@John Peaveler answered your humane handling questions that we ran out of time for in the aftershow. Thanks, John! You can now watch this episode of Shelter Med LIVE on demand and download John and Dr. Gaston's resources as well. After a July break, Shelter Med LIVE will return August 19 with Dr. Maria Pyrdek (Pasadena Humane) and Dr. Ashley Patterson (California Veterinary Emergency Team). We'll talk triaging trauma in shelter and field settings. How do you decide what to treat and what to transfer? Join us to discuss!
Q: We are a shelter who also does HQHVSN. While I understand that when shelter animals are examined, if they aren't "feeling it" that day, we can give them a break and try it again fresh another day and/or with another staff member. We don't have that option during public SN surgeries - you can't tell a pet parent that their pet wasn't into it that day and come back another day. I'd like your thoughts on that.
A: Giving a break can vary depending on the situation, and in this circumstance we can't always 'retry.' It may look like releasing pressure from the leash-we have been taught to hold it tight and close, and we may not realize we are always doing it. It may look like taking the dog to a different area where there is less traffic and more space, allowing a sniff or shake off. Reducing tension/stress can help relieve wind-up feelings that are more likely to result in a bite and panic/distress for the dog. I personally work at HQHVSN clinics and understand the challenges they pose-this may be the only time that particular animal is able to see a veterinarian and receive access to care. If the animal is in distress and our approach isn't working whether to complete an exam or inject a premedication, I stop. I stop and assess: what is reasonable here? I have had owners wait, if able, so I can get a waiver signed, which means a limited exam that is completed under anesthesia. I ensure staff are proactive in early recognition of these dogs when they enter the lobby. I have discussed whether the client has resources to return with anxiolytics on board, knowing that may not be feasible.
For those cases where placing a muzzle and close contact results in more struggle for everyone, I will look to my environment and use protective contact. For example, I have had a staff member walk the dog along the side of a gate so I can inject quickly (generally speaking for a medium-large breed dog with a bite risk, I will use a 5ml syringe, 18g needle, do not draw back for ease and speed. Injection poles are also a great tool). I may use a two-leash system, where the dog is walked and I inject with the handlers redirecting pressure away from me or them (this takes training). I do, always, observe body language. Does the dog show sociability when pressure is removed? Do they respond to 'regular' touch positively (in this example, would a towel or alternate approach to handling work-a collar straight arm 'grab' for example may be tolerated over a body/neck restrain. Either way, staff safety is a top priority, and my goal is to provide premedication safely and as quickly as possible. How that looks depends on the individual. For high-risk dogs where there is a concern for significant escalation, I have changed my premedication to a one-anesthetic injection. This is out of the scope of the question, but it is important that I review my analgesia plan should I need to switch to a one-injection approach.
I will add that adjusting handling to the animal has not resulted in delaying surgery or extending the day; it has actually been the opposite. This is what humane handling looks like to me; we listen, stop and reassess if our approach is prolonging and increasing distress.
Q: Do you recommend using the Chill protocol (trazodone & gabapentin)?
A: The quick answer is yes; however, what that looks like will depend on your individual set-up and resources. A few considerations I would throw out there: Trazodone and Gabapentin have been proven to reduce FAS in situational cases (see the latest Fear Free study specifically on this combination). However, we have more drugs at our disposal that are generally safe and can target neurotransmitters that are responsible for fear, arousal, fight/flight.
Dosage is also important-can you trial beforehand? If not, I typically will not withhold anxiolytics, as I have only found them to help both the animal and staff during a veterinary visit. The 1–2-hour window in my hands and shared recently by boarded veterinary behaviorists isn't going to get you optimal effect. I would advise administering anxiolytics 3-4 hours before the event. If you expect pain to be part of that individual's clinical picture, I don't hesitate to include this in either my pre-visit protocol or during the visit.
Q: How do you recommend teaching new handling techniques and tools to staff who have been doing it the "old" way and are very set in their ways and don't want to change?
A: I firstly want to acknowledge that if you are an individual advocating for change in our industry, thank you-and with that being said, it can feel frustrating and even too big of a hill to climb at times. Hang in there!
What I have personally had success with is to approach change with showing people what we CAN do and not what NOT to do. Saying 'no' or dismissing current handling skills can cause a defensive response and significant pushback. These skills keep that person feeling safe and that's important.
Instead, I will point out behavior objectively. I will ask 'Do we think this animal is in distress, suffering, painful, fearful (add whatever word best describes the animal's response in an empathic way)?' And then offer solutions. Over time, people become curious, especially if they have seen success. Success depends on motive for sure, but I will assign positive intent that we are all in this to help and care for our patients. I will also reiterate that the safety and comfort of each staff member is important and encourage them to voice what doesn't feel right.
In my last shelter, I would often share podcast episodes, short articles, and write up a brief paragraph, evoking critical thought over our approach and understanding of animal behavior. I then found staff would bring thoughts and questions up at huddles. Making behavior a normal part of our consideration for the day will slowly impact change, at least in my experience. This does take patience and does not occur overnight.
I also like to ask staff how they think this animal will turn up for their next veterinary visit if we do not listen to them communicating. What does this mean for that animal? A bite could end in surrender and even euthanasia, not to mention the trauma this can inflict on families. What we do in the clinic shapes learning experiences and can transfer into their everyday life. For anyone who dismisses welfare, which has been extremely rare, I will discuss this privately with them, especially if I am in a leadership role.
------------------------------
Elise Winn
UC Davis Koret Shelter Medicine Program -
www.sheltermedicine.com------------------------------