of cats, and you are seeing lots and lots of sick patients, then consider whether nutrition is a priority in your clinic. Are you always calculating RER, measuring body condition and muscle condition score?
And what about feeding tube interventions? So this is one of our videos that we have as part of our inhabitant cat guidelines, and we show you step by step how to place NO tubes, O tubes, and there's one for owners on how to look after them. And in a clinic that's seeing a lot of sick cats and hospitalising cats, you really should be placing some feeding tubes.
Final thought on medications, it's another part of being a cat friendly clinic is not just knowing what medications to prescribe, it's supporting our owners and giving them. So I'd ask you, if you're doing everything else that I've said today, are you supporting your owners with medicating? You can see from some of our research that owners find it really difficult to give oral medications to cats.
So have you got a handout? You talk about putting in treats, do you tell them if they can crush it in food? All of this can really elevate your, your cat friendly practise, cat friendly clinic.
So I'll take home messages and here's my black cat again. My cat just showing you that he can be a killer outside, but he can also be a cherished part of the family, and that's the interesting controversies of cats, isn't it? The contrasting behaviours that they show.
That's why I love them. But just to take home, even if you're a cat-friendly clinic, you know, are you keeping up the good habits? One thing we often see is staff changes in veterinary clinics, and when those staff changes occur, we can often lose the cat advocates from the clinics.
We can lose that person that was really into cats, and therefore that that level can, can go down. So think about whether it's part of your onboarding to have a chat that you are a cat friendly clinic, or even if you're not, that you respect cats and, and you're trying to look after them as best you can. If you lose your cat advocate, then does someone else want to do it?
Think about what that cat sees in their basket from the owner's home all the way through to your clinic, through to your prep room. Is there anything that you can improve from a cat's senses point of view? Have a fresh look.
And if you're not a cat-friendly clinic, maybe you don't intend to become one. I hope that there's a few tips and tricks that even just help how you, you know, how you handle cats and, and help get those jobs done, but done in an efficient and cat-friendly way. Here's a QR code and you can go to our website for finding lots and lots and lots more information.
And thank you very much for asking me to speak to you. I've really enjoyed discussing cat-friendly clinic, and I've put my email address on there if you have any queries or questions. Thanks very much for everyone listening for that.
As I said, Samantha is, has recorded that previously, so we won't be able to ask her any of the questions that you've put up, but we will forward those. I'm thrilled now to have one of my favourite vets, who's gonna be speaking next to a world. Wide famous behaviourist, veterinary behaviourist, it's Sarah Heath.
She lives just down the road from me in Chester, is also a Liverpool fan. We're in a tiny bit of mourning because our team lost on Sunday, but, we'll keep our chin ups the season has still got some time to go. That's football, soccer, if you're listening in America.
But Sarah today isn't gonna be talking about football. She's gonna be talking about confrontational cats. Why do they behave the way that they do?
And . Really interestingly, as much as er I feel I know quite a lot about cats, and I've been adopted by a cat during the pandemic, Sarah regularly gives myself and my wife some advice on our Well, I wouldn't even say challenging, just original and unique pussycats that we're on his staff for, which is Buddy, and he's been on the programme for the virtual congress as well. So, Sarah, as always, always enjoy and look forward to listening to you talking and as I say, please don't mention the F word and then you can get started.
Hi, Antony. Always a pleasure. Great to hear your voice.
And, yes, wasn't so good, was it, at the weekend, but onwards and upwards, and, it will all be fine in the end, I'm sure. Hi, everybody. I hope you're having a really brilliant, virtual congress, and all part of webinar vet for really starting the trend of online learning way before COVID.
Now everyone's doing it, but it's great to see the virtual, webinar, congress working as well as it always has. So great also to follow on from Sam. pleasure to listen to Sam talking about cats as ever.
And thank you for the credit for the Heath model, about emotional health. So, I'm gonna be looking at that model a little bit as we talk about this topic of confrontational cats, and think about why they behave that way. So, the learning outcomes I was thinking of covering tonight in this presentation is to consider the implications of feline confrontational behaviour.
You'll notice I don't use the. The word aggression. Anyone who's ever heard me speak before will know that I really dislike the word aggression, because it, it is so poorly defined.
And it, it, it means a 1 1000 things to 1000 different people. So I really try not to use that word. And also, very much do not use the term aggressive cat, as if it is a property of the individual.
But hopefully, by the end of this presentation, you'll be with, with me on that page that It is not a trait of the individual. It's a result of many varying factors. So, yes, they display confrontational behaviour, but that doesn't mean that that is a trait of them as an individual.
And that's probably quite relevant at the moment in the light of certain ridiculous legislation in the UK courtesy of a government that doesn't understand. But we'll move on from that. So consider the implications of feline confrontational behaviour.
Understand the application of a behavioural medicine approach. When we're thinking about these sorts of cases, I want to outline how behavioural medicine helps you to get to the bottom of these issues. Appreciate the range of potential underlying causes, and there are many, and then relate that to treatment and management approaches.
So let's start off then thinking about the implications of feline confrontational behaviour. Of course, cats may not appear to pose much of a threat, and certainly if we look at them in terms of their physical size, people may overlook the potential for them to inflict damage. And I think if I'm got a quite an audience here with, veterinary personnel, practise personnel, then you may have a very different view of that because of your experiences.
But I think out in the general public, certainly, there's a perception that, well, cats are small, surely they can't do that much damage. But we know that they're very well armed, so they have a, a combination of the weapons at the front, that they can inflict damage with, and we'll talk a little bit about the nature of the damage that can be inflicted and the reason why that is important in, in how we deal with these cases. But also.
So they have, of course, this equipment at all four corners. So here we've got a situation where we've got a lot of potential to do physical harm and injuries from feline confrontational behaviour shouldn't be underestimated. These are actually pictures from human injuries, related to cats.
So these are cat injuries, the one on the left hand side, you can see the puncturing, which you're probably all familiar with, and scratching. Maybe the one on the right hand side, is less easily recognised as a cat inflicted injury at the beginning. I could.
I have put on here, other images, which, obviously, we don't want to be upsetting people. I don't know what time of the day it is in all the countries in the world, but some of you may be eating breakfast. So we don't want to be looking at really gory pictures, but I do want to just emphasise that there is a risk of physical injury, both to people and also to other animals.
And we need to remember that certain individuals are going to be more at risk than others. So if you think about the human animal and the potential for that to be damaged by a cat in a confrontational encounter, that's gonna be particularly relevant if we have small children, or we have elderly people or anyone who's immunocompromised for any reason. We also need to remember the risk of zoonosis, of course, and, we need to consider this bacterial contamination levels in the mouth of cats.
We know that they have, you know, severe levels of bacterial contamination, things like, pastorella malticcier, which we may be very familiar with. But it's not just the fact that there's a lot of potential pathogens in the mouth of the cat if they bite you, but also the nature of the way they bite. So they bite with penetration.
And that means there's almost an injecting of pathogens into the muscular tissue that they're biting. And so, medical advice is crucial in situations where there are injuries, and it's really important not to underestimate the damage that can be done, not just by the physical injury. So we may have, you know, a puncture wound as we can see in these two examples, or here in that abductor muscle mass at the base of the.
Them, which is a quite a common location. So we have the actual physical injury, but we also need to remember about those pathogens, the fact that they are now potentially deep in that tissue, and then we get tracking, of that infection, and, and we all know how serious it can become. What about risk of injury to themselves?
So one of the reasons that we know that cats are very different from our canine companions and something that, Sam talked about in her presentation, is the fact that cats are solitary survivors. They're not a. Socially obligate species, they don't live naturally in social groups with the aim of cooperative survival, and that makes them very different in terms of the potential for injury to be problematic for them because, If you, if you like no one ever going to, it's no one's ever going to bring them breakfast in bed if they're injured.
So this is something that they do need to be geared up to, to, to protect their own survival, and the risk of injury is very real, even if they were the first one who was going to initiate that confrontation, there may actually be significant risk of injury to themselves. So once they. Engaged in that combat, cats don't have behavioural diffusion mechanisms.
So the diffusion mechanisms that are very important in lowering the risk of escalation of combat are very much related to mutual survival. So in other words, if you're a socially obligate mammal, a dog, a human animal, or a, or a, a horse, for example, then it's you in your vested interest to ensure that this doesn't escalate because we all need to survive. And therefore, when you're a solitary survivor like a cat, that and those mechanisms are not very well established.
It doesn't mean they don't exist at all, but they're not very well developed. And so feline conflict carries a high risk of injury to both of the parties, and those of you who are working in, general veterinary practise will be very familiar with this sort of presentation, either at the head end or the tail end of a penetrated bite from another cat. And you're also, I'm sure, very familiar with the situations where you shave them and you look and you see bruising, but you cannot find any penetrating wound.
And then 3 days later, they're back in, giving you probably one of the most satisfying aspects of general practise work of lancing that abscess. So it makes real sense that cats will work hard to avoid physical confrontation if they can. And that reflects, then, on understanding when it does happen, that there must be a real reason for it.
They're not going to be engaging in confrontation without a need to do so because of the potential of risk to themselves. In addition, when we're dealing with confrontational presentations in cats, we also need to remember there are welfare implications not only for the cat themselves, but also for that cat caregiver relationship. And that affects the cat, but it also affects the caregiver.
And Sam spoke really nicely in her presentation about the importance of relationship between caregiver and cat, and Anthony talks so fondly of Buddy, who is, by the way, an amazing cat, for those of us who've met him. But it's an important relationship between that caregiver and the cat, which is put under strain. It's put at risk if there is confrontational behaviour.
And confrontational behaviour at the veterinary practise also decreases the frequency of veterinary visits with implications for the cats, something that er Sam talked about in her presentation. When we think of it in a veterinary context as well, we know that there are welfare implications for veterinary staff. If we have a potential for injury, and I saw in the questions and answers of the chat box which was going on during Sam's presentation that somebody, put in there about we, we do need to protect our staff, and of course we do.
It is important to remember that dealing with confrontational behaviour, can be unpleasant and it can be have an impact on our veterinary staff as well. And then when we think about things like multi-cat households where there's a possibility of cat cat confrontation, then that has a lot of implications as well. Those implications are related to, welfare for all of.
Cats who are involved in that, in that household. So we need to remember that there are welfare implications, which are varied due to the variation of the different contexts in which feline confrontational behaviour exists. And then welfare issues in neighbourhoods is something obviously in, in, I know these, the people at this conference are from all over the world and we live in very different environments and some people may only have cats who are in an indoor environment, others like the UK where I am, may.
Have cats that are more likely to have, access under their own steam to the environment and be able to be in the neighbourhood. And when that happens, and we get confrontational, behaviour between cats in a neighbourhood, that can really lead to issues of tension between the human caregivers of those cats, and it can have quite serious welfare implications. So I said that our one of our learning outcomes was to think, take a behavioural medicine approach when we're thinking about these cases.
What do I mean by that? Our behavioural medicine is the veterinary discipline that recognised what I term the health triad. The idea that the cat, as all species, including human animals, have three dimensions to their health.
The physical health is the one that as veterinary professionals, we're very, very familiar with, and we spend a lot of time studying physical health, quite rightly. But we We also need to remember the other two components, which are the cognitive health, which is the way an animal processes information about the world around it and the way it lays down memories and learns. And that's going to be very relevant when we think about confrontational behaviour.
And then their emotional health, which Sam has touched on in the previous presentation, where she talked about emotional health. And it's important when we're presented with a case of confrontational behaviour, that we think about all three of these aspects, and remember that they are not mutually exclusive. These three elements all interplay with each other, which is why it's no longer considered.
Appropriate to ask the question, is this problem medical or behavioural? Because it isn't either or. When, when we think about a presentation, we have to think about these three components being interrelated and influencing one another.
So if we think of physical health, we have to consider possible physiological causes of confrontational behaviour. Thinking about cognition, we're gonna be thinking about those potential learned components, the memory formations, which were alluded to a little bit by Sam as well when she talked about how you interact with the cat during one consultation will impact on how it behaves during future ones. And I'll expand on that a little bit today.
And then also emotional health, and this is the analogy, there are a few analogies within the Heath model of emotional health. This is the sink analogy, which represents the aspects of emotional health, which are the valence and the valence was mentioned by some the is the, when we have either a engaging or a protective emotion and the individual can have a bias to one towards one or other of those forms of emotion, we think of that bias in humans as optimism and pessimism. We talk about it more in in veterinary behavioural medicine as an engaging bias or a protected bias within the terminology of the Heath model.
But what we're talking about is the fact we have emotions that drive behaviours which are designed to engage and also those that are designed to protect. So emotional arousal was mentioned again by Sam, in the sink model I think about emotional arousal as being the amount of emotion in the sink regardless of its valence. So it's just how much emotion is this individual carrying around or dealing with at this moment in time.
So let's first think about physical health. What are the potential physical health factors that we might think about when presented with confrontational behaviour? And way at the top there for me is pain, although remembering, and I said earlier, you cannot divorce the three aspects of the health triad.
We do need to remember that pain also has an emotional and a cognitive component to it. Pain is not just the physical sensory experience and the motor response to that experience. We have the issues of acute pain, mentioned again in Sam's presentation, she talked about cats who are in hospitalisation situations or in for surgery.
So cats who are suffering acute pain through things like trauma. And then we have the issue of chronic pain. So chronic pain is a disease, of course, very important that we Remember, that it's, it's a disease process, and chronic pain affects, the cats quite a lot.
And we talked about that with, with Sam as well, that even in young cats, we tend to think about, arthritic pain in older individuals, but we do know that that also can occur, in younger animals within the cat. And I'm not going to talk about pain in great detail, but just in terms of how it may relate to the presentation of confrontational behaviour. But don't think that pain only results in confrontational behaviour.
There are many, many ways in which pain is exhibited through behavioural change, which would be the topic of another presentation. Neurological conditions certainly need to think about those when we have an individual showing confrontational behaviour. Is it possible there's an underlying neurological condition or potentially an endocrine imbalance?
And if we think about our feline patients, we may readily. Think about the character changes that caregivers often report in their hyperthyroid cats, and sometimes caregivers notice these changes in behaviour, particularly particularly confrontational behaviour before they notice anything else. Anything that affects adrenal function has the potential, of course, to impact on emotional health, because the adrenal function is part of the HPA axis system, which is about emotional control.
So if we do have any disease process that affects adrenal functioning, that has the potential to affect emotion and therefore behavioural output. What about the role of acute pain then in confrontation? So the sources are mainly accidental or surgical.
Of course there are short term practical implications of this and things that we readily think about in the veterinary world is when we are manipulating an animal with an injury or assessing an animal after surgery, we often look for confrontational responses as a way of assessing that level of. Pain, and patients who are in acute pain may show overt confrontational responses, but not all cats, or any species are active responders to pain. So they may respond to pain as well in different ways.
And there are the other potential responses to protective emotion, other than repulsion, and we'll explain that in just a moment. What about chronic pain? Well, as I say, when we think about chronic pain, I think we often think about .
Orthopaedic, musculoskeletal, genitive joint disease pain. This is Oliver, one of my patients, and you can see when he goes up the stairs, hopefully you can detect that level of pain relatively easily. But when you see him walking on the flat, you'll see that actually it's quite difficult to see that pain.
And he has a very, very, caring, interactive caregiver, and yet, she was totally unaware that there was any pain before I went and met Oliver, at our house. Visit. So I think it's really important, yes, to think about orthopaedic pain, but don't forget the other potentials.
So, pain from ear disease, obviously related to the skin issues, certainly we can have issues with that. Dental, oral, discomfort from the mouth, something that we mustn't underestimate. We often hear anecdotal reporting from caregivers that when their cats go in for dentals and have their oral health improved, that they then start to show.
Different behaviour. They, make comments like, gosh, did you do a personality transplant with my cat when you had it in for a dental? He's so much more loving, so much more easy to interact with.
He used to be quite, challenging and quite confrontational, but now since his dental, he's a different cat. So dental, or, or oral pain probably is more accurate than dental. Abdominal pain, certainly any visceral pain, and we certainly, I think, underestimate the potential for visceral pain to influence behaviour, went to a, a fantastic conference at the Royal Society of Medicine last year, which was a co-conference between .
Human medics and veterinary practitioners talking about the importance of visceral pain. So I do think we often underestimate the importance of it. Skin related discomfort as well, and then things like neuropathic pain.
So this is an individual. I just, be quiet while you hear the noise. Which is quite distressing actually.
This cat has feline or a facial pain syndrome. And so it's quite a good example of neuropathic pain, a trigeminal neuralgia related pain, but often presents with behavioural considerations, and one of the important things is the interplay between the discomfort of that individual and the, the potential for, for the, the potential for that to be, yeah, be difficult for them, in terms of behavioural presentation. So, why is pain relevant in confrontational presentations?
Well, pain is perceived, of course, in the brain, and the limbic system is involved in the physiology of pain. So the part of the brain that controls, the perception of the pain process is also crucially important in emotional processing. And of course we need to remember, .
That the limbic system, is, is has got these dual function, if you like. So this is where physical and emotional health really interplays. Emotional disturbance then influences the perception of pain and the relevance of that pain to that individual.
So the perception and how, how important that particular pain focus is for that individual is influenced by their emotional state. And if they have pain, the other thing that can happen is because pain is also an emotion, it can take up their emotional capacity, and that can lead to obviously other behavioural issues. So we may get other behavioural outputs.
So, let's just think about those emotional disorders that may also affect the emotional capacity other than than pain, so things like generalised anxiety for example. So generalised anxiety will influence the the level of emotion within the sink. It's gonna raise that level of emotion higher, and that's something that we obviously need to be aware of when we think about these individuals who are showing confrontational behaviour.
So as well as the gross behavioural change that's coming from that physical effect of pain, we want to look for these other potential behavioural responses. Body language, facial expression, all of those things are associated with protective emotional bias, and we may be able to detect that pain, obviously, before we get to the point of confrontational behaviour. The other thing to remember is the interplay between pain as in emotion and fear anxiety.
Again, something that Sam touched on, but fear, anxiety and pain are part of the same process. They're part of the same emotional system. In PANET's model, we have this situation that in PANET's model, fear, anxiety and pain are actually mentioned as one system.
In behavioural medicine, we tend to separate those out, and we tend to talk about pain as a separate system, but they are fundamentally the same, and therefore, if they're in a state of fear, anxiety or frustration, then the perception of pain, will also be impacted. And the contextual evaluation of any patient then, is really crucial when we're deciding whether or not there is, anything going on in terms of a link with pain. Let's then think about the emotional dimension of confrontational behaviour.
We've touched on the sink already, and I've talked about these components of the valence and the arousal. But the other component we need to think about is capacity or sink size. So, the size of the sink in the in the sink analogy is the capacity for that individual to cope with emotion.
So whenever we turn on a tap of whether it's engaging or protective, we're going to increase the level of arousals. We talked about these other two aspects before, and that's going to raise that level of emotion within the sink. What we want to do is stay with our emotional arousal level within the sink at all times.
We don't want to be flooding or exceeding that capacity. So, as well as thinking about our input into the sink, we also need to think about the, oh, sorry, the thing, thing has just opened. I don't know how to close that.
I think it might be on the screen. Sorry. As well as thinking about the input of the emotion, we also need to think as well about the drainage.
The drainage is the resilience. It's the getting rid of emotion once it's no longer needed. And if we don't have good emotional drainage, and that individual is holding on to that emotion, Then that relative level of arousal is going to be increasing.
So arousal is the result of a balance between the sink size, the input of. Emotion and the output or the drainage of that emotion. So, when we talk about valence, we've already talked about the fact we have positive and we have protective or positive and engaging or protective or negative emotions.
And they're listed here according to Jack Banksett's model, and the Heath model is based on the Jack Banksett model. It's a it uses that original research from Jack Pangse and then it goes on to put it into a more clinical context, if you like, trying to use more caregiver friendly language where they will be able to understand what we're talking about. And when we think about these emotions, we need to remember they're not mutually exclusive.
So we need to think about the potential for an individual to have desire-seeking motivation, to want to engage, but to be fearful and anxious at the same time. And again, Sam talked about that in her talk about the cats in the clinic, where you try to give them something like food. Which increases their desire seeking motivation, but if they're actually worried about you, they find you difficult, then there's also going to be the problem that they are going to be fearful and anxious as well as desire seeking.
We represent that in the sink by the mixer tap where you have the potential for more than one emotion at the same time. So anything that increases that level of residue in the sink makes it more likely that the next time you turn the tap on, they're actually gonna exceed their capacity. They're going to be out of their ability to control their emotions, and they're going to be potentially exhibiting behaviour that is more difficult or more challenging for us to deal with.
And that residue might be due to an underlying emotional health issue. It might be because a physical health issue like chronic pain is affecting pardon me, is affecting their emotions, or it may be due to the emotional impact of this current context. And the example we talked about earlier this evening, of course, is the context of the veterinary visit.
So let's think about which of these emotional states we are going to be thinking about when we're looking for differentials in terms of confrontational behavioural change. Desire seeking and social play are examples of engaging emotion. And when you see those, you may think, well, surely a cat that's in a state of desire seeking or social play is in that optimistic bias.
Why would they be confrontational in their behaviour? Surely, it's these ones, the red ones, the protective ones of pain, fear, anxiety. And frustration that are likely to be involved when we have an individual who's confrontational.
Well, both those viewpoints are actually correct that pain and fear anxiety and frustration, yes, is potentially more likely. It's certainly the one that we tend to, to jump on, especially in the veterinary context. But I think it's very important we don't forget.
That desire seeking and social play can be involved in reports, particularly from caregivers of confrontational responses. So let's look at the desire seeking system. It's a positive or engaging system which enables an animal to move towards necessary resources, things they need to survive.
So the sort of resources that trigger this system in a domestic context are things like food and shelter and resting places and object play, so play that's based on predation or social company. So these are the things that actually switch on that desire seeking system. The social play system is a system that gas involved in interaction between members of the same species.
And this is how they learn about social competence, they learn about how to relate to one another in a social context. And very importantly, it's about where they rehearse the delivery and the response to threat. So immediately think about threat behaviour is confrontational and you need to learn how to use it successfully to aid your survival.
And the way you do that is by rehearsing those interactions with a member of your own species in a. Totally safe environment. And so this motivation leads to the wrestling, physical interactive style of play that is so familiar in kittens when they're learning to be a cat.
It's context specific in terms of its motivation, and it's most successful between members of the same species, because it only works if both parties are sure that this context is safe. They know that they're not actually in any danger. And Then they can learn how to behave without either party experiencing fear and anxiety.
But obviously, when that social play system is, being triggered in a context where one or other of the parties does not feel safe, then we have the potential for it to go wrong. So we mustn't forget engaging emotions in the context of perceived confrontation. We have the potential for predatory or object play related behaviour to result in ambushing, which I'm sure we're all familiar with, individuals who are human caregivers who are getting injured around their ankles when they are ambushed by the cat at the base of the staircase or when the cat jumps out from behind the curtain, or indeed, where one cat in a household is using the tail of another cat as a toy that just happens to be attached to another cat.
So it's relevant to perceived confrontation towards other cats, to people, to other pets, chase behaviour, ankles, tails, may be the targets of this behaviour. But when we want to try and rectify it, we have to remember this cat is actually in an engaging emotional bias. There's no protection involved here, the protective emotion is being generated in the recipient of this behaviour.
For social play, because we said all parties need to understand the context, it's best served between kittens because once cats become socially mature at 2 to 3 years of age and they go into being more of a solitary survival species, then actually the role of social play diminishes. I mean it goes away completely, but it diminishes. So when one party has not comprehended that the context is social play, then it, it's a bit like a rugby player walking down the high street on a Saturday and feeling socially play motivated to tackle the person walking towards them.
But the person walking towards them, because they're on a high street on a Saturday afternoon and not wearing rugby kit and on a rugby pitch, as that rugby player tackles them to the ground, their emotional response to that is one of fear, anxiety as they believe they're being mugged. And the same will happen between cats if one individual, perhaps of a younger age, for example, is needs trying to. Engage with that cat in social play, but because the other cat is older, maybe the other cat is really old and also has some kind of of chronic pain issue.
And, and actually the response from them is one of fear, anxiety, pain, and maybe also frustration. So social play can be at the heart of perceived confrontation, particularly between cats in the same household. We can also play a part in the human cat interaction, primarily where it's the human who is the rugby player on the high street, believing that they are playing in a social way with their cat, trying to rough and tumble with their cat.
But if the cat perceives it as a threat, then that's not going to be, perceived in that way. They are then going to become fearful and anxious and respond potentially with confrontation. First then look at the protective emotions.
So fear anxiety, I think is the one that most people spring to when they think about a confrontational cat, just would urge a little bit of caution there, not to assume that it's fear anxiety, because there may be other motivations as we're highlighting tonight. This system is all about the preservation of security, both for yourself and your resources, and has this anxiety component to it, which is the anticipatory form of fear, the bit where you're getting ready for the potential for there to be danger. So this system can be triggered when there is no actual danger, but where that individual perceives that there may be.
So it can happen in situations of uncertainty, for example, where you're not sure what to expect. Fear, however, is triggered by the presence of a threat or in some cases a perceived threat. And then pain we've already talked about, but just thinking about it as an emotional motivation, this is the response to environmental stimuli related to either actual or potential tissue damage.
So let's think then about these protective emotions. When we have protective emotion, we have a range of different ways in which you can respond. They can either respond with behaviours which are designed to take the animal away from the stimulus or the stimulus away from the animal.
So get the cat away thing that it's fearful of, or is threatening it with pain, or to take that thing away from the animal. But there may be situations where that is either not possible or not desirable. Now, for the cat, it's primarily when it's not possible, and therefore they need to limit the potential damage that could be caused by the stimulus if it can't be got rid of.
So we can think about this as two types of behavioural response. One is to increase distance from and reduce interaction with the trigger, and the other is to find out more about it. So when we think about the confrontational cat, we're thinking about those that are using what we call repulsion.
The other behavioural responses to protective emotion, appeasement, which is the active gathering of information, can also be shown from pain or from fear anxiety, but would not be reported as being confrontational. So appeasement is the active gathering of information, not used as much by non-socially. Get cats because they don't have that obligation to keep that emotion that relationship together for co-survival.
But it does have some role within social groupings, and I believe is the root of the affiliative behaviours of aloe rubbing and aloe grooming that we're so familiar with as being behaviours that we use to identify social groups. Inhibition was talked about again by Sam, the idea that this is the gathering of information, where space increasing options are just not available. It can also occur where there's a drive to gather information rather than increase space.
So the one we see mainly in the veterinary practise is they just don't have the option to increase space because we have to do whatever we need to do, and therefore they may use inhibition. But there are situations. For more sociable cats, where they do have a very high desire-seeking motivation to have social interaction, but they are also experience fear, fear or anxiety because of that social interaction, that it wouldn't make more sense to stay where that trigger is, but just to find out more about it.
So here we have the cat who's used avoidance a little bit, retreated, but is now really intensely trying to gather information. So avoidance is of course one of the ways we can increase that distance, which might include physical movement, but often is much more passive in the cat. It can be just literally closing their eyes, it can be moving their head away.
And then we have repulsion, the one that we think of in confrontational responses. It could be physical, and when we say that cats are confrontational, that's often actually what we mean. We mean physically.
But confrontational repulsion doesn't have to be physical. We may use visual signalling or may use vocalisation in order to increase that distance between them and the thing that they're concerned about. So the tree analogy, which er Sam did mention in her presentation, is another part of the heath model.
And the idea of this tree analogy is to explain the relationship between these behaviours so that we can understand why a cat might choose repulsion when we know that it's not a very heavily selected behavioural response in cats naturally. So, I use the tree analogy to think about how do we feel safe if we are triggered by protective emotion. And I liken it to climbing a tree when you feel unsafe, to look for somewhere where you can hide out, where you can stay on that branch and feel safe, and come to terms with that negative emotion or that protective emotion, enabling you to get on with your day.
And we've got 4 branches on this tree, 2 on one side, increased distance and decrease interaction, and 2 on the other side, increase availability of information. And we've already talked about the names of those behavioural responses. They are though independent branches.
They are not linked on one continuum. So you could choose to go up one or other of these four responses or maybe go up more than one at a time. And often we see, like the black cat that we saw in the picture just now, that had used avoidance, and moved to a distance.
And then was gathering visual information. So avoidance and inhibition being used. And we have increasing intensity within each branch.
So, at the bottom of each branch, we have low intensity of that particular response. And as we go up the branch, we go to higher intensity. But what we must remember is that which one you select is not related to how fearful or anxious or painful you are.
It's not related at all to the intensity of the emotion. The choice of these is only related. To the valence, to the experience of the individual, and to the opportunity to use that response.
And so we can think about selecting one and then looking, as I say, as represented here by this little blue cross, the safe spot. And I represent that as being the branch, side branch and where it meets the main branch is where you sit and feel safe and come to terms with your emotional response. So let's understand that in relation to confrontation from a cat who is at the vets.
So a cat at the vets chooses an avoidance response and decides to stay within its carrier. If it's successful, as was so nicely illustrated in Sam's talk of showing how to allow a cat to stay within its cat carrier for the veterinary visit, it has, and it's successive avoidance at a low intensity. So this doesn't need to run.
This doesn't need to, you know, get out of the consult room because staying in the carrier has created that place of safety. They've decreased their interaction with the trigger, with the veterinary personnel. They've decreased that input of protective emotion, but.
They are still fearful and anxious, and it's really important we don't believe that an animal that's showing one of these protective emotional behavioural responses is free from fear. It's not. It is still fearful and anxious, but it's coping with that fear and anxiety at the moment, and that's what's important.
It's reached a point of coping. There's no need there for it, therefore for it to try to physically move away, and there's no need for it to change its response or to jump onto repulsion to start to hiss and swipe, because it's reached a place of safety, but it is still fearful. The problem happens if we don't recognise these low intensity branches when they happen, when we don't see that behaviour and recognise what it is, and we therefore make it unsuccessful.
So if that avoidance response, staying in the carrier, doesn't work, so in this video we can see what happened. And I'm, I'm sorry about the video. It's a very distressing video.
I'm sure you don't need it. Don't see this now hopefully very often. I'll stop it there because we don't really want to be distressed ourselves.
But you can see that this cat has tried to reach this point on the branch and stay there and feel safe, but has been overridden by the lack of understanding of the people involved, leads to then the cat needs to intensify that response. It doesn't feel safe. And if that intensification doesn't work, as it didn't here, because they kept trying to pull the cat out, then we have the potential that they're actually going to change to a different response, but they'll do that at the same intensity.
They won't go back to the beginning and start again, they'll go to the same intensity. And if that intensity is not enough, then they'll escalate on the new branch. The other thing that happens is frustration has now become involved, and frustration is the emotion that's triggered when you don't succeed.
And if you don't succeed and you get frustrated, then you will intensify and accelerate the response and become additionally confrontational. So, this is when these animals become more dangerous. I just put this picture in here of taking the cat carrier lid off as well.
Please be really careful when you do that, that if you Just pull the top of the lid off and expose the cat, completely, then actually you are stopping them feeling safe in their carrier. And my dear friend and colleague, Elena Roden has talked about how you should use a towel as a full sealing before you take the lid off. So, you would lift this lid a little way, and then feed a towel in between the lid and the cat before you take the lid off.
So the cat remains hidden. In its towel, so it has a towel as a full ceiling, rather than just pulling that lid off. So the frustration system is triggered by failure, as we said, it's a basically can be in association with any other emotional response.
So it's driven by an emotional response to do something and can't achieve it, then it will become frustrated. So in that situation in the veterinary practise, I tried to use avoidance to cope with my fear anxiety, but I was thwarted in doing that, then frustration will be triggered. Frustration accelerates and intensifies and also increases confrontational behaviour, as I've just stated.
So this is the one, the frustration that can often make these behaviours more, more dangerous if you like. So the emotional motivations associated with failure to retain or or or to be able to get to to control resources can be associated with increased emotional arousal. So yes, it can, but frustration can also occur in low states of emotional arousal and then contribute to it.
So it can begin, it can begin the process rather than necessarily be the end of the process. So frustration does result in high levels of of emotional arousal usually because it's another tap being turned on, more emotion coming into the sink. So frustration can be associated and said with any of the other emotional motivations.
Remember that could be the engaging ones as well. In behavioural medicine with maladaptive emotional responses, they often experience frustration. So if you've got a cat that's got an anxiety disorder, their perception of danger is abnormal, they're more likely to tip into frustration more quickly.
So the original motivation is not always abnormal or maladaptive, sometimes they were justified by having that original motivation, and therefore we need to remember that it, it can occur because a cat is in a domestic environment, for example. So And here we have a cat who desire seeking motivation to get up high, needs to get up high, and they're in a domestic environment where there are no access points to three dimensional space, then frustration will often lead them to climb curtains with intensity and acceleration and to become quite confrontational if you try to intervene. If they have something approaching them that they feel is threatening, and they can't use their emotional response of avoidance, for example, so a hand is coming towards them that appears like a threat and they can't get away, then frustration will be triggered.
So always consider arousal when we're thinking about confrontational behaviour. Always think about what happened before that confrontational event and what's the ongoing life experience of that individual. Were they in a state of high emotional arousal before we even started to interact with them?
Because when arousal is high, our real priority is to get those taps down. We talk about the sensory input of the cat in the consult room, for example. Turn the lights down, get rid of the sound.
What you're doing is you're turning off those taps of emotional input that are not necessary. And then secondly, we want to pull the plug out. We want to get rid of any emotion that's not necessary anymore.
Can we give this cat the opportunity to drain out that emotion? And in the hospital situation, it's things like allowing them enough opportunity to sleep. Are we actually disturbing the sleep of our hospitalised patients to the extent that they're not draining out their emotion and they're in a higher state of arousal, and then when we try and interact with them, to monitor them or to give them treatments, they're starting from too high a level of arousal.
And then finally I just want to mention the cognitive component of confrontational behaviour. Cognition impacts on the pro on confrontation through the process of learning. So if the emotional motivations occur in a specific context.
Then you will get what's called classical conditioning. So your protective emotion is creating a repulsion response, and that protective emotion is experienced in the cat carrier or in the veterinary practise, then through classical conditioning, the. Text alone will lead to a repulsion response over time.
They will learn to use that response even if the injection or the painful interaction is no longer happening. It's the context now that's the trigger. Also, repulsion responses are influenced by what we call operant conditioning.
This is where you've got a que, leads to an action, leads to a consequence, and then that consequence influences the probability that that individual will do that action in that context again. So, we have an unfamiliar cat. Leads to a confrontational response, so this cat sees another cat who's unfamiliar, and has a confrontational response, and that other cat runs away.
Then that running away, the retreating of the other cat will increase the probability that the next time that cat sees the unfamiliar cat, it will use a confrontational response. So the behaviour will change over time as learning influences the way that re re confrontational behaviour is used. So confrontational behaviour can take many forms.
Obviously, in our context when we're talking about cats, usually, whether it's confrontational or not is defined by a human observer. But we must understand that the responses are not necessarily all coming from the same cause, so we need to define what those responses are. Just calling a cat aggressive or even confrontational, without defining the intricacies of what exactly did the cat do means means it's much more difficult to identify the motivation.
So get a really good description of what this confrontational behaviour looks like. We use the terms repulsion and confrontation in the Heath model in order to allow us to expand on the purpose of the behaviour for the individual. Repulsion has a very specific context.
It has the aim of increasing distance from the trigger and decreasing interaction with it. So a variety of factors are gonna be involved when we see confrontational behaviour, and if we use a behavioural medicine approach, we're gonna think about the physical, the emotional, and the cognitive factors. Physical, think about pain, neurology, endocrine imbalance, those are just a few of the potential reasons.
Cognition, we're gonna think about whether there's been classical conditioning, associating that behaviour with that environment, and have they learned from the consequences of that confrontational response. And then finally, thinking about our emotions, some confrontational behaviour does have the aim of increasing distance and decreasing interaction. What we would term repulsion responses in the heat model to protective emotions of fear, anxiety and pain.
But some of them result from high levels of emotional arousal associated with the sensation of failure. So there's frustration. And some are actually misinterpreted forms of approach behaviour, which are related to desire seeking or social play.
So, approaching confrontational behaviour is gonna mean we have to think about identifying and resolving those physical causes, about identifying those emotional responses and providing appropriate. Output, particularly for the engaging emotions, and when it is a situation of a protective emotion, to modify the environment so that all of those environmental needs are met, and so they can resolve with the low branch. Behaviours on the protective emotional responses tree, and then treat them if they have maladaptive emotional responses.
And don't forget cognition and the role of behavioural modification and learning. So thank you very much for your attention. I hope you found that helpful, and I can stop sharing my screen.
And we have time, I hope, for a few questions. Yeah, let's have a look, see if we've got any questions. We have, .
Somebody asking, they said I'm a caregiver. I've. Feal, my 3 year old British Blue, is frequently frustrated as she can go from seeking social interaction to swiping and biting pretty quickly.
She's also an itchy cat, so I feel that we could be both involved in this one, Sarah. Frequently over grooming to the point of creating skin lesions and bald patches, she's been on steroids with limited success. Is it possible she has so much skin discomfort that is making her frustrated?
And if so, how can I help her? That's a really lovely question. I'm very sorry that your poor little British Blue is suffering, from itchy skin and, and obviously as Anthony just said, he's the dermatologist in the room.
It may be able to, to offer you some advice about that. But absolutely, what you're saying there is really, sort of really good understanding. So it's excellent to see that, yes, I would say high arousal and also the potential for frustration are very likely to be involved, in what you're experiencing with your, your cat.
So. There will be a combined approach. Claire Edge, a friend and colleague of mine who's a neurologist, we, she and I started something called multidisciplinary rounds for our residents a few years ago, in which we have this multidisciplinary approach to cases.
And this is a lovely example of exactly that, where you need the expertise of a dermatologist to deal with the itchy skin, but you also need to be thinking about this from an emotional perspective. Just on some, some quick points, I would think about arousal, so, on the principles of using the sync analogy, you would need to turn some taps off. So I'd look at the life of your cat, see what can we turn down or off in terms of emotional input, try and lower that arousal a bit.
Think about it, can we find a way. To help this cat succeed in dealing with its emotion of, potential discomfort. And now that will be related to the dermatology input, and, and not necessarily steroids, but I don't want to creep into dermatology, but think about other ways we can treat that.
So, yes, absolutely. I think you're spot on. That this is, somewhere where we've got physical and emotional health combining.
And then you've got your cognition that, that when your cat turns to that more repelling response, that actually the touching stops or the interaction stops, and maybe that results in some level of comfort, and therefore, that may be part of it as well. So, I, I would urge you to ask your, your veterinary, practitioner to help you, with referral, probably for, for, for both or either your GP that may want to deal with the dermatology themselves. They may have someone in their practise who can help you with the behavioural, emotional health component.
If not, I would think about referral for that. Thanks very much, Sarah, I would just add, obviously treat for the basic, most common skin problems, so flea allergy, possibly food allergy, and if it's steroid unresponsive, then by a process of eliminating everything else, you might be left with this kind of psychogenic alopecia, but actually it's a really rare, problem. And I, and I think, sorry, you know, you were very good with the BVDSG group, probably 10 or 15.
Years ago, and it was one of the times that I think we first really met, which was talking as you've done today, about the two elements, which is the psychological health and the physical health, and yeah, we actually. Yeah, we understand a lot more as well now, Antony. I actually spoke to BV, the British Veterinary Dermatology Society again this year on, because we've, we've expanded our understanding so far in terms of, this understanding of the link between dermatological disease and emotional health.
In human, animals, they actually have a, branch of dermatology called psychodermatology, in which they talk. About this psoriasis and eczema and those sorts of things in humans. So, it's a massive area, and something that, yeah, very glad that I have the opportunity to work with dermatologists on this, topic and, and to say, yes, about 15 years ago was the first time, we, we spoke about it, but just as recently as this year, well, back end of last year, in the the autumn meeting, we talked about it again.
Yeah. I, I did get the booklet, I suppose, 15 years ago, people would often say it was a feline endocrine alopecia or it's a psychogenic alopecia, and that was just a lazy way of not really searching for the dermatology diagnosis, although obviously, probably in most of those cats there was also a psychological element, so it's. It's the kind of balance, isn't it?
Yeah, it's a really good illustration as well of the what I said, you know, when I talked about behavioural medicine that we, we have moved away now, please, from is it behavioural or is it medical. Yeah it's, it's not compartmentalised like that. So, yes, the, the psychogenic alopecia is not a diagnosis that we would recognise, now, because, yeah, we, we.
Yes, they have often got a dermatological component and an emotional component, because you cannot separate out these three elements of health, from one another. Yeah, definitely. Mary Elaine has said loved your presentation, thank you, Michelle said, two more great webinars, obviously also Samantha, thank you both.
Hannah says thank both of you lovely professionals so much for these presentations, so lots of love being, Shown by the audience, thank you. Ocean is saying, but in veterinary practise, we need to examine and touch the animals, so how can we, prevent escalation. The, so the crux of preventing escalation is, is, if you think about the tree analogy, and you think about the low hanging branches are the ones we want them to feel comfortable on.
So what we're always trying to do is to get to a point of safety and security at the lowest intensity of whichever branch they've chosen. So even if they do go up the repulsion branch, if they can. Feel a sensation of safety by employing a hiss, or a, or a low growl, then they won't need to escalate.
So it's our ability to manipulate the situation so they feel a sensation of safety, and it doesn't mean that we don't get our job done. The staying in the cat carrier is the one of the nicest examples because it's so obvious that, that cat is just a Avoiding, but it's successful. And then in, with Ilona, when she uses the towel as the false ceiling before you actually take the lid off, so you stop the potential for surprise.
I have seen some cats really struggle when the lid is just lifted off, without any protection. That by using that towel, what you can then do is you just show the bits of the cat that you actually need to look at at any point in time. And the rest of the time, then the rest of the cat is hidden.
And therefore is still at that point on that low branch where it is successful. And if you're not looking at the head, it's even better because the head is under that towel all of the time while you're looking at the rest of its body. Obviously, if you want to look at its ear or its eyes, then you need to move the, the towel away from the head temporary.
But the rest of the body is feeling like it's cocooned and inside something by the sensation of that towel over it. So it, it's making them successful or perceiving success at the lowest possible point on whichever branch they've chosen to use. And not thinking of this as one continuum of responses.
So, so please don't think that, oh, you know, that cat that's in a state of just turning away is miles away from showing repulsion. It's not. It, it's, it's one little step away from using repulsion, because repulsions are completely.
Different branch, and it can step to that at any moment. You don't need to have gone all the way up an inhibition branch before you start on the repulsion branch. They are, they're separate from each other.
So it's not one continuum, it's for independent, responses, each with their own gradation of intensity, and you can use more than one at a time. Yeah, and I think some. Said that, you know, that surprise, oh I didn't expect the cat to do that.
It's kind of a misreading of. Where the cat's at it, I think if you, as you become a better reader of, of cat behaviour, then you won't be as surprised by, and in fact you maybe won't get some of that behaviour because you'll actually work in a way to prevent that escalation. Yeah, absolutely, and that's that's very much the principles of cat friendly practise.
Femka is saying, is it possible to find the branch figure anywhere, and Diana is saying, is there a way to contact Sarah via email if you want to access a learning path for behaviour medicine for her country. So I, I think I put your email address up, didn't you? Is it?
Dawn, if you give the office at behavioralproductions.co.uk email address, then that's fine.
You can, you can contact me on that. In terms of the tree analogy at the moment, I don't have it in a published, form, but we are working on creating some. Handouts and materials so that we would be able to give people access to the analogies, and the, the sync analogy and also the tree analogy.
So, bear with us, wait a little bit longer, and, yeah, we're working on it to make it in a form where people can use it. And, the, behavioural Productions website, will eventually have that information, but we're working on that website at the moment. Website work always takes a long time.
So, so, yes, I, from experience, I know these things. It's quite interesting, quite a lot of anonymous, comments, but do feel free, you know, I know the name, but I'm not going to necessarily tell everybody else, so, do feel free to put your name down. We've got this other anonymous comment saying, do you recommend any supplements to assist with or to use alongside behavioural modification programmes and I.
Suspect not that it's particular supplements, and I don't think we've talked about it a huge amount, but we've obviously done some work and some podcasts with you around the pheromones and, and just putting cats in a good position, you know, by feeding and so on to make sure that . You know, things, things like featherweight can have a really positive effect in a practise as well, can't they? Not on their own but as a part of.
Definitely there are supplemental approaches to behavioural modification in its cognitive form, so again, when you think about behavioural modification, you're addressing the cognition. But, and it's really important to use an emotional response as well. And so, yeah, when we've got things like anxiety, at the basis of the, of the problem, then using anxiolytics in terms of medications.
But we also have the possibility of using nutraceuticals. We probably could talk about that all night in terms of another topic. There are some.
Issues potentially in terms of evidence, and we could debate those. But certainly anecdotally, reporting from caregivers is that some of those supplements can be very helpful. The ones I would use would be the ones where I'm happy with the basis of the theory behind them.
So I think that, has got agents which increase availability of serotonin, dopamine, GABA. I would be looking at those, but obviously what we don't really know is the, is the, the amount of influence that, so quantitatively how much they influence those neurotransmitters, but certainly nutritional supplements are, are a tool in our toolbox, as are pheromones, as, Anthony just talked about. So the fellyway range and the adaptyl range.
There are also herbal preparations that are similar in the way they're delivered, like they have a diffuser device, but they are not an alternative to the pheromone because they work in a completely different way. So I'm not saying they're not useful, they can be useful, but please, please don't think of them as an alternative. If you're going to decide to use a herbal, pre pre preparation in a diffuser, like something like pet remedy, or you're going to use something that's, basically aromatherapy in a diffuser, like there's, the Vet plus product.
Then remember that they are not alternatives to the pheromones. They are acting as anxiolytics based on the principle that in the case of the, that plus one that, that, I think it's lavender, chamomile and rose, so it's using aromatherapy, for which they're, you know. We need to think about the evidence for that, and then also for malarian, which is involved in pet remedy.
Certainly anecdotally, reporting from caregivers again does suggest that these products can be beneficial to some individuals and, and so they may all have a place. But they're not an either or, so you, you, if you're going to use a pheromone, you're not gonna replace that by using one of those other products. You could use them as well as, you could use them instead of because you've decided to use a completely different approach, but it's not, an alternative.
And it, it, I think it came across also in Sam's presentation, just those simple things that we maybe don't think about like. When we're carrying the, the cat into the surgery, you know, as, as a client, and, you know, the, the boxes swinging one way and other, and then obviously he or she is, is put into the hopefully cat friendly kennel area, but nevertheless, people are talking loud, they've got loud music on, etc. All of these things are very unsettling for, for the cats as well, aren't they?
Yeah, so, so when you, when you say supplement, your question, questioner, says supplement, obviously the other supplemental stuff we're doing is, is the environmental change, which isn't behavioural modifications, you're not directly impacting on changing a behavioural response of the individual through learning. So maybe, yeah, a slightly different term, but. Environmental modification or environmental optimisation, not enrichment.
We don't want to be enriching the environment, in those contexts, we may actually increase arousal detrimentally by using enrichment. So we want to be optimising the environment or modifying the environment. But certainly, yeah, that's important too.
April says wonderful presentations. Thank you so much. Tara says thank you, very interesting webinars this evening.
Sandra has said what an amazing presentation and wealth of information. Thank you very much, Doctor Heath. I'm a cat veterinarian and do home cat friendly consultations and learning more about behavioural medicine and health.
And then we've had an anonymous attendee say, you know, as perhaps a supplementary to Sandra's comment, do you have any tips or advice for mobile vets who are managing fear and anxiety-driven avoidance or repulsion behaviours in the cat's home setting? You know, how, how do we maybe look at that differently, because that's obviously where you're often carrying out your consults as well, isn't it, Sarah? Yeah, absolutely.
It is a very different environment to be working in, so one of the things, you were saying there that in the, in the consultation room, you found the carrier. Thing to be helpful, but obviously when they're at home, that flight response is more exaggerated because they have actually found that, you know, going into another room is more successful, so they're, they're more likely to do that, they've got more space. And, and as you've also mentioned there, they may be more confident, therefore inhibition, which is their response of, of, you know, not giving anything away and just taking information in is not as readily used in a home environment.
And that's very certainly true. So the setting up of the environment is going to be really important in the home. I would suggest that it is a smaller, location with less possibility for avoidance in its physical movement form, so.
Do, do you be careful with the terminology that I personally think the, the flight fight freeze has been misused, because it's actually related to the SAM axis response, which is the acute stress response, rather than it's the non. Reflex response of flight, flight and freeze, whereas what we're talking about is the, the more chronic reaction through the HP access control, which is related to a consciously decided behavioural response. I do think they're completely different, but, avoidance may involve physical movement, and so we might call that flight.
But we also have on that avoidance branch, this whole range of potential avoidance behaviours. So if we can make avoidance more successful at a lower intensity, even within the home, then they will select that rather than go straight up to that higher intensity. So it's setting up the room that you're gonna use, even though you're going into their home, I would also.
You know, if I was doing something like a, a physical health consultation like you're doing, when I'm going to home rather than what I'm doing, then I would put a lot more time into what I ask them to do before I get there, making sure I phone before I actually arrive. Making sure that the cat is somewhere where it it has some limited ability to use the full avoidance response, but we're gonna set them up when we get in there so that they can, can use an avoidance response, but not at that high intensity. Hope that helps.
It's quite a complex . Yeah, that's, that's really good so I'm gonna sort of limit this to the last question, we're we're 20 minutes over, but of course a lot of people have stayed cos cos sometimes the questions are. Well, they always are interesting, aren't they, but you know, to, to continue the conversation on and I, I.
I think it's a really nice question, statement, you know, request from Leah, . Particularly also around what you've said, but also Samantha, when, when situations just aren't as ideal as as you would like them to be. So the question is, do you have any suggestions for a very busy charity set up where there is not a cat friendly ward and a busy hallway is where the cats have to be kept at times.
I do like to put towels across the carriers when they are in the hallway, as there is a lot of foot traffic from people and dogs. I feel quite stressed for a lot of them. The staff are amazing and doing their best, but I think there could be some small suggestions that would make a huge difference, and, you know, I think that's often the way that with a bit of thought, there can be ways perhaps of changing when the cats come in so that there's not as many dogs, that there are always some small suggestions, as Lea is saying, that can make a huge difference, aren't there?
Yeah, Leah, first of all, you know, thank you for the work you do, in that charity set up. We all know how vitally important it is, and that, you know, we, we need to be able to offer, care, to cats who are living in, in situations that maybe are not so ideal. And also, they're human caregivers who may also be living in situations that are not that ideal.
So thank you for the work that you do. I think, obviously, you're talking about having a busy hallway, and I understand that, that the cats need to be in there. I think about the towels are great.
It's a really good idea. Also, just thinking about whether you can use, sort of, partitioning or barriers that would maybe reduce the impact of that foot traffic. If you think about the foot traffic going close to those carriers, and particularly the dogs.
You can think about visual access from the carriers, so could we turn the carriers around so that the, the entrance to the carrier is going towards the wall, rather than going to the internal part of the hallway where the movement's happening? Could we think about some screening or something like that, that we could put around, so between the, the, where the cats are and where the people and dogs are walking? Yeah, the these are all sort of very small things that might make a difference.
I do think that, you know, when you're in that situation, we have to admit that they are going to be stressed, because it isn't an ideal situation for them. Can we minimise the time. That they're in there for.
And depending on what they're coming in for and what your procedures are and what's going to happen to them next, can we think about using any medication to assist them, but obviously, that may be a budget issue in a charity set up as well. We may not be able to do that financially. So, yeah, we always have to Try our real, really try our best to give practical things that we can actually work with, and then modify those suggestions according to, to what the reality of life is.
Because sadly, Leah, as, as I'm sure you know, from the work that you're doing, that life is not ideal for everybody. And yeah, you're doing a great job trying to support those for whom it's not. And, yeah, if we, if we can be of any more assistance to give you more, any more help, let me know.
Thanks so much, Sarah.
