Hello and welcome to this webinar. That dog is nasty and other things we shouldn't say or do in the clinic. This is an evidence-based approach to improving patient welfare.
My name is Hayley Walters. I'm a registered veterinary nurse, and I qualified back in 1999. So hopefully I've got some experience to share with you today.
We'll jump straight into it because I've got lots to get through. Here are your learning objectives from today's webinar. Appreciate that behaviour is driven by emotion and labelling of animals is unhelpful.
Identify when a dog is feeling anxious and threatened. Be aware that pain alters behaviour, so being able to recognise and score pain in cats and dogs is paramount. We'll also touch on why applying a buster collar won't improve welfare, and by the end, you should also be able to identify the practical steps or the dos and don'ts to improve patient welfare in each area of the clinic.
As I said, I've been a veterinary nurse since 1999, but I haven't always been a veterinary nurse working with animal welfare education. And a long time ago, a really good vet friend of mine and an animal welfare scientist, was asked by a rescue shelter if it was better to house dogs, singly, in pairs or in trees. And I thought about it for a while and I cast my mind back to all the dogs I had ever seen, or worked with in shelters, and I finally said pairs.
And she said, you have to look at the evidence, Hayley. We cannot make decisions on how to improve the welfare for any species based on guesswork, or tradition, or, or even our own experience. It, it really has to be done on research and evidence if we're going to improve welfare effectively for the animals in our lives.
And that is what this webinar is going to focus on the evidence that is available to improve welfare for patients in the veterinary clinic. A study assessed the occupational hazards in veterinary practises by analysing accidents insurance data in order to stimulate strategies to prevent occupational accidents. And what they discovered was that 60, 66% of the reported accidents were due to scratches, bites, or kicks from animals.
And the other accidents were due to, us inhaling things and sticking needles accidentally in ourselves and getting stuff in our eyes, but 66% of these accidents in practise were caused by our own patients. So they concluded that prevention strategies for veterinarians should focus on accidents caused by animals. And another survey, Found that 98%, 98% of nurses have experienced injuries from dogs and cats.
I would probably hazard a guess that that is more likely 100%, but we have to follow the evidence. Now, owners aren't experiencing these levels of attacks and injuries in their own homes. So what's going on in our clinics?
What can we do so that these animals don't feel like they need to attack us? Other research, and depending on what study you you read, showed that 41% of companion dogs displayed mild to moderate fearful behaviour when examined by a veterinarian, and 14% exhibited extreme, fear, severe or extreme fear. I looked at a lot of research, and there weren't any numbers for cats, but most of the studies assumed that most cats showed impaired welfare when they were in the clinic.
So how can we improve patient welfare and therefore get less injured when we're just doing our job? First impressions for an animal at the clinic are usually really negative. In fact, they are horrendous when you think about it.
Little babies coming in and what do they get? They get vaccinated, they get microchipped, and then they get neutered. These are all pretty awful experiences, no matter how hard we try to make them wonderful.
And these experiences can have a lifelong negative effect on how an animal feels about the clinic. These fearful animals are then difficult to handle, and then it can result in us using aversive handling techniques. And these, these poor patients having to be carried in or even dragged in, and then they're muzzled for the examinations, and they're forcefully restrained.
It's really, really unpleasant for them. Unpleasant for them and often cited by owners as the reason for not bringing their pet in, and this may result in delayed treatment for the patients or poor owner compliance with treatments. The ladder of aggression is a really good starting point to help us recognise what a dog might be trying to communicate to us when it is in the clinic.
I think a better name for it might be the ladder to threat repelling behaviour, but that is not quite as catchy as the ladder of aggression. The ladder of aggression is a series of steps of the gestures that dogs typically show when exposed to stress or threats. Mildly anxious dogs, so in green here low down on the ladder, they might lip lick or yawn or or gaze avert, you know, avert their gaze to show their discomfort.
But if these behavioural signs are ignored by us or, or the threat persists, so that's us keeping trying to examine them or handle them, then the dog will advance up the ladder and progress to threat repelling behaviour, such as growling or snapping or biting. And it does this in order to mitigate the the potential threats and also try and create a space between themselves and the threat or the perceived threat. So the gestures shown on the lower rungs of the ladder is can be likened to a dog whispering to us, I'm feeling worried.
Please don't threaten me. Please calm down. Please stay away.
And the gestures on the higher rungs of the ladder are the dogs shouting, Stop! Leave me alone right now, and understanding the meaning of these gestures. Will really help us and it will help the dog have to resort to the last resort, which is aggression, or threat repelling behaviour as we really ought to be calling it.
So if we look at the very bottom of the ladder of of threat repelling behaviour or aggression, we can see here that the dog is ever so slightly anxious and in this situation, the dogs will often yawn, or blink or, or lick their noses. And these are called displacement behaviours. So normal behaviours done at abnormal times.
So yawning outside of the context of being tired and licking the nose outside the context of, of just eating. And we can often see the whites of the eyes here too, and I'm sure plenty of you have seen animals come into the waiting room, come into the consult room, and instantly licking their noses, whites of their eyes showing, giving it, giving a big yawn, . And I did used to know, heard of a veterinary nurse who every time a patient yawned at her, would poke her head at the patient's face and say, oh, sorry, am I boring you?
And that's a real, that's a real shame that that communication from the dog has been missed by a veterinary professional. Now as the anxiety level increases slightly, the dog will turn its head away from the situation or the object that's causing the anxiety, and, and we often see this again, don't we, in the, in the consulting room and the waiting room, those dogs that just completely turn their head away so that they're not looking at the thing that they're feeling threatened by. And next, the dog will turn its whole body away.
Often they, they might sit down or they might lift a paw like this poor little terrified chihuahua here. Very often we don't notice the paw lift, or we think it's cute. We think that they are begging for food, or potentially wanting to give a high five, but it's a really clear signal from the dog about how worried they're feeling.
If the situation doesn't improve for the dog, which it very often doesn't in the clinic, does it, but if, if the dog is able to, it will try and walk away from the potential threats. So in this instance, it's a child, and this really must be respected. The dog is being really sensible, and it's trying to remove itself or escape, in its mind, the stressor.
If the dog is not allowed to get away, very often we see the ears going back, we see the gaze averting to, and this is all being done in an attempt to communicate to us how anxious they are feeling. And next, as they get more anxious, we'll start to see some really obvious body language changes. So this dog here standing, or, or, or squatting crouch, crouched with their tail tucked right under there.
You can also see that she's showing the whites of her eyes. She's not looking at anybody, so she's gaze averting and she's got her ears pulled right back. It's really obvious how she's feeling.
This one might not be so obvious to some people, . It can be misconstrued, but this is a dog that's gone halfway further than halfway up the ladder of aggression. Now the dog at the top is giving off appeasing behaviour, and you can see there she's got tightening around her eyes, so orbital tightening.
She's pulled her ears back. Her front legs are very stiff and held to her body. She's lifted up her back leg as well, tail tucked under.
Now this is a easing behaviour. She is asking for space. She is not asking for a tummy tickle.
We must be careful that we don't view this as submissive behaviour, that the dog is now seeing you as the top dog, and we as submitted to you, and now you can do anything you want to it. That's not the case. This is a dog that's trying to calm you down and trying to ask for space.
This dog could still just as easily. If ignored, go up the ladder and end up biting you. So just be very wary when you see this.
Now the dog in the, in the bottom picture is asking for a tummy tickle. We can see their relaxed face, tongue lolling out the mouth, the tail is relaxed, the legs are relaxed. This dog, potentially in the past, gave off an appeasing gesture.
It was misread and the tummy was tickled. But the dog learned, Oh, and I lie on my back like this, I get my tummy tickled. So we must be very careful.
And I've remember working in practise once, and, a dog rolled over on its back like this. The nurse thought it was asking for a tummy tickle, tickled the dog's tummy. The dog tensed up even more.
Someone took a photo of it, put it on the, the vet, on the, that practises Facebook site, saying, the dog. Name very much enjoying attention from a nurse today whilst he stayed with us, and I was like, no, that's, that's really not what this dog was doing. It was not enjoying itself at all.
And so it is missed by us as veterinary professionals, and we must be aware that we're interpreting what they're saying to us correctly. Stiffening up and staring. Now we're getting into dangerous territory as the dog is feeling the need to have to defend itself rather than give off those lovely appeasing signs.
And we'll see the dog stiffen up and stare, and this dog is chained up, so we'll not have the luxury of being able to go through all of those more subtle behaviours to achieve the result at once, which is for us to go away. . And this is often the case, isn't it, in the clinic.
They don't have the luxury or the time to be able to go through all those gestures. So very often we'll get a dog immediately that is stiffened and staring at us. And as I said, the ladder of aggression is what most dogs will do, but the dog's situation and the dog's past learning experiences will very much influence the dog's behaviour.
As will what we do and how we respond when we see the behaviour. So if we back off this dog now, it won't need to escalate and should and should go back down the ladder. If the threat persists though, we might see the growl.
Now the growl is not to be punished ever. We do punish the growl though, don't we? And I've seen it for years and years and years where a dog growls at us and it gets told off.
It gets shouted at. We say, stop it, that's naughty. And then the dog gets labelled as nasty or naughty.
But that growl is an early warning system that may prevent us from getting bitten. And it may seem very obvious, but dogs cannot talk, and if they could talk, they might, leading up to the growl have said things like, oh gosh, this is a bit frightening. I'm not sure about this place.
I don't know this person. I don't like them coming towards me. Oh, now they're trying to touch me.
OK, I'm going to leave now if that's OK, as I'm really not comfortable. 00, you really are touching me now. Well, now I feel even more worried.
I'm going to have to ask you to stop that now. Please stop. I really don't like it.
Stop. This is your last chance before I take physical action, but they can't say those things. So they growl, and when they growl, they get punished.
How sad. So be appreciative of the growl, it's the only voice that they have. And really, they should be thanked for using it.
I know that I appreciate those Akitas that growl at me, that is for sure. But if the threat still continues, we have the snap next. And very often when a dog snaps, they miss, and that's called an air snap.
And they're meant to miss, bless them, they are still communicating and trying to take the least risky course of action. Now, often the snap is enough for us to finally, stop what we are doing, although we should have listened sooner. And just as a side note, a dog that snaps at you is not trying to dominate you, and you do not have to persist in what you are doing in order to show the dog who is boss, or, as I hear, used to hear so many times, to not let the dog win.
Think about those Chihuahua nail clips. They're not trying to win. They are simply doing what they can to protect themselves.
That is all. And we have the bite. When the dog has no choice left, that's what we get.
We get the bite. . And everything that I've talked about on this ladder of aggression, dogs will use these on us, they'll use them on other dogs obviously to communicate, and even on other species, you might have seen dogs doing this to to your cats at home.
I must stress though that the dog's previous learning experience and the situation the dog is in will have a huge influence on whether you see all of these individual stages or whether they jump straight to a particular rung immediately. So don't think that you're, that you are, are safe, and don't think that, oh, it gave me no warning, this dog's nasty because their previous learning experiences will very much influence how they, react to you and the situation. Now smaller dogs, bless them, have a bad reputation when it comes to snapping and biting, and generally seem to reach the top of the ladder much more quickly than larger dogs.
And there are several factors at play here. Research has shown that small dogs are generally more fearful than larger dogs, but when you are shin high to most humans and and and other dogs. The world is probably a pretty daunting place, so some dogs choose to be on the offensive, then rather, rather than on the defensive, .
And this is a strategy that they have learned works for them, so very often you might be walking your dog down the road and you another dog is coming towards you and immediately that dog starts barking, barking at you. So that dog is on the offensive, it's getting very often it's getting the first word in and because it wants, it wants space, it wants you to stay away from them. Now little dogs, because they are so small, and because we as humans can so easily overpower them, we tend to ignore their threat rebelling threat repelling behaviour because their very size means that they are not as big a risk to us like, say, a German shepherd that stiffens up or growls at us is.
Very often when they, when they growl at us, we're like, Oh, look at you trying to be all big and brave. We just find it amusing and we don't take it seriously, and we tend to continue with what we are doing, ignoring their protests, and then they bite. And guess what?
It works for them. We pull away. So these little dogs learn that that behaviour confers success.
So what is the point of going through all of those other gestures? It may as well go straight for the bite next time. And they do, don't they?
We all dread that chihuahua, pug, Yorkie, Jack Russell nail clip. But if we respect what they are communicating to us early doors when they're puppies coming in and, and we don't just muzzle them and pin them down, then they shouldn't ever have to escalate to that behaviour. So the We cannot label animals as nasty, and that is the whole point of my talk today.
All behaviour is driven by in emotion. Behaviour does not just happen in a vacuum. When you hug someone, it might be because you are happy to see them, or you feel sorry for them, or you're sad and you need comforting.
And when you slump down at work, it might be because you are tired or maybe you're upset or maybe you're overwhelmed. All of your behaviour is driven by an emotion as well. Behaviour really is the window to how an animal or a person is feeling.
And labelling animals with derogatory names is really unprofessional. Imagine if your kid at school, if you found out that your kid at school or your grandma in the nursing home had been given a name that really didn't reflect who they actually were. .
You'd be very, very upset by that. And labelling animals also fails to recognise their emotional state. And also it doesn't encourage colleagues to find an alternative way to approach or treat or interact with that animal.
It's quite lazy just to label them. And really we should be asking ourselves what can I do to make this animal feel like it doesn't need to bite or scratch me. It is our job to make them feel comfortable and relaxed.
So for those 66% of serious injuries in the clinic that resulted in, actually resulted in 3 or more days off work, they weren't caused by nasty animals. Get this dog in a different situation. They were caused by animals who were feeling so threatened and frightened that they felt that their only choice was to defend themselves using aggressive techniques.
Could these, these patients that I've shown you now in different situations, how different their behaviour is because of their emotional state changing. I want to talk now about the way we handle and hold and restrain and interact with animals. And just as a side note, I'm not a fan of the word restrain.
I checked out synonyms for that word, and they are in prison, detain, confine, and lock up, and they're all very negative words I suppose that's by the by, but, but words do matter. And imagine if this was the way doctors treated us. Every time we saw our doctor, we got pinned to the ground like that, like this.
Obviously forcefully holding animals down is really negative welfare. The animal has no choice and no control, and Those are two very important factors in an animal's life and human's life as well, choice and control, frightening for them. There's an increased likelihood of everybody getting injured when we behave, in these very forceful ways.
And obviously the animal will resent being handled even more next time and then they'll have to escalate their threat repelling behaviour and then we have to escalate how we restrain them. So, what we want to be using, obviously is low stress handling. I know, it's, everyone's heard of low stress handling and fear free.
It is a bit of a buzzword right now, but this wouldn't be a proper webinar if I didn't mention it. So, it means holding and positioning animals with gentle restraint, using food, rewards and making it a really positive experience for them. Reducing the amount of anxiety the animal experiences in the visits and thinking about it from the animal's perspective, just putting yourself in their shoes for a for a moment.
We should be using long, slow strokes, calming voices, and brief pause pauses in between what we're doing. And very often we don't see this, do we? Sometimes we see, a favourite, client, a favourite patient of ours in the waiting room, and we go over, hello, how are you?
And we vigorously stroke them and we use a high pitched excited voice and we ramp them up and then take them into the consulting room and expect them to sit still, but we really need to just be much calmer around these patients. We need to be using touch gradients. So this means where we touch the least sensitive areas first on the patient, like, like the shoulder, and then work our way gradually down very slowly to the more sensitive areas that we might actually be needing to examine, like looking at their feet or, or inside their ears, not just diving straight into those sensitive areas, but gradually getting to it.
So it's not such a shock for them. And then also adjusting the procedure based on the animal's body language, so reading them, looking at what they're trying to communicate to us, and we really don't want to be getting into the habit of holding animals really tightly so that they anticipate something aversive, well about to happen to them. Low stress handling continued, let's ask ourselves, does the dog really need to go on the table?
If you ask yourselves how often a dog goes on the table in its home life, it's, it's literally never, unless it's stealing something from there. But when we put them on the table, that table is high up, the table wobbles, it might be slippery. It's a really unpleasant experience for them.
Nothing good ever happens when you put on a table when you're a dog. So please, if you have knees that bend, use them, get down to the dog's level if you can't do the examinations on the floor. Please try and advise all cat owners to buy cat boxes where the top can be removed and examine cats in the base of the box.
They didn't want to go in the in the cat carrier likely in the first place, and now they're being now they're staying in the cat carrier cause they find it preferable to being on that table. So take the top off if you can and examine the cat in the base of the box and encourage owners to put a nice big towel or blanket in there, no slipping around on. You know, one sheet of newspaper that they probably urinated and defecated on as well.
Towelling over scruffing. I don't know many people who scruff anymore, but obviously that is, a big no, no. Scruffing only naturally happens, in three events in a cat's life.
One, if they're being carried as a kitten by their mother, and they're much lighter then, and she's normally doing it to move them to a place of safety. Next incident of scruffing in a cat's life naturally would be if they, if it's a female and she's being mated. We've all heard the noise female cats make when they're being mated.
It doesn't sound like she's having a great experience. And then also, when cats are fighting, they might, bite the back of each other's. Next.
So scruffing is a really negative experience. It removes the cat's ability of choice and control, which is very stressful for an animal as well as a human. At best it's uncomfortable for them.
You know, pulling all that skin on the back of the neck. And at worst, it's painful. So, always use the cat burrito or purrito, if you can.
If you think you're gonna need to scruff a cat, then always have your towel ready in advance. And obviously be very careful of those arthritic cats because, you might just be forcing them into more uncomfortable positions. But.
Just be organised. Make sure you know who you're dealing with. High reward treats have not some boring old free packet of some dry biscuits, but really high reward treats, licky licks for cats, chopped up chicken, or liver if you, if you can have, or liver paste for dogs.
If you write that animal's name for, for a dog on the floor before, in, in a, like a liver paste, before the owner comes in, they will love you forever. The dog will lick it up and the owner will absolutely love you forever. Food bomb the floor as well.
Don't expect these patients to be taking the food from your hand. You're a person that they are already wary of, and they probably want the food, but it's coming from your hands, so they might feel conflicted. So put it on the floor.
This encourages seeking behaviour, which is a really positive behaviour for animals. It means you can talk to the clients whilst they're focused on eating the food on the floor, obviously if they're allowed food. And it gives the animal time to settle in before you then crack up with your examination.
Obviously as well, use anxiolytics or sedatives for patients who are really exhibiting threat repelling behaviour, and need to be examined on that day. So gabapentin and trazodone should definitely be considered for those patients, not just ploughing on, trying to trying to overpower them. Walking sedation, I don't know if any of you have heard of these or if you've used them, seen them in action, but it basically is for those animals that need sedating but really can't be restrained whilst they're sedated.
. So somebody walks, have used the word restrained there. See how automatic it is and ingrained into the veterinary language. So for those dogs that can't be held and can't be distracted.
So, somebody walks the dog down the corridor, the dog is normally muzzled, for safety, and a vet or a nurse who is experienced in giving intramuscular injections, they'll hide in the doorway, or they'll hide behind a corner. And as the dog walks past the The, the sedative is injected usually into the lumbarra axial muscles. And then that dog is placed in a kennel, or sits with its own a nice and quietly.
It is a skill, that needs to be practised. My top tip is to use a 21 gauge needle when you're doing it. So a green needle, and make sure that that needle is fitted really securely to the syringe cause you're going to be injecting quite quickly.
There's no need to, there's no need or, or time to pull back on the plunger, before you inject. So just once, once you've got it in that muscle, just go for it as confidently as you can. And this is a really great technique for reducing stress for everybody dealing with this dog.
It's a much nicer experience for everybody. Moving on to pain now, as I think it's really important to be able to spot pain quickly and treat it effectively in order to improve welfare for our patients. Veterinary professionals, have both a a professional and a moral duty of care towards animals and treating their pain.
But there are plenty of other reasons why treating pain is really, really important. And these are, if you don't treat pain, the animal has an increased stress response, so lots of circulating stress hormones will appear, and this really weakens the, animal's immune system, which we absolutely don't want the opposite of what we want. Pain causes anorexia, or hypoorexia.
If you can think of yourself when you're in pain, the last thing you really want to do is eat. And with the best surgery in the world, if an animal isn't eating, it is not getting better. We must meet its nutritional requirements.
We have an increased heart rate and blood pressure when an animal is painful, and if that animal is under anaesthetic and your analgesia is inadequate, then blood pumps around even more, and the surgeon gets pretty annoyed because their field of vision is completely obscured by blood. But if that animal has recovered from an anaesthetic, and it's painful, so has an increased heart rate and blood pressure, all those little vessels that have been tied off, all those capillaries that were allowed to clot, are now going to start bleeding, and that is a really serious issue for those patients. Interfering with the wound.
When a wound is painful, an animal licks the wound. And obviously we know that animals' mouths are filthy, and we end up with infected wounds and wound breakdown. If they're licking the wound, often we just plonk a bust a collar on them, don't we?
And that's quite stressful for the patient, and stops them from being able to alleviate their pain, which was by licking. Depression has been reported in humans, and sleep disturbances also, you know, yourself, when you're painful, it's really hard to get to sleep and sleeping is, of the utmost importance for mental and physical health. Development of a chronic pain state, this is well reported in humans, so pain that is inadequately treated inadequately treated at the time of surgery is, can develop into a chronic pain state.
Now our patients are nonverbal, so they are not self reporting, but this is well documented in human surgery in human medicine, so we must treat pain appropriately at the time of acute pain to prevent these chronic pain states from happening. And then behavioural changes. When an animal is in pain, whether it's in the clinic or in the home environment, their behaviour changes and labelling them as nasty or vicious or dominant as they try and use their protective and threat repelling behaviours, shuts down any opportunity to question why an animal is behaving that way.
So I just want to touch on pain now so that we are really familiar with how to recognise it, er and how to help owners also recognise it so we don't get unfair rehomings or even euthanasias for those patients whose behaviour has changed because they are painful. Recognising pain, we're gonna do cats and dogs together, so behavioural changes, not wanting to be touched, hiding at the back of the cage, that inability to settle and to sleep, can be a really early indicator of how they're feeling. And it's really important that we notice what a patient's behaviour is like before the surgery so that we can very quickly see any behavioural changes after the surgery.
So if they're at the front of the cage prior to being spayed and they're now huddled at the back of the cage, that should definitely ring alarm bells. They're disinterested in their food or their surroundings, they're refusing to exercise. They're unable to groom themselves or access their resources.
All of these indicate pain. This black and white cat in the picture here was actually brought in by his observant owner because he had stopped grooming himself. You can see the muck all down.
His chest and legs and around his face, and sure enough, when we examined him, there was actually a large tumour under his tongue that was, that was causing him so much pain he couldn't now clean himself, which is obviously one of a cat's number one priorities. They have a reduced emotional capacity when they are painful. So there might be an aggressive response to being handled, and they might be less able to cope in certain situations.
So those lovely, lovely lifelong loyal pets that we've had now suddenly try and snap at you when you're trying to towel dry their feet after a walk. And that needs to be recognised, as a behavioural change likely to be caused by pain. We see postural changes when a dog or cat is painful.
It might be tense or rigid, reluctant or or unable to move. The prayer position, not sure how many of you have seen this, but this indicates quite severe abdominal pain. Not to be mistaken for a play bow, when they get down on their elbows and, and waggle their bums saying, play with me, play with me.
We can see that these dogs aren't doing a play bout because, the tail. Is not in the air. We've got gay averting, we've got very tense faces is pulled back.
So the preposition I've seen in patients post neutering, mostly, the cocker spaniel in this picture had eaten wood chippings, which was causing intense pain of his intestines. It's me taking a sip of water. Hunched spine, tucked up abdomen.
We often see this in patients who've had ex-lapse, or or some other abdominal surgery, so perhaps being spayed, then when they're tucking up their tummies. And we ourselves, we do this, don't we? When we have abdominal pain, we often get into that, sort of foetal position, pull our knees up to our chest.
Head lowering. This is one that often gets, goes unnoticed, but when the head starts hanging lower than the shoulders, that can be an indicator of pain. Or just an unusual position.
You see a dog or a cat and you think, what an unusual position for you to be in, especially in the clinic. Then just stop and assess that patient. The black and white cat in the bottom of the picture here, was admitted, admitted him into that cage, and he got into that position.
And I, first of all, thought, casual cat in the clinic like this, and then, Turned around 2 minutes later, he was still in that position, so I took the picture, he was in for x-rays and sure enough, there were 2 large tumours in his abdomen, and this was the only position he could find to get comfortable in, so not to be ignored. Interfering with the wound or guarding the wound, we all know that dogs and cats will lick their wounds, post surgery, but it is normally only because they are painful. So pain caused by wounds, almost always get licked and chewed, and, this can obviously be avoided with good analgesia and a good surgical technique as well.
Vocalising cats or dogs that vocalise post-surgery should not be ignored. It may well be that they are asking for attention, they want to go home, they need the toilet, maybe they're hungry, they just need a cuddle, but it shouldn't be ignored, especially if they weren't vocalising pre-surgery. Now we can't include mouth breathing as a sign of pain, even though panting and mouth breathing certainly er does come with pain, but it could also come with an animal that's really, really stressed or has respiratory issues.
So that has, I've not included that in this list. Facial changes, tense face and muzzle, orbital tightening, so, pulling back of the eyes and ear position changes are all really good indicators of pain. And what's lovely about these is that they are an involuntary thing that the animal does.
So even if they're a prey species, they can't help but do this. So even rabbits, mice and rats, will also have facial changes, facial grimacing, as it's called, when they're painful. And some research has been done into cats.
And if you look at the black and white cats in the bottom picture, if you were to draw an imaginary line from its from one lateral campus through both medials and out the other lateral canthus, for a non-painful cat, you tend to get more of a a U shape or a. Straighter line, but for the, for the tabby here that is very painful, we've got more of that V shape. So when the eyes are really squinted, pulled back or or quite slitty like that, that can certainly be something that we're paying attention to, as an indicator of pain.
For owners The ISFM cat website is absolutely brilliant, and you can be giving them handouts like this so that they can recognise when their cats are in pain, or this might be something that you want to put up in your own prep rooms or, or kennels. And then for dogs, the Colorado State University is also quite a nice visual guide to help us notice when animals are in pain. This isn't validated, but it is still a really nice guide that we can either give to owners or, or make sure that we have up.
This is a nice video, not for the dog, but this dog, it was an 18 month old dog, had come in for an exploratory laparotomy, and this was the dog 24 hours post X lap. I want to see how many indicators of pain you can see in this, in this lovely 18 month old dog. So we've got That hunched up, tucked up, hunched spine and tucked up abdomen.
Go head lowering, gaze averting. He's panting, which we can't use as an indicator of pain because he might be hot, he might just exercised. He was licking his nose, not an indicator of pain, but is an indicator of anxiety, as we know, and pain does make animals anxious.
He can't really get comfortable. He's not sitting down or lying down. He's also at the back of his cage.
And he just can't seem to settle. Very hang dog here. So hopefully we would all recognise that that dog absolutely required pain scoring and more analgesia.
This is a cat here, this is a cat. It's the end end stage of of chronic renal failure. Let's see what we can see here.
So we've got a head lowering, ears pulled to the side, which I haven't mentioned yet, but certainly squinting of the eyes. Didn't really want to be touched there by his owner. It's quite tucked up.
He's not interacting. He's quite cross about being touched. So we must be able to measure and score pain, to be able to effectively treat it and to be objective about doing it.
And I, I'm hoping all of you are very familiar with the Glasgow Composite Me pain scale. It measures acute pain, that's surgical, medical, inflammatory, or traumatic. It's validated, decision making tool that anybody can use, absolutely anybody can do this in 2 minutes, score, score an animal.
As you know, the descriptors are ranked num numerically, a score is generated. The higher the score, the worse the pain. There's a separate version for cats.
There's 8 questions for cats and 6 questions for dogs. I'm not going to go through the whole pain scale. Just gonna look at, a couple of example questions.
So for the dog, if the dog can walk, then you pop a lead on that dog and lead it out of the kennel. And then you note its response to how it gets out the kennel. So here we're looking at mobility.
Now in the past when I was a baby nurse, I didn't know about the Glasgow pain score. I don't think it existed all those years ago. And I used to, if they, if they were reluctant to come out the kennel or they were slow or stiff, I used to just pull the lead, jivvy them like, come on now, come on and pull them out, and I'd missed a massive sign of pain.
And then, one of the other parts of the dog pain score is to do gentle palpation 5 centimetres around the op site. Some people think this is controversial. They call it the poke the wound test.
Say that you're almost having to inflict pain to see if you've got pain, but that is absolutely not the case. You're just looking at the animal's response to gentle palpation. And if the animal does nothing, absolutely brilliant, but any of the others need to be, noted.
So here you just response to wound palpation. A score of 6 or more out of 24 if you've done the entire pain score means you need to give more analgesia. If you don't do the bit where you take them out of the kennel, because they, have had maybe spinal surgery, perhaps, or, orthopaedic surgery, that means that they're not ready to walk, and then you score them out of 20, and if they get 5 or more out of 20, then they need more analgesia.
But on the whole, we do the whole, whole pain score and a score of 6 or more. Consult the vet if you're a nurse, or if you are the vet. Consider giving analgesia, and once you've given it, pain score them again 20 minutes later.
Check that that analgesia you've given has been effective. Check that that score has come down. For cats, we're looking at, if they're paying any attention to the wound.
This is also on the dog one as well. If they're ignoring it, brilliant, if they're paying any sort of attention to it, they score one, so there's attention to wound. And another sample question on the cat one is, how it responds to stroking.
We all know cats normally lean into a stroke or bob into a stroke. So if they, if they, respond to stroking, that's great. That's what we want to see.
But if they don't respond or if they're aggressive, that should ring alarm bells. So there we're just looking response to stroking. And for cats, it's very simple.
It's just a straight out of 20, and if they score 5 or more, we need to be giving more analgesia, and then repain scoring again 20 minutes later to check it's worked. Please, in your practise, and I know this is common, do not just score the non-routine procedures. My current job is I work with a lot of student nurses in many different clinics, and I regularly hear that pain scoring is done using the Glasgow Composite Me pain scale, but it's not done for the routine ops, it's not done for the dentals or the spays or the castrates.
It's only done for the big, bigger ops, the X laps, like this coat hanger being removed in this picture on the right hand side. It's done for the big, the big ortho ops, and it's not done on anything that is, is done routinely. But why?
That does not make sense. A routine procedure does not negate pain scoring just because it is routine. It's not routine for that patient.
They've still been cut, and I've heard that some practises say that the only pain score. They only pains school their patients if they think they're painful. Now, how does that make sense?
How do you know if they are painful if you don't score them? I, I know that time and experience will help with that. But if you're a new grad, or if you're a student nurse, then how do you know who to pain and score?
And it really should just be routine, and it should be on all patients' hospitalisation sheets to fill in that pain score result alongside the TPR, the temperature pulse respiration, urination, defecation, eaten, drunk. It should be on there. It should be so routine that we don't even think about.
It's automatic. I'm finishing . This bit on behaviour and pain in the UK, around 72% of referrals to behavioural specialists are linked to acute and chronic pain.
So those behavioural problems may not be behavioural problems after all, they are just a painful animal trying to cope. So we must always remember that. The Feline Grimace Scale app is something that is, is sweeping the veterinary nation now.
Hopefully you've all heard of it. Hopefully you've all downloaded it. But if you haven't, I would really like you to do that now, because we're just gonna pain and score a couple of cats using the feline Grimace scale app.
I'm just opening it up on my phone now. Obviously, pause the lecture if you need to download this app. It is completely free.
It was. Created by the University of Montreal, some amazing vets that work there. And it, it basically allows you to very, very quickly, using the app, assess pain in cats by analysing changes in facial expressions.
And this is something that can also be given to owners, to use, at home. So please download the app now, and we're gonna look at the first picture that I would love you to score. So what you're scoring, as you can see as you use the app, is the cat's ear position, orbital tightening, muzzle tension, whisker, whiskers changing position, and head position.
Now this is validated, so this is certainly something that can be easily used, so I'd love you to paint score that cat and then let me know what score you got. You can't let me know, sorry, but note down what score you got. And then this is the cat post analgesia.
Looking a bit better. So I scored this cat, and I've done, done this talk quite a few times, and everyone gets around 6 or 7 for this cat, which I think is pretty, pretty spot on. So when you get a score of 4 or more out of, 10, then you need to be giving more analgesia.
So this cat did receive more analgesia. OK, next cat now, I'd love you to score. Is this cat?
Sorry, the previous cat, I should have said, had had, liver and intestinal biopsy, so it had an exploratory laparotomy. This cat was brought in as an emergency with a, with an awful tail pool, injury and a wound on its tail. So please score this cat using the app.
Or is it if you need to. And this cat was scored as a as a 5 out of 10, and this is the cat post analgesia. So hopefully you all got somewhere around 4 or 5 for this cat and then therefore would have given more analgesia.
So the app is something really useful that I really hope everyone in your clinic can be encouraged to use. OK, I'm gonna finish now with a walk around the clinic and how we can improve patient welfare in each area of the clinic using an evidence-based approach. So to be able to write this talk, I have done so much research to be able to say what I'm going to say now.
This isn't just the world according to me. So let's start off in the waiting room. Here are your dos and don'ts.
So don't have cats and dogs waiting in the area. If you can help it, it is very stressful for them. I appreciate that many clinics are very small.
But if you can help it, do not have them in the same place. Try not to paint the walls all white. It is visually jarring for animals.
And don't use strong smelling disinfectants, or even wear perfume. And consider the hand cream that you're using even when you're handling these animals. the, the sense of smell is a cat and dog's primary sense, so be considerate to to their world, which is very much an olfactory based world.
Do have separate waiting rooms, or set or areas for cats and dogs and have cat shelves in them too for them to place the baskets on. If, if space allows, please try and do this. Don't paint the walls, do paint the walls in calm colours for dogs and cats.
This is, hues in the soft yellow to violet range. Do consider the olfactory environment of the clinic in the use of synthetic pheromones, so fellaway and, and adapttyl. Do have tasty treats available by the scales and on reception as well, so that they can easily be reached and easily given to those patients.
So often I go into waiting rooms and I see dogs, focusing their attention on other dogs, either wanting to play with them, or just say hello, and I, and the other dog is trembling under the chair, and I just think, oh, we could redirect its attention so easily if we had some really tasty treats. On to the consulting room now. Do not withhold delicious treats if a patient is allowed treats.
Please, please, be really generous. Do not put all dogs on tables to examine. Do not pull or tip cats out of the carriers, as I mentioned earlier.
Do not take patients into the prep room for procedures. We do this so often. We take the patient from the consulting room and into the back, into prep for blood draws and, and back.
Changes that that patient has had to acclimatise to the car, then to the waiting room, then to the consulting room, and then it's taken away from its owner, the only familiar thing in its life right now, and into prep room, which is often the party room, and it's got other patients in it and full of other smells and strange sounds. So don't be taking these patients away from, their owners, away from the consulting room, the treatment room. What I would love to see happening in consulting rooms is lots of treats being liberally given, scattered on the floor, allowing patients time to settle in and to acclimatise, padded mats or beds on the floor for dogs to be examined on.
Do examine cats in the base of their carriers, let them bury into that towel, and you can move parts of the towel, as you need to expose that area of the cat. Just like if you've ever been for a massage, they don't just whip. The whole towel off you and then only focus on massaging your shoulder.
They, they move the masseuse, will move the towel and cover you, and only expose the bits that they need. So think about that for our cats when they're being examined. Those really frightened cats do have seating available for owners.
This helps, create a calmer environment. Pets can sit on owners' knees if that's what's going to make them feel more comfortable, and it also helps the owners feel more comfortable as well. Do procedures, blood draws, bandage changes, etc.
In the consulting room. If you don't want to do it in front of the client, and that's perfectly understandable, just ask them to leave. Ask them to go in the waiting room whilst you do it.
As I said, don't drag that animal into prep to do it. Leave them in the room that they've become acclimatised to. On to prep now.
Prep is my favourite area in the clinic. But if you've got patients in there, please don't treat it like a party room. This is a really frightening day for them, and they need a calm environment, in order to help, feel a bit more relaxed.
Don't place animals on cold hard tables that should go without saying, but so often I still, I see on social media or on veterinary promotional literature, dogs and cats on cold hard tables. Please give those a bed. If that's gonna be expensive, ask the owner, you know, use the The bed that it's come with in its box, or if that animal is hospitalised, take its bed from its kennel.
It smells like it already and pop it on the floor on the table that you're going to be using. Just no uncomfortable surfaces anymore for these animals. Do not forcefully restrain patience, displaying threat repelling behaviours.
Do not think you have to win. And I'm so sad of hearing that word still. I can't let him win.
Don't want him to think he's won. He doesn't know he's in a competition with you. He's just thinking he's got to protect himself.
Do please have the minimal amount of people necessary in prep and do have beds on all tables for all procedures. As I said, you can take them from the animal's kennel so that they smell like them if they've already been admitted. Do premedicate anxious or difficult to restrain patients before that are having a GA before placing the IV cannula.
So very often I see patients or hear of patients that, someone's had 2 attempts or 3 attempts at placing an IV. It's failed, it's blown, the vein's blown, the animals struggled, and, then I hear those words, let's pre-med him now. I think, oh, why don't we just do that first and then place the IV?
I appreciate if you use medoomidine, the vein can be a little harder to find, but with practise, it will be OK and it'll be a nicer experience for everybody. Do give preemptive multimodal analgesia to all patients undergoing painful procedures. This will help prevent sensitization, or the wind up phenomenon.
So multimodal analgesia is, the aim of the game here. That would be a whole other lecture to talk about that, though. OK, onto the operating room.
Don't place animals in comfortable positions on the surgery table, especially those arthritic patients. So be thoughtful when you're positioning them, or potentially tying their legs down. Keep an eye on the, on their blood pressure and their heart rate and see what They're finding more comfortable, but, but really please be, be very careful with those, especially those that are needing to lie on their backs for a long period of time, those hips will probably not enjoy that.
So get them nicely padded, rolled up towels or pads underneath them so that they're lying in a more natural position for themselves. Don't simply turn up the vaporizer if the animal is experiencing no susception as opposed to light anaesthesia. So no susception is when the brain is receiving signals about the pain that's been inflicted on them, but the the animal is unable to do anything about it because it's been anaesthetized, but the brain is being bombarded with pain signals, and you'll see an increase in heart rate, blood pressure, and maybe panting.
But the eyes will remain down and there'll be no palpable reflex and no movement or vocalisation. Whereas with light anaesthesia, the eyes will probably come back up. You'll see palpibral, you might see twitching.
Now, those animals need more anaesthetic. They might need the vaporizer turning up, or they might need, you know, and some IV anaesthesia. But if, if the animal is at an adequate depth of anaesthetic and you see an increase in heart rate and blood pressure or panting, please consider giving more analgesia, or a local anaesthetic.
There is no pain relief in, in isoflurane or. Sevoflurane, so make sure you're using the correct drug for the correct, response to surgery. Do not allow the animal's anaesthetic to become light as sutures are being placed.
Now, this is a little bit old school, and you might see it with older vets or nurses. I used to do this because I was brought up on ha on using halothane, which did take them a long time to recover from. And it was very traditional to start.
And correct to turn animals down as the to turn the the vaporizer down as sutures were being placed. But now with isofluorine and sevoflurane, it's very short acting, and an animal should remain properly and completely anaesthetized until the very last thing is done. And, and that will include removing drapes, and placing bandages and cleaning wounds.
They should not be in a weird limbo state where they're starting to become conscious, as you still do those final procedures. The animal should remain fully unconscious until you are done, and it can be. properly watched, once you've taken it down and potentially taken it through to a kennel or maybe leave it in theatre, whatever it is your practise does, but it shouldn't be in a limbo, in a weird limbo state as you continue to, do things to it.
If you've ever had an anaesthetic. Becoming conscious after an anaesthetic or recovering from an anaesthetic is one of the strangest things that can happen to you. And if you imagine that someone's slopping a solution around on you to clean all the blood off you or even worse, putting sutures in or taking towel clamps off you, that is a really awful experience, so.
They're either anaesthetized or they're conscious, nothing in between. Do not overstimulate the patient to hasten the swallowing reflex. Now, when I was a baby nurse, this was done all the time.
We were a very busy practise. We had lots to get through, and we would pump the legs, and we would rigorously rough, ruffle them, rub them. We would tickle inside their ears, flip them over.
I know all this stuff still goes on today. Practises are busy, but what you're doing is artificially. Lightening that animal so that it swallows and then you can remove the tube, which is what you're after cause you know you can't leave a dog alone or a cat alone whilst it's still intubated, and then once you've got it, you feel that you can go, that animal's now conscious enough to be left.
And you can go on and do the next job. However, you've artificially lightened that patient. Once you've got that tube out and left it alone, it will go back down to the depth it was, and you've lost that protected airway, and a protected airway is obviously essential until they are genuinely conscious enough to have their ET tube removed.
OK, operating room do do staff GA patients for the minimal time to prevent hunger, 6 hours for adults, 2 to 4 hours for puppies and kittens, . Apologies, and do allow water up until the point of pre-medication to prevent thirst and dehydration. So dehydration is not only unpleasant, but it can lead to hypotension, impaired cardiac function, infections, and also kidney failure.
So we really do want them to stay as hydrated as possible. Do keep patients warm to prevent hypothermia. Hypothermia is a recognised torture technique, and the consequences of hypothermia include morbid myocardial events, reduced resistance to surgical wound infection, impaired coagulation and delayed recovery, or what we'd call a longer wake up time from the anaesthetic, and also postoperative shivering.
And human patients in the research done on them, have actually identified feeling cold as one of the most unpleasant aspects of their treatment and actually sometimes worse than any pain associated with the procedure. So it's really important to keep them warm. I visited one practise and they had a bear hugger, but it wasn't used because the.
The theory was that if they were shivering, they were warming themselves up. Now, shivering is, unpleasant. It's, not only unpleasant, but it's, physiologically stressful because it elevates blood pressure and heart rate and oxygen consumption.
And it may aggravate pain, and even hinder wound closure by simply stretching the surgical site. So please, please, please keep them warm. Really important.
Use whatever you have, keep monitoring the temperature, wrap up those feet, those legs, get your bear huggers on, your towels, your blankets, do whatever you can. Make sure their feet aren't touching a cold drip, drip stand or a cold table. Really, really, I can't stress enough, as I say, it's a recognised torture technique, hypothermia, and it's something that we need to do our best to prevent.
Do use lidocaine or buppivacaine for regional anaesthesia or local anaesthetic box at surgical sites. Still hearing of practises, removing teeth with no local anaesthetic. Yes, they're under anaesthetic when it happens, but their brain is still getting all those messages about pain being inflicted.
You'll have really sore, sad patients, post dental, if you've not used local anaesthetic. Those blocks are fairly straight. Forward to do local anaesthetic is not lidocaine Bca.
They're not expensive drugs. So please consider using them intraperitone, intra intraperitoneal for your bit space, intradermally, around your wounds. If you're a veterinary nurse, obviously you don't have the power, but you could, you could just simply ask the vet, would you like me to get the local?
And then it, it's, it's there, it's been suggested. Oops, sorry, that's an intradermal lidocaine injection happening there to a bitch spray. And then do allow patients to recover from anaesthetics in their own time.
Use their name and gentle stroking, positive patient welfare. I remember when I became conscious when I recovered from an anaesthetic that I had, I had two nurses next to me. They were both rubbing my arm, and they said, Hey Lee, Hayley.
And it was very, very reassuring. If someone had been pumping my legs or tickling inside my ear, I think it'd have been a very different experience for me. Quick word on post-op analgesia and Buster collars.
As I said earlier, Buster collar's a place where an animal is licking the wound, they are licking their wounds because they're in pain, they are my pet hate . Yes, we needed to use them in the past, but there are so many choices of analgesia now, multimodal analgesia, and we have such a better understanding of pain now and pain recognition and how detrimental pain is to a patient that we really shouldn't just be popping on buster collars. .
And as I said, we've stopped the animal from alleviating its pain in the only way it knows how, which is licking. I'm sorry, but I call it lazy vetting. There are, there are times when a buster collar is needed, but it's not, it's not, it shouldn't be just the thing we reach to and send every patient home with.
If you do a lovely thoughtful clip and prep, pre-perry and post-op pain relief, nice gentle tissue handling and sutures that aren't too tight, you shouldn't need to be putting a buster collar on all those cats spaces and all those bitch bays and dog castrates. . You might need to give more post-op opioids.
If your pre-op opioid duration of action is passed and the non-steroidals aren't controlling the pain. So just, you know, be pain scoring these patients. And they should be going home with analgesia after every surgical procedure, and that includes dental extractions, obviously, and cast castrates because they often get overlooked.
And the general rule of thumb. I, you should give 3 days of postop analgesia for a castrate, 5 for a spay, and 7 for anything bigger. And my final word on Buster colours is, if I had a headache and I was rubbing my forehead because my head hurts, I would sincerely hope that someone would give me some paracetamol and ibuprofen, rather than just tie my hands behind my back.
So consider pet medical shirts instead of Buster collars if you are concerned. Obviously for, for ear and eye surgery, yes, I appreciate Buster collars do need to be given, but just have a look at what your practise is doing and just maybe question it. Finally, kennels.
If you can help it, do not house cats and dogs together. Don't have the cages facing each other. This can be very threatening or very frustrating for cats and dogs.
Don't keep disinfecting the cage and changing the bedding, unless they're infectious cages. Don't do that every day. You're, as I said, the sense of smell is really important.
So we want olfactory familiarity for these patients. And if you disinfect their cage and change their bedding every day, this can't happen. Don't shout at barking dogs.
I know we've all done it. I know they can drive us mad, but they are communicating to us. They're trying to ask for something or tell us something.
So please, please try your best not to just get annoyed by those barking dogs. Don't allow patients obviously to urinate or defecate in their kennels and cages. Make sure you've got a good schedule going of when they can get to the toilets.
They've got access to a litter tray if they need it. Make sure their routine is predictable. And as I said earlier, don't assume that routine procedures don't need pain scoring.
Please do use visual barriers if necessary. If you have got pages, cages next to each other, just a sheet of cardboard or a towel can help if you've got animals that are next to each other and really not enjoying that experience. Do ask owners for their pets preferences on admits.
You can fill out a preferences questionnaire, worm if they've got, a favourite type of food or treat, favourite, type of bowl. Maybe they drink and drink from a water fountain. Do they prefer a, a flat bed or a nest bed?
Is there, a substrate that they prefer to go to the toilet on? This is for dogs and for cats. Is there, is there a queue or command for them to go to the toilet?
Is there anything that they're particularly anxious or fearful about? Do they perhaps not like their ears? Touched that they are they scared of men, for example, all of this stuff we really do need to know.
It would be really strange if you dropped your kid off at nursery for the first time and they didn't ask you a few questions about your, your kid's character and preferences, and it ought to be the same for when we're admitting patients. Apologies. Here's an example of a preference questionnaire.
Music therapy, so there's been a lot of research done on music therapy, and I have included, included it as a definite do because there's not been enough research that, that, . Unanimously supports that music therapy is beneficial to welfare because, we don't know what volume to play it at, what distance the speakers should be from the patient. We don't know, if that animal has come from a home that constantly, that has music playing.
We don't know how long it needs to be played for, how long, or do they need periods of silence. We don't know enough. What I do know from anecdotal evidence is that music is great for the humans.
Normally for the human's welfare, it makes us feel good. So if you do have the radio on, please be aware of the volume it is at, because dogs and cats hearing are superior to ours. And what might just seem a normal level for you might just be, meant, auditory torture for them.
Do time all your examinations and your treatments to be done at the same time so that we allow patients to sleep undisturbed through the night. If you can let those patients get at least, at least 6 hours of solid sleep. This often can't happen in referral centres or, out of hours centres, but do your best, dim the lights.
Any patients that are having treatments through the night, do your best to put those in a separate area, so you're not disturbing all those patients. If you've ever been hospitalised yourself and try to sleep the night through a human NHS hospital, it just is horrific. It can't happen.
And we need to appreciate that our patients also need to have sleep and rest. Do provide all cats with a litter tray and somewhere to hide in their cage. That is paramount to their welfare.
Cats that are frightened will either run or hide. They can't run in the cage, so they must have somewhere to hide. It doesn't have to be fancy.
It can, it can be a cardboard box, but I appreciate for some people that is, annoying, cause where do you keep those cardboard boxes and then they all need to go into the recycling? Where do you? Yeah, where do you store them, are you gonna have a good enough supplies.
So you can use anything, and one of the best things I ever saw used is those little plastic bathroom stools. You pop that in the back of the cage and then you put a towel over the top, and then you've got a surface that the cat can sit on if it wants to, which is lovely, cause cats like height, or they can hide in when they're feeling fearful. So consider those.
And do perform a pain score regularly, and again 20 to 30 minutes after analgesia is given. So those are my kennel dos. If you have run out of pain scores, or you are trying to save the planet and print less, or the rep hasn't left you with any pain scores, for whatever reason, my top tip is to get it screenshotted and on your phone.
We all keep Phones in our pockets. We can all add up twos and ones and threes. So have it on your phone.
Put it in your favourites, so you're not scrolling through 10,000 pictures. To find the pain score, I've only got a few pictures in my favourites, so that's where I, you can see I've lovehearted it. So that's where I keep my pain scores, and then I can very, very easily pain score an animal.
So that is, something I really strongly recommend to you all. OK, we're gonna finish on this picture, and I've used this picture because every physical aspect of this tetanus dog's care has been considered. So it's, it's literally everything that I've covered in, in this webinar.
So it's got a fan on it to keep it cool. It's really nicely padded underneath. It's got urinary catheter and urinary bagging.
This dog has tetanus, so it's unable to, to do anything, to walk, to move, to eat or anything. There's incontinence pads underneath its bottom and and also under its mouth as the dog was struggling to swallow. It's got a central lining.
It's got a syringe driver for its CRI. It's constant rate infusion of analgesia. It has an esophageal feeding tube, so we meet the nutritional requirements, .
And so there was, also thought given to his psychological needs. So the nurse that admitted this dog was told that this dog was frightened of other dogs, and on either side of this kennel, the walls were made of glass. So it was a glass sided kennel, so she hung sheets up so that this dog couldn't see the other dogs, looking in at it.
And even though this dog was completely recumbent and barely conscious, that thought had still been, considered and The thing that that really prompted me to take this picture is the thing I'm sure you've noticed. This dog was in a really busy, noisy 24 hour ICU ward. And as I said, sleep is hugely important to getting better and to mental well-being, and she'd put cotton wool, in the dog's ears, so that things just weren't so loud for it to could get some sleep.
And it's that level of care and attention to detail that we should all be striving for with our patients. So thank you very much. If you are considering improving welfare in your patient, then I can't recommend enough considering becoming a dog friendly clinic or a cat friendly clinic or a rabbit welfare friendly clinic.
So, have a look at all their websites. And see if that's something that you could do for your clinic if you haven't already done so. I am heartened by how many people are cat friendly and gold level cat friendly.
The dog friendly is, is newer to the table, but it's certainly something that we should all be striving for and rabbit friendly as well. So, if you would like to, I'm not sure if I'm allowed to plug this on here, but if you would like to learn more about what I've said, I do also work for the University of Edinburgh, and we've got, some online courses, that talks about this stuff more in detail. They're called MOOCs, massive open access online courses.
They're completely free, and will, will help towards your CPD. So, thank you very much. I really appreciate your time, and I hope that's been useful to you.
Thank you.
