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Wednesday, April 12, 2017

The cost of rough and tumble veterinary visits

Recently, a couple brought in their 2 pug dogs for check up.  I had not seen these dogs for care in a few years.  The couple moved about 3 hours north, and that would have been a bit of a drive for veterinary care!  Now the couple were living back in my area, and the dogs needed a check up.  " really bad breath - be sure to check teeth". was noted on one of the chart.  OK, dental exams are part of check ups so that would be fine.

The dogs were their usual happy, but  mildly anxious selves.  If you have ever  cared for a pug, panting  continuously is normal  for these dogs.  The pushed in face, small nose, long soft palate and big tongue makes creates a small airway.  This is the tricky part of examining  pugs, or any of the brachycephalic ( pushed in face) dogs for that matter.  When they start to fidget, paw, or struggle it can become very difficult for them to breathe.  Examination of the eyes, ears and mouth can be more challenging, because it  involves approaching them from the front.  Many dogs see  this as a threat, pulling away from the approach.   In pulling away, they start to struggle which causes them to breathe harder and pant more intensely.  It is more difficult for them to breathe now, so they continue to struggle trying to escape the restraint.

  In traditional handling, often a second or third person is called in to hold the dog  to  "just get the job done".   The dog will  become very agitated and even have severe difficulty breathing as they struggle.  Now the dog has  learned  to struggle for  any handling right  from the start.  The struggle is real - these dogs are fighting for air.  I am not here to discuss the breed, or breeding that created this health risk.   I want to have everyone understand from the animal's point of view why they resist handling in the first place, and how  traditional handling  creates a very rough experience.  Owners see this struggle,  and know it is not good for their pet.

Back to my story -  I reviewed the history for both dogs with my technician.  Both dogs were presented for nail trim, general exam and " bad breath" for one.  As I reviewed the history with my technician, she noted the dogs had not had veterinary care  since the last time I had seen them a few years before.  The breath was foul, and from the information that the dog did not want to play ball, or use the chew bones, she suspected  mouth problem had been present a number of months.  Why had they not sought care before this I wondered?  I put that in the back of my head and  entered the exam room.

I was  greeted by 2 active,  pugs  slathered with Adaptil ( mother dog calming pheromone) to help calm them in preparation for exam.  My technician knew the Adaptil helped these dogs be calm because we  a medical record system ( Bella Behavior Label System tm)  to record  the handling plan  for each patient.  We still had the medical records from years ago and the tech and I followed that plan  providing  a low stress exam and nail trim.  For the first dog, we used the calming pheromone, a cowl technique , and positioned the owner to continuously deliver baby food by syringe to her dog as I clipped the nails.  There was a little prancing at first, but with the right approach, rewards and low stress restraint the first dog was standing happily for care.
cowl technique - "Low Stress Handling, Restraint, et al" SYin 

When we started the exam on the  dog with the mouth odor, I could see he was more fidgety.  Fidget is a sign of anxiety and normal when there is pain.  Mouth odor usually equals dental disease and mouth pain so I knew I should be careful about examining his head and mouth.   We put the cowl on him and I used a pretzel stick  to lift his lip to avoid  excessive touch which would stimulate pain.
using a pretzel stick to lift the lip minimizes touch and pain 
 His gums  were inflamed with advanced periodontal disease,  to the point one of the first molars was just about ready to fall out.  He was always difficult for the owners to look in his mouth, so they could now see what was causing the foul odor.  I  carefully showed the owners the problem teeth, and the wife was especially upset that her dog was in pain and she had not realized the extent of it.  She could not see the extent at home, and had been in a quandary of what to do for him.    We set up his dental immediately, checked his blood work and started him on medication in preparation for the dental.

I was wondering why they had delayed care for his teeth.  They had smelled the bad breath, suspected dental problems for over 6 months but had not sought care.  My curiosity was not to accuse them of wrong doing but rather understand why they would delay care.  So I asked " From the records I saw that his last exam was from myself a few years ago.  Was it difficult to get him in for care at your new home or was there something else going on?  I was curious and just want to understand".  The husband immediately said " We could not find a vet who would care for them without hurting them. They were all too rough and I was not taking them back"  So I asked for more specifics and the wife added " They just called in more people to hold them harder, or took them to the back and who knows what was going on there.  Here you use the towel and some food and are kind in your care."  The husband added " If they are that rough around us, what are they like handling our dogs when we are not around."    I understood - they had seen the traditional handling which can often escalate fear and anxiety in our patients.  This couple had the money, had the knowledge of what their pets needed and were near a major metropolitan area so there were plenty of clinics around.  Yet despite that they lost trust in veterinary care due to their pet's experience.  

This had his dental 2 days later after being prepped with antibiotic and pain relief.  He had multiple extractions, deep cleaning and treatment to his gums for which he  immediately felt better.  Anesthesia went well and  we used calming pheromones in  cage, kept his area quiet and allowed him to go home early to reduce his stress.  The clients were happy that he was on his way to better health and that we cared for him in a way that was best for him.

The Bayer corporation ran a pet owner survey in 2011 which showed that approximately 35% of pet do not bring their pets in for care due to pet stress.  A repeated study was done in 2014 with not much improvement on this number.  As a veterinarian who has made positive veterinary care a standard in my practice, I am not surprised by these statistics.  I have had many seek my practice like this family because they saw the stress their pet was in during care and wanted to find a different approach.  Presently there is the  Low Stress Handling  tm Certification,  Fear Free sm Certification, and Cat Friendly Hospital programs to help veterinary staff learn specific ways to reduce stress and anxiety in care.  The text book " Low Stress Handling, Restraint , et al" by Dr Sophia Yin ( drsophiayin.com)  is the guide for all animal care professionals.  The American Veterinary Society of Animal Behavior has released a  positive veterinary care position statement.  I encourage all veterinary staff, trainers, groomers, and animal owners to read this statement and owners to seek veterinary professionals who follow these guidelines.  

Change is happening, and thank you to the  owners who make it clear that the animal's experience is essential to choosing  veterinary care. With vocal pet owners, more practices will embrace these standards .  Some veterinary clinics have followed this standards for years and I  applaud all of you. Practices new to  creating less stressful techniques, I am cheering you on as well.  I am especially thankful to the students who have taken the certification programs at the additional time and cost to bring this skill to the profession.  Hopefully it will become a standard for both  veterinarian and technical colleges.
Every day - Every way - Every patient keep it kind and low stress 



Monday, March 9, 2015

Why I tie- dyed my lab coats -  Stop  white coat syndrome in pets!



This little dog would only allow me to touch him without my lab coat on
Have you ever seen white coat syndrome with pets?  You know what I mean - the pet is calm, relaxed or even happy with the staff until the doctor walks in with the white coat.  I have seen this at my office, although the pets who have come in since  so used to rewards at the clinic from me as well as the staff, my uniform does not affect them much.  For other pets, the white coat means trouble.  Time for needles and poking around that is not fun.  When you remove your coat, the animal is less anxious. 

  We note on the medical record what pets have  white coat anxiety so I can remove my lab coat before I come into the room.  This has helped a lot  to keep the pet less anxious.   The problem now is,  how do I keep my clothes clean?  Personally,  I like the lab coat look for the doctor.  It distinguishes the doctor  from the rest of the staff.   So here is the quandary - how do I get the lab coat look without it  being white?  Would just a different color make a difference to these white coat syndrome pets?

In my search for non white lab coats, I found some  colored ones, and even rainbow tie dyed ones. They were too bold for my taste.  My tech suggested that I tie dye my old white coats  to experiment and make it kind of fun .  I have never tie dyed anything, but after reading a few crafting blogs on dyeing, it did  not seem  too  complicated.  I actually had fun doing it!

twisted up coat secured with rubber bands
I wanted to keep things as neat as possible and have a subtle dyeing effect.  The first coat I wetted down,  then using a paint brush I just brushed the dye, diluted to 2 ml dye to 1 pint hot water,  onto the coat.  I worked on this in a Rubbermaid under the bed storage box so the mess would be contained.  After I brushed the dye on, I let it sit in the covered tub for 8 hours, then rinsed it clean.  I had a neat, watercolor effect to my coat which everyone liked.  The second coat I used rubber bands to make the typical tie dye effect.  I used the same tub and a small squirt bottle to control applying the dye.  This one had more pattern but was still subtle. 
For others I twisted the coat around and held it with rubber bands - this has a star burst effect.   For these coats I kept the same ratio of dye to liquid but made a larger volume to soak the coat in. 
Use metal tongs to rotate the coats in the dye


   I began  wearing these coats, which  took a little for me to get used to.  I guess I am a traditionalist when it comes to lab coats.  I pursued, and  one day, a dog who is usually nervous for exams  was acting much better.  I was wearing the tie dyed coat and I noticed on the record this dog did not like white coats. I had forgotten to look at the record ( my bad!) and kept my tie dyed lab coat on.  He was much less anxious with the tie dye coat on.  I have made an effort to wear the tie dyed coats with white coat syndrome dogs and they are all acting a lot better. So now I have my solution - a lab coat that protects me,  and does not trigger anxiety in  the pets as much.  



Friday, October 3, 2014

A butterfly was born at my dad's funeral






June 10, 2014 my father John Foote passed away peacefully at his home in Jarman  Center Senior living, surrounded not only by his immediate family, but also a terrarium full of butterflies that lived with him in his final days.  These monarch caterpillars were gathered in from the outdoors to live and become chrysalis's  later to be released after emergence as part of the Monarch butterfly restoration project at Jarman Center.  Dad had released the first butterfly that was "born"   when the monarch butterfly restoration project started a few years ago. 
Dad is releasing the first butterfly born a few years ago

  To help put a positive spin on dad's final days, Cindy Pringle one of his care givers,  brought a terrarium with 5  developing caterpillars in to live in dad's apartment.  Dad was able to witness the first caterpillar actually transform into a chrysalis. All 5 of the caterpillars transformed into the chrysalis stage as dad declined.  By the time dad passed away, the first chrysalis was 6 days into the typical 10 day incubation period.  There were some hopes that a butterfly would be born before dad passed, but that was not to be.
Dad and I are admiring the j formed caterpillar ready to become a chrysallis

On the morning of dad's funeral, Cindy brought the terrarium to the funeral.  The chrysalis dad saw develop was just about  ready to emerge. She thought maybe it might happen at the funeral.  If not,  at least these developing butterflies could "attend" dad's funeral .  As Cindy said maybe it is wishful thinking to hope it will emerge, my sister Nancy and I said - " It will.  We just know it"   
The little  terrarium sat to  the side of the alter, just under the statue of the Virgin Mary .  I don't think too many people were even aware of it until my sister's closing comments pointed out the butterflies and how special it was to see the connection of dad's physical  transformation like the caterpillars.  We proceeded out of the church, following the casket down to the hearse.  As dad was loaded into the vehicle, Cindy ran outside and exclaimed " Sally, Nancy the butterfly is being born!"   I literally jumped up, and yelled at Tim the funeral director " The butterfly is being born!!  How fantastic" and ran back into the church.   Sure enough, there was the butterfly just hanging out of its old shell slowly unfurling it's wings.  Nancy grabbed the I pod  - I grabbed the laptop with my sister's family in Switzerland  on SKYPE, so they too could witness this miracle.   It was so wonderful to watch the little wings open up with friends  crowded around this little terrarium.  It only took about 6 minutes for the wings to fully open and to really see how beautiful it was.   The butterfly was invited to the funeral diner and  later that afternoon my sisters and I with residents from Jarman went to Wimple Park in Tuscola to release it.
Many of the residents came along for the release

Nancy, Barb, and myself with the butterfly at Wimple Park

There is an abundance of Milk Weed near the entrance to the park, by the small creek.  The butterfly  climbed onto  my sister's fingers lingering  for a few minutes before  resting on a nearby milkweed.  It was a female, fitting since dad had 3 daughters and 2 granddaughters as his offspring.  The butterfly flew off into the wind, strong, agile and knowing exactly what it was and where it needed to be.  
  This experience was so like my dad's  nature.  Positive, forward moving and in tune with nature.     Although dad is buried in Chicago, now I have a local place of remembrance also  filled with nature.   When I go here, I notice all the birds, butterflies and other creatures that make Wimple Park home.  It really helps me remember to be present in this moment with everyone I encounter.

 Maybe to some it was just a co incidence that the butterfly  emerged  at the end of the funeral.  I won't argue with them.    For me, I felt there was a reason for that timing, and it has been one of the most uplifting experiences of my life, helping me through my grief over losing dad.  As a veterinarian I have heard lots of stories from families about how their pets helped them spiritually.  One woman related how the family dog would find personal items of a daughter that had recently passed,  and bring them to a family member having particular difficulty with the daughter's loss.  This little dog was trying to help a person in grief take those difficult first steps of acknowledgement.  Another friend told of how the family cat laid with the dying elderly mother right up to the end, and then would not leave the body when the funeral home staff came.  The cat kept finding a way to get back in the room to lay right on the woman slowing down the transfer process as if on purpose.   Personally, I don't think any of these situations were just co incidence.

There are many more stories like these where animals - be they pets, butterflies or any other creature have appeared when someone  needed a  sign that a spirit is still here.  For many of us, this is a wonderfully strong affirmation of our belief in life after death.  Personally I don't think it is crazy - I think these connections of animals and the spiritual is  real.  The longer I am a veterinarian, the more often I witness that animals are angels among us.
Me and my dad

I hope for anyone in grief that you too have an affirming experience - your butterfly moment.   Be open to the world of nature around you, especially your pets.     I hope it gives you a sense of wonder and awe as it did me and my family.
Thanks, Dr Sally J Foote  
    

Tuesday, April 22, 2014

Storm safety plans - everyone needs one!



Tornado / Storm safety drills for pet  watch here  
Do your pets know where to do when a storm is coming?

I recently presented a thunderstorm phobia - storm safety plan talk  in my community  - Tuscola Illinois.  Our town was lucky  to escape the touchdown of  tornadoes that passed through central Illinois last November.  A few homes in rural Tuscola were badly damaged, and I thought about this as April approached.  I wondered how many pet owners have trained their dogs and cats to quickly come to the basement, bathroom or into their crate when a storm is approaching?  My staff and I began to ask clients on every exam how well their pets would go to a safe place.  The results varied with many clients admitting to not having a plan.  I made it a point at my presentation to include how to train one's pet to go to a safe place no matter how calm the pet was during storms or afraid.  Here is the information for you: 

 storm safety plan for dogs: 
First, set up a comfortable storm safe area.  For the  basement, put a blanket  for them to lay on.  Some dogs like to lay on the concrete or tile and that is fine.  There is some theory that this may be grounding the pet to reduce the electrical charges in the air that they sense.  If your dog like the concrete then don't worry about a blanket.   
Second, hang a leash near the basement entry.  Use the leash for fun things like a walk, or going to the park so your dog will like the leash.  A 6 foot leash,( not a flexi type)  is best.  Using the leash  will help your dog to know where you want them to go, quickly and you will also have a hold of them to prevent escape. 
If you have multiple dogs, have a place you can tie  the leash in the safe room as you can gather up the other dogs.  This will prevent one from getting out  as you get all your pets in.  A grab bar meant for showers can be installed low on the wall to tether them.   
make the tether spot fun - use a food puzzle

Here is the drill:  Do not feed them dinner out of the bowl.  Put the food nuggets in your pocket and call your dog to you.  Give them a few nuggets  for coming.  Walk towards the leash and give them food as you walk to the leash, attach the leash and go to the basement/bathroom door.  Reward as you open the door, every few steps into the bathroom/basement area.  The key is to keep the dog focused on the reward every few steps .  Toss kibble into the tub to get your dog to jump in.   Step into the tub yourself with your dog and lots of reward here.  You may need to be in the tub with your pets during a bad storm so get them used to the huddle.  If you can have a cd player that plays heavy rock music in your safe room to calm your pets.  Avoid radios that will sound alarms which may startle your pet.   Repeat this drill every few days so it is fun and automatic.  Then when the big storm comes you will have a plan that your pet knows and everyone will be  a lot  more calm and safe.  

 Storm safety plan for cats  -   First train them to go to their carriers easily so  you can take the carrier to your safe room.  Even in a hallway, the carrier increases the safety for your cats.  
  Cats don't like their carriers because they  are only used to go to the veterinarian.   The goal is to get your cat to love running into the carrier.
yes, cats can love the carrier

 First,   keep your carrier out at all times.  Make it a part of the family room furniture.  Put a favorite blanket in it.  Do not put your cat's food out for a day.  Take the food nuggets and toss them on the floor around the carrier.  Make it a game by tossing just one nugget at a time around and then into the carrier.  This is a great way to play with your cat.  If the dry food is not enticing enough, then try small bits of tuna or other tasty treat tossed into the crate.
When your cat will run right into the carrier for a treat, close the door without latching it.  Just close the door and then allow the cat to come out after eating.  When the cat is eating the food with the door closed, then go to latching it.  Keep practicing calling your cat - tossing nuggets into the crate and latching the crate door as your cat is calm in the crate.   Now you can put the crate in the bathroom, take it to the basement or leave it in a windowless area.  

Watch  demonstrations of storm training  on my youtube channel drsallyjfoote.  You can get there directly from my clinic home page by clicking the you tube button on the home page.

If your dog or cat is nervous on the storm days,  there are non sedating medications available to calm your pet.  If your pet is too nervous to take a reward, they need anti-anxiety medication or supplement to help them.  Adaptil pheromone collars help many dogs, lasting 30 days without any side effects.  Supplements such as Zylkene, the milk calming supplement or the Anxitane can also help.    The right product for your pet  determined by your veterinarian knowledgeable in behavior, will help your pet be more calm.  There is more storm information at  my  clinic website www.okawvetclinic.com  that may help you.   I also offer consults for storm phobic dogs and cats to get them on the right medication, supplement, and safety plan. 
carrie is all set for storms with her Thunder shirt!
Thanks Dr. Sally J Foote Okaw Veterinary Clinci Tuscola Il 217-253-3221