Behaviorally preparing your patients for medical procedures (Proceedings)

We all understand the frustration that veterinarians and owners feel when an animal doesn't follow post-op instructions of ‘don't move' and ‘stay crated'. Not only is it difficult for owners to understand the potential downfall of not following instructions, it is also difficult for some animals to handle such requirements.

Prevention

Like in all areas of veterinary medicine, an ounce of prevention is worth a pound of cure. It is imperative that ALL staff in veterinary practices need to follow low-stress handling practices. There are a lot of opportunities for veterinary staff to learn and practice these techniques to improve the welfare of the animals in the practice. Additionally owners WILL mimic what you do, and they need to be able to handle their pet in many different situations.

The additional step staff should be implementing is teaching owners how to perform specific procedures that need to be done in a home situation, both to prevent problems from occurring, as well as to help owners deal with the immediate procedures at hand. For example, if an owner is taught how to clean out their dog's ears, they will catch the ear infection much earlier than those who do not perform these procedures.

Crate training

Crate training ahead of time will dramatically improve a dog's ability to cope with post-surgical confinement. Most people have heard of crate training but may not know what it really is or why it works. The following is a brief discussion about crate training, how to use it, and some common mistakes made. Crate training takes time, effort, and a lot of patience, but when used properly, it can be a positive experience for both the owner and their dog.

Why?

Crate training is a great way to limit a dog's mobility while it recovers from surgery. It will cut down on the number of times he has the opportunity to become too active and risk injuring himself. It will give the owner more peace of mind and freedom to be away from home during its recovery. If he is used to being crated it will also be easier and less stressful for him to travel, to be in a cage at the veterinarian, or to be confined for any other reason in the future. The owner may choose to continue to use the crate into the future as his very own comfortable “room”.

In the wild, dogs naturally seek out dens for sleeping quarters. Presumably this is because it gives the dog a sense of security. Dogs instinctively do not like to soil in their dens and will go outside to eliminate. Crating your dog is simply using his instinct to rest in his den. Some people feel apprehensive about crating their dog, thinking that it is mean and that their dog won't like it. However, since dogs seek out dens on their own, a crate can be both natural and comforting.

What type of crate?

Both wire and plastic crates are available. Both work well, so it depends on an owner's personal preference. Keep in mind that plastic crates can be used for airline travel while wire crates may be collapsible, thus easier for storage. Getting the right size is very important. The dog should be able to stand up and turn around freely in his crate, but it should not be big enough for him to have a separate toilet area.

Steps in crate training

First, make sure the crate is comfortable by placing a towel or bed inside. Place the crate in a common area and put toys and treats inside for the dog to discover. Never force a dog into the crate, as going in should always be a positive experience. Praise him every time that he goes into the kennel.

After he is comfortable going inside his crate for treats, beginning feeding his meals inside the crate. Start closing door while he is eating, but open it before he is done. Next, leave the door closed for longer increments of time, building slowly. Never open door when he is whining or scratching, but only open it when he is quiet. If he is consistently whining, he is being closed in for too long, so go back to an amount of time he tolerates well and increase more slowly.

After that, start crating him at other times besides his meals. Always give him an incentive to go into the crate (treats, food-filled toys, such as a Kong®, etc.) First stay in the room with him and then start leaving the room for short increments of time, building very slowly. Once he handles this well you can start leaving the house for short periods of time, again slowly increasing length of time. The length of time it takes for an individual to learn varies from dog to dog, so remember that patience is the key to a dog's success.

Problems and common mistakes

Crate too small or too big: If a dog's crate is too small, he will not be comfortable inside, and therefore crating will not be a pleasant experience for him. However, if it is too big, he may use part of it as a toilet.

• Forcing dog into crate: Forcing a dog inside can be scary for him, making him associate crating with an unpleasant experience. Crates should NEVER be used as punishment. Always have safe toys or treats inside to have it be a pleasant, rewarding experience for him.

• Moving too fast: Baby steps are very important! Slow shaping of behavior is imperative for success.

• Leaving inside for too long: Even with proper training dogs need to go to the bathroom frequently and can't be expected to “hold it” for extended periods of time (e.g. overnight, all day while at work). If your dog is having accidents in the crate it's most likely not his fault-he just needs to be let outside more frequently.

• Whining: Ignore a dog when he is whining or barking in crate. This means no positive or negative attention. Letting him out will train him that he can get out when he cries, and scolding him will be confusing or even rewarding to him since what he really wants is the owner's attention!

• Using a crate to manage anxiety: If the dog has separation anxiety or other anxieties, crating him may stop the house from being destroyed, but it likely does nothing to decrease his anxiety, and it may make a dog even more anxious.  For example, he may break his teeth trying to chew his way out or rip out his nails trying to dig his way out.  If a dog has anxiety problems, they need to work on this problem with help from you or a veterinary behaviorist, perhaps necessitating the use of anti-anxiety medications.

Litterbox management

Post-op care of cats often include a change in the area of elimination for cats, and/or a change in the substrate or litterbox. Ideally a cat should be given that choice pre-op so that it is not a shock to them when they come home from the veterinary clinic.

Type of litterbox

Cats often have limited mobility post-op. Short-sided litterboxes, such as baking sheets, could be used in the short term so that they can more easily enter into the box. It should also be located close to where the cat spends its time, so that it does not have to travel far to eliminate.

Litter

Veterinarians often recommend non-clay litter post-op, so that the litter doesn't stick to the wound. However, cats sometimes have strong preferences for specific types of litter, and a change in the substrate can lead to a cat developing inappropriate elimination on another substrate. There are different types of non-clay litter, including paper pellets, pine pellets, and shredded paper (commercial or ‘homemade').

Quiet enrichment

It is one thing to ask owners to not let their pet move for 6 weeks, it's another to expect a pet to actually enjoy that. It is important to understand that if you tell owners that their dog can't do x/y/z, while not giving them anything that they CAN do, they will make up that ‘can do' list on their own.

Food-dispensing tools

The reasons for using these tools include giving the animal something to do when the owner is not present, and letting the animal “forage” for its food, which is more ethologically correct than eating its full ration out of a food bowl, even though our pets adapt well.  Animals spend a good portion of their day hunting (carnivores) or foraging (herbivores) for food, which they are not able to do when they are fed their ration out of a bowl. 

Animals could be fed their entire daily ration in these tools.  Things to recommend to owners are for them to start out easy for the animal, gradually increasing the difficulty for the animal, and using larger quantities of the tasty treats at the beginning.

Self-play toys are especially good for pets which are crated for long periods of time. A lot of self-play toys dispense food, which motivates the pet to play with the toy. The basic principle is that you fill up the toy with food, and the pet learns to manipulate the toy to release the food out of a hole. Some examples are: Kong toys ®; Roll-a-Treat Balls ®; Deli Dome ®; and Pavlov's Cat ®. Owners can make their own toys with such objects as racquet or tennis balls, or disposable water bottles with plastic lids. Cut a hole into the ball or container, fill it up with dry kibble, and, presto, the pet is entertained.

Caution must be taken when recommending these types of toys for your clients to use.  Certainly take into consideration dietary restrictions for that pet.  Safety must also be taken into consideration, so that the animal does not injure itself or swallow part of the tool during vigorous chewing or become overexcited, thus, defeating the purpose of being kept quiet.  .

Solitary tools

In addition to the food-dispensing tools, there are other types of things that animals can use when they are alone.  Such things include visual enrichment, odors, and other types of toys. Some animals may enjoy watching television, and there are some videos available for purchase for pets to watch.  However, perches by windows with bird feeders outside may provide more enjoyment for some pets.  Be aware that roaming cats may be attracted to the yard, and become a trigger for the household cat to begin urine marking.

Odors can also enrich the environment of some animals, especially when taking kenneled animals into consideration.  Odors, such as lavender, may provide some calming effects.  Music and/or other radio sounds may provide enrichment or calming effect for some pets.  Take into consideration the volume of the noise, and be aware that, while pleasing to us, some odors are aversive to animals.

Human interaction and training

A human's interaction with a pet is a very important way in which an animal's life is enriched, as the human-animal bond is secured.  Some pets prefer to just be petted and handled instead of playing, especially as their physical ability to do so decreases.  Some animals would prefer training. There are many quiet types of behaviors that can be taught, such as lie down, etc.

Intervention

Depending on the medical procedure performed, different handling techniques should be highlighted. Overarching all of this is proper pain control…if something is painful, no amount of behavior modification will make this animal tolerate it.

Some processes that need to be done could be: wound care and bandage changes; physical therapy and rehab; expression of the bladder; changing of bedding.