aaha web conference: aafp feline-friendly … web conference: aafp feline-friendly handling...

AAHA Web Conference: AAFP Feline-Friendly Handling Guidelines

March 5 - 18, 2012

1

AAFP Feline-Friendly Handling Guidelines March 5 – 18, 2012

By

Ilona Rodan, DVM, DABVP (Feline Practice)

Cat Care Clinic, Madison, Wisconsin

Co-Chair, AAFP-ISFM Feline Friendly Handling Guidelines

In collaboration with The American Association of Feline Practitioners and

The International Society of Feline Medicine

AAHA gratefully acknowledges Boehringer Ingelheim Vetmedica,

Nestlé Purina and IDEXX Laboratories for their sponsorship of

this web conference.

Cats Are the Most Popular Pet

• There are 13% more cats than dogs in the US

• 90% of people love their cats

• 78% of people consider their cats to be family members*

* Taylor P, Funk C, Craighill P. Gauging family intimacy: dogs edge cats (dads trail both): Pew

Research Center, 2006.

But Cats Are Still the Underdog

• Dogs visit the vet more than 2x as often as cats*

• Adult and senior cats are perceived as needing less care than kittens*

• Indoor cats are perceived as needing less care*

* Bayer Veterinary Care Usage Study


March 5 - 18, 2012

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Feline Resistance • 58.2% of owners say their cat

hates going to the vet* • Cats go to the vet more often if

it isn’t difficult to get the cat into the carrier*

• 37.6% of cat owners say that thinking about taking their cats to the vet is stressful.* • Owner dissatisfaction starts

before they get to the hospital

*Bayer Veterinary Care Usage Study

Why Aren’t Cats Getting the Care??

Goals of Feline Handling Guidelines

Improve handling to: • Reduce feline fear, aggression,

anxiety, and pain • Protect and strengthen human-

feline-veterinary bond • Provide better lifelong feline

healthcare • Increase client compliance and

education • Prevention and early recognition of

medical & behavior problems

• Increase safety, efficiency, and job satisfaction for veterinary teams

Overview of Webinar Topics

Understanding the cat

Recognizing fear and anxiety

Getting the cat to the vet

A positive practice

environment

How to interact with

the cat


March 5 - 18, 2012

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Understanding the Cat

• We love our cats, but do we really understand them??

• Misconceptions:

– Cat owners: • Cats are easy to take care of

• Indoor cats don’t need veterinary care

– Veterinary teams: • Cats are mean, “evil” at the

vet hospital

• Cats need tight restraint

• Cat people are crazy

Think Like a Cat: Understanding Cats and Why They React as They Do

• Cats have retained many behaviors of their wild ancestors:

- Excellent hunters - led to their relationship with

people

- Solitary hunters - can sense and avoid danger - Need to protect themselves

- Hide pain and illness - Also to protect themselves

Feline Behavior Concepts


March 5 - 18, 2012

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The Flight or Fight Response

If fearful, cats will • Avoid (Flee or fiddle) • Hide (Freeze) • Fight only as a last

resort Allow cats to feel hidden

Cats Are Social Animals

• Their social structure is different from humans and dogs

• When enough food, cats choose to live in social groups, colonies • Female cats live together,

cooperatively nursing and raising the young

• Cats choose with whom to be social; “affiliates” • Affilates allorub – rub each

other

• Affiliates “allogroom”

• Preferred areas are the head and neck

How to Work With a Cat


March 5 - 18, 2012

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Each Cat is an Individual

• Genetics

• Environment

• Sensitive period of socialization – Definition: the age during which

events may have long-term effects on development.

– Occurs much earlier in kittens than in puppies

• 2-7 weeks of age

– Expose to positive experiences and reward/reinforce*

• However, any cat may become fearful if: – Loud voices

– Sudden movements

– Rough handling

Any Cat Prefers the Familiar

• The unfamiliar - Away from home

Carriers Car rides Veterinary visits

- Changes in home New cat or other pet New person in home

• Unfamiliar or loud sounds,

voices

• Unfamiliar smells

• Rapid or jerky movements

• Touched in unfamiliar ways

Recognizing Anxiety and Fear

• Fear is a response that enables avoidance of perceived danger

• Anxiety occurs with anticipation of an adverse event because of a prior negative, fearful or painful experience.


March 5 - 18, 2012

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The Cat’s Point of View Understanding Fear and Stress

They do not eat or move. They appear as if they do not need care but they do.

Frozen In Fear Aggressive “Bad Cat”

They can be vocal, bite, scratch or hiss. They feel like there is no other choice.

The act of getting the cat to the vet and all that happens at the practice are unfamiliar – similar to predators in the wild – causing fear.

Our goal is to make our feline patients feel safe and secure.

Without a sense of security &

wellbeing

With appropriate handling and care

A Content Patient

Cat Posturing

The Calm Cat

• Ears forward

• Pupils not dilated

• Hair flat

• Relaxed body

Fearful Cat - Freeze

• Ears back

• Pupils dilated

• Hair bristled

• Hunkered down

• Tense


March 5 - 18, 2012

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Cats Fight Only as a Last Resort • Because cats are solitary hunters,

they must maintain their physical health and avoid fights whenever possible.*

• The primary goal of cat communication is to prevent altercations, and cats fight only as a last resort, when other communications have failed.

By understanding the cat’s communications and body postures, we can reduce aggression. *Bowen J, Heath S: An overview of feline social behaviour and communication: Behaviour Problems in Small Animals: Practical Advice for the Veterinary Team, ed 1, 2005, Saunders Ltd.

Levels of Fear

Preparing the Client and Cat for the Veterinary Visit – WHY is this important??

• Cat and owner stress associated with the veterinary visit • Reduced feline visits

• Increased feline diseases

• Patient comfort and reduced fear • Fear and fear-associated

problems start at home

• Human safety

• Clients will go elsewhere if the experience is bad

• What happens if we only tell a client to “put the cat in the carrier”


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Client Education: Preparing the Client and Cat for the Veterinary Visit

Teach the principles:

• Cats like the familiar • Make carrier familiar

• Car rides & vet visits familiar

• Home maintenance procedures and handling

• Stay calm! • Cats sense our stress

•Cats learn through positive reinforcement

•Don’t force or push into carrier •Reward the positive •No punishment

Client Education: The Carrier?

Before the first visit: • Ask if they have a carrier

If not, make recommendations: • Carriers that can be taken

apart in the middle • Carriers that load both from

the top and the front • Hard-sided carriers can be

easily seat-belted in

• Ask if they have difficulty getting their cat into the carrier

Client Education – Make the Carrier Familiar

• Start as kittens if possible

• Cats like the security of something around them

• Put the carrier in a room the cat likes to be in

• Add comfortable bedding or clothing of a favorite person

• Toss treats, catnip, or toys into carrier

• Stay calm

• Don’t force the cat to go into the carrier

• Let the cat choose to go into the carrier


March 5 - 18, 2012

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• Use feline synthetic pheromone analog - 30 minutes prior to travel

• Bring familiar items that the cat likes to the veterinary visit – Familiar blanket or clothing of a favorite person

– Favorite treats, toys, catnip

– Comb or other grooming utensil if cat enjoys grooming

• Fun car trips, including to the vet for treats and weight checks

Make it Familiar

What Happens if No Time to Train Cat to Carrier - Calmly place the cat in a small room

where can’t hide - Calmly bring in carrier and place cat

through top opening - Feline synthetic pheromone analog

Don’t chase the cat around the house!!

NPO for Car Trips

• Minimum of 3-6 hours to prevent car sickness

• Fasted sample helps prevent lipemia which can effect lab sample results

• Seat belt the carrier

• To reduce anxiety – Alprazolam

– Don’t use acepromazine

• To prevent car sickness – Cover carrier with towel

– Alprazolam

– +/- maropitant*

*Hickman MA, Cox SR, Mahabir S, et al: Safety,

pharmacokinetics and use of the novel NK-1

receptor antagonist maropitant for the

prevention of emesis and motion & sickness in cats. J Vet Pharmacol Ther 31:220-229, 2008.

S P E C I A L ARTICLE / AAFP/ISFM guidelines on feline-friendly handling

JFMS CLINICAL PRACTICE 367

Carriers provide safety for both client and cat during transport,24 and often give a cat a sense of security by being hidden in a secure,

closed container. Surveys are ongoing to determine the best attributes of carriers. They should, however, be sturdy, secure and

stable for the cat, easy for the client to carry, and quiet so that opening the carrier does not startle the cat. Some cats like to see

out, whereas others are less anxious when covered. The design should permit easy removal of the cat if it will not come out on its

own, or should allow the cat to be easily examined in the bottom of its carrier. A removable top is useful for fearful and fear-

aggressive cats, as well as for sick, painful or limited-mobility cats.

C a t c a r r i e r s

Training the cat to use the carrierThe goal is for the cat to learn to associate the carrier with positive experiences and

routinely enter it voluntarily. Make the carrier a familiar part of furniture at home, with

soft bedding for comfort. If the cat responds favorably to treats, catnip and/or toys, place

these in the open carrier as positive reinforcement to encourage the cat to enter the carrier

at home. Some owners may find it helpful to train the cat to enter the carrier using a word

or clicker as a cue. Individual cats respond differently to treats; use them if that makes

the cat less stressed or anxious.

Getting an unwilling cat into the carrierIf the cat has not been accustomed to the carrier at the time a veterinary visit is imminent,

plan a strategy that will work with the type of carrier and the home environment. Putting the

carrier in a small room with few hiding places may encourage the cat to choose the carrier.

Consider use of a synthetic feline facial pheromone (FFP) analog spray in the carrier at least

30 minutes prior to transport to help calm the cat. Open the carrier and place familiar bed-

ding, a toy and/or treat inside. Encourage the cat to enter the carrier voluntarily. Do not chase

the cat to get it into the carrier. If needed, remove the top of the carrier while encouraging

the cat to go into the bottom tray, then calmly replace the top.

Transporting the carrier in a vehiclePrior to any scheduled veterinary visit, practice lifting the car-

rier and getting it in and out of the car. Try this first without the

cat, to be sure that there isn’t too much jostling or knocking of

the carrier, and then with the cat inside. During travel secure

the carrier by placing it on the floor or by using a seatbelt,

because a moving carrier can frighten the cat. Placing a towel

over the carrier can prevent visual arousal.

The goal is for

the cat to enter

the carrier

voluntarily.

Carriers provide safety for both client and cat during

transport, and often give a cat a sense of security.

A variety of carrier styles exist, such as this one which zips open, allowing the cat to be slowly exposed,as appropriate, while it remains on its own bedding. Courtesy of Dr Anne-Clair e Gagnon

A more conventional carrier, withremovable top and front. Courtesy ofDr Sophia Yin

Carrier secured with a seatbelt. Courtesy of Dr Eliza Sundahl

Relaxed kitty, with a favorite toy! Courtesy of Dr Ilona Rodan


March 5 - 18, 2012

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Resources for Clients

AAFP Client education brochure

www.catvets.com

Catalyst Council videos: • Cat Carriers: Friends, Not

Foes • Encourage Cat Vet Visits, I.

Rodan • Tips for taking your cat to

the veterinarian, I. Rodan • Cat Carrier Training, Dr.

Jacqui Neilson and Bug • Day 2 of Cat Carrier

Training, Dr. Jacqui Neilson and Bug

www.catalystcouncil.org/resources/video/ and CATalyst Council on You Tube

The Environment:

Any Practice That Sees Cats Can be Feline-Friendly!

Whether an exclusively feline hospital, companion, or mixed animal hospital - Show clients that we love cats! Understanding of cats

• Avoidance as protective mechanism

• Cats are not “evil” or“mean”

• FEAR is the most common cause of aggression in the veterinary hospital

• PAIN is also a cause of aggression

Any Practice That Sees Cats Can be “Feline-Friendly”

• Have a separate cat waiting room

• Keep carriers off floor (away

from dogs)/cover carriers

• Separate times for cat appointments

• Surgery and dental days for cats only

• Doctors and technicians who work best with cats to see cat appointments

http://www.catvets,com

http://www.catalystcouncil.org/resources/video/

http://www.catalystcouncil.org/resources/video/


March 5 - 18, 2012

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The Exam Room

• If possible, have designated cat rooms

• Try to keep the cat in the exam room for everything

• Have all needed supplies in room

• Keep on fabric or soft surfaces

– Preferably from home

– Fleece

– Stainless steel is slippery and cold

– Formica is better

• Sample collection – Easier on the patient

– Enhances value

– Moving a cat to a new environment alerts the cat and increases the BP

• Start with blood pressure if appropriate – Preferable to get BP

measurements in the exam room instead of taking the patient to the treatment area*

* References:

1. Belew A, Barlett, T, Brown SA, 1999

2. Love L, Harvey R, 2006.

3. ACVIM Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats (2007)

www.acvim.org/websites/acvim/index.php?p=22

Perform Procedures in Exam Room Whenever Possible

Manage Odors

Cats have an

excellent sense

of smell

Their sense of smell drives many of their behaviors

• Communicate with other cats

• Mark to deposit scent – Comfort self

– Make safe

• Pick up scents that people usually don’t notice – Other cats

– Dogs, etc.

– Alcohol

– Cleaning supplies

– Perfumes

http://www.acvim.org/websites/acvim/index.php?p=22


March 5 - 18, 2012

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Feline Synthetic Pheromone Analog*

• Calming effect in stressful environments

• Reduce anxiety, fear, and aggression

• Does not reduce struggling

• Increase normal grooming &

food intake if hospitalized

Uses:

Add diffusers to each room where cats may be

Use spray:

- On Towels

- In cages

- In carriers

- On uniforms

- +/- on hands

*Kronen PW, Ludders JW, Erb HN, MoonPF, Gleed RD, Koski S, A

synthetic fraction of feline facial pheromones calms but does not reduce struggling in cats before venous catheterization. Vet Anaesth Analg. July 2006;33(4):258-65.)

*Pageat P, Gaultier E: Current research in canine and feline pheromones, Vet Clin North Am Small Anim Pract, 33:187, 2003

Minimize Visual and Auditory Cues

• Cats are aroused by rapid movement

• Fearful seeing the unfamiliar

• Move slowly and

calmly • Don’t let them see

other animals • Cover carrier • Take a different

route

• Keep away from clinic cats

• Sense of hearing is more acute than ours

• Speak in soft voices

• Quiet environment – Away from phones

– Away from loud equipment

– Use of soothing background music may be helpful

Provide Positive Experiences


March 5 - 18, 2012

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The Challenges of Cat Cages and Wards

• Fear if see other patients

• Cat wards

• Side-to-side cages

• Lack of familiarity and reduced sense of control leads to FEAR

• Need hiding places to cope better

• Want vantage points to monitor the environment

• Space to keep litter away from food, water, and bedding

• Stress of hospitalization inhibits normal behaviors*

• Eating, elimination, sleeping * Griffin B, Hume KR: Recognition and management of stress in

housed cats. In August J (ed): Consultations in feline internal medicine, ed 5, St. Louis, 2006, Saunders Elsevier, p 717.

• What the fearful caged cat looks like

Familiarity and Consistency for Caged Animals

• Use cat’s carrier, bedding, or “house” in cage

• Regular diet if possible

• The cat’s toys

• Consistent schedule, kennel people, and food*

*Ellis S, Environmental Enrichment: Practical Strategies for improving

feline welfare, J of Fel Med & Surg (2009)11, 901-912.

Provide Places to Hide so Cat Can Choose if Wants to Hide

• What happens if there is not the option to hide

• Provide places that are more desirable for the cat to hide


March 5 - 18, 2012

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Optimal Caging Options with Places to Hide and Places to Perch

Stainless Steel or Formica?

Getting a Cat out of a Cage

• Don’t pull the cat out of the cage

• Don’t loom over the cat • Give the cat a sense of

control - Let the cat come to you - Let the cat go into a carrier - Take the cat out along with

the cat bed, cat carrier, etc. that is in the cage


March 5 - 18, 2012

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Handling the Cat What Can We do to Make it Less Stressful for the Cat?

• Avoid direct eye contact

• Move slowly; avoid hand gestures

• Be on the same level as he cat

• Never loom over – come from the side

• Speak calmly and quietly

• Stay calm – our emotions can effect the cat

The Exam Room

Whenever possible, get the cat and client into the exam room ASAP

Examine the cat where the cat wants to be examined

• Allows the cat to have a sense of control over their environment, making it less stressful

Interacting with the Cat

• First encounter makes it or breaks it

• Move slowly • Safer • More efficient and

successful

• Least commotion • All needed items in exam

room

• Allow the cat to remain in the carrier while obtaining history

• Individualize handling • Distract kittens with toys • Distract adults and

seniors with treats or catnip


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Other Handling Tips

• Cats prefer to face away from us; let the cat face the client

• Cats feel more secure when leaning against an arm or body while in our laps or as we hold them

• Slow is fast and fast is slow

• Prepare all needed equipment in advance

• The fewer people, the better

• The least restraint is the best

Which is the Best Way to Hold Onto the Legs? Why?

If the Cat Won’t Come out of the Carrier on its Own

S P E C I A L ARTICLE / AAFP/ISFM guidelines on feline-friendly handling

JFMS CLINICAL PRACTICE 367

Carriers provide safety for both client and cat during transport,24 and often give a cat a sense of security by being hidden in a secure,

closed container. Surveys are ongoing to determine the best attributes of carriers. They should, however, be sturdy, secure and

stable for the cat, easy for the client to carry, and quiet so that opening the carrier does not startle the cat. Some cats like to see

out, whereas others are less anxious when covered. The design should permit easy removal of the cat if it will not come out on its

own, or should allow the cat to be easily examined in the bottom of its carrier. A removable top is useful for fearful and fear-

aggressive cats, as well as for sick, painful or limited-mobility cats.

C a t c a r r i e r s

Training the cat to use the carrierThe goal is for the cat to learn to associate the carrier with positive experiences and

routinely enter it voluntarily. Make the carrier a familiar part of furniture at home, with

soft bedding for comfort. If the cat responds favorably to treats, catnip and/or toys, place

these in the open carrier as positive reinforcement to encourage the cat to enter the carrier

at home. Some owners may find it helpful to train the cat to enter the carrier using a word

or clicker as a cue. Individual cats respond differently to treats; use them if that makes

the cat less stressed or anxious.

Getting an unwilling cat into the carrierIf the cat has not been accustomed to the carrier at the time a veterinary visit is imminent,

plan a strategy that will work with the type of carrier and the home environment. Putting the

carrier in a small room with few hiding places may encourage the cat to choose the carrier.

Consider use of a synthetic feline facial pheromone (FFP) analog spray in the carrier at least

30 minutes prior to transport to help calm the cat. Open the carrier and place familiar bed-

ding, a toy and/or treat inside. Encourage the cat to enter the carrier voluntarily. Do not chase

the cat to get it into the carrier. If needed, remove the top of the carrier while encouraging

the cat to go into the bottom tray, then calmly replace the top.

Transporting the carrier in a vehiclePrior to any scheduled veterinary visit, practice lifting the car-

rier and getting it in and out of the car. Try this first without the

cat, to be sure that there isn’t too much jostling or knocking of

the carrier, and then with the cat inside. During travel secure

the carrier by placing it on the floor or by using a seatbelt,

because a moving carrier can frighten the cat. Placing a towel

over the carrier can prevent visual arousal.

The goal is for

the cat to enter

the carrier

voluntarily.

Carriers provide safety for both client and cat during

transport, and often give a cat a sense of security.

A variety of carrier styles exist, such as this one which zips open, allowing the cat to be slowly exposed,as appropriate, while it remains on its own bedding. Courtesy of Dr Anne-Clair e Gagnon

A more conventional carrier, withremovable top and front. Courtesy ofDr Sophia Yin

Carrier secured with a seatbelt. Courtesy of Dr Eliza Sundahl

Relaxed kitty, with a favorite toy! Courtesy of Dr Ilona Rodan


March 5 - 18, 2012

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Massage or Stroke Around Head or Neck

• The head and neck are preferred areas for physical touch.

Examining Senior and Painful Patients

• Senior patients often have arthritis – One study indicates that 90%

of cats 12 and older have arthritic changes on x-rays

– Stiffness upon awakening, slowing down, not jumping to regular places, +/-limping

• Remember - cats are masters at hiding illness.

• Provide “fluffies” • Don’t stretch out if uncomfortable • Analgesia

Prevent Pain – Remember What Cats Need

• Places to hide

• Comfortable bedding

• Quiet, odor-free

• Familiar scent

– Clothing of favorite person

– Synthetic feline pheromone analog

• Gentle handling

• Analgesia – if recognize or suspect pain


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What About the Most Difficult Patients?

• Try to break the pattern:

• Think anti-anxiety – Alprazolam

• Think analgesia – Buprenorphine

– How many of our patients hurt and we don’t know it?

– What causes pain in the cat?

• Muzzle to decrease visual stimuli and prevent biting

• Towel techniques

• Sedation or anesthesia if needed

Towel Techniques

For the Challenging Fearfully Aggressive Cat

• Slide a towel between the top and bottom halves of the carrier

• Remain calm • Sedate if needed • Analgesia if needed • Educate the client about

what - and why - we are doing – We are modeling learning

behavior for clients


March 5 - 18, 2012

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What About Scruffing or “Clipping”

• Scruffing doesn’t allow a sense of control

• Often increases fear and fear aggression

• Cats are usually calmer and easier to handle if they are not scruffed

• Often safer not to scruff

• Never pick up the cat by the scruff

• Clipnosis also doesn’t allow a sense of control

• May increase fear

So What do You do With THE Most Difficult Patients??

• Remember why they are difficult – Fear

– Pain

– Never punish, either physically or verbally

• Chemical restraint or anesthesia – Increases safety

– Reduces stress of cat, client, and us

– Use before cat “loses it” • Use if cat is fearful, anxious or aggressive

• Painful situation where analgesia is not sufficient

• When other handling isn’t sufficient

Chemical Restraint

• SQ or IM – less stressful for patient

• Use reversible agents when possible

• Low-dose dexmedetomidine (is reversible) + an opioid to sedate

• +/- benzodiazepine (midazolam) – Increase sedation

– Muscle relaxation

• +/- ketamine – Further sedation


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Preventing Problems Returning Home

• Bring both cats to the clinic at the same time

• Have familiar smell – Bedding – Feline synthetic pheromone

analog

• Monitor reactions of at home before letting the cat out of the carrier

• If needed, separate for 24+ hours – If still problems, call

• Remain calm!

Develop a Plan of Action

• Adopt handling techniques that are based on understanding feline behavior to: - Reduce feline and

client stress - Increase veterinary

care for cats to improve their health and welfare

Develop a standard operating procedure (SOP) for handing with relatively small and simple steps at each stage of the veterinary visit www.catvets.com

http://www.catvets.com


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Questions to the Speaker

Please email your questions to [email protected] by

Sunday, March 25, 2012.

Dr. Rodan will provide written responses to all of the questions

and they will be posted on AAHA’s website by Friday, April 6,

2012.

1. To complete the evaluation, please go to the following website:

http://www.keysurvey.com/survey/414460/1c40/

2. After completing the evaluation, you will automatically be linked to the

Continuing Education Certificate. The CE certificate can only be accessed

after the evaluation is completed.

3. Download the CE Certificate (in PDF format) to your computer and print

enough copies for those persons viewing the web conference with you.

Instructions for CE Certificate

Thank you for your participation!

AAHA gratefully acknowledges Boehringer Ingelheim Vetmedica, Nestlé Purina and

IDEXX Laboratories for their sponsorship of this web conference.

In collaboration with The American Association of Feline Practitioners and

The International Society of Feline Medicine

http://www.keysurvey.com/survey/414460/1c40/

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