Cosette

Cosette

Sunday, July 14, 2013

The Art of Animal Handling

If you overheard that a given person "needed to be physically restrained", what would you figure about that person?  Probably that he/she was assaulting someone, behaving in a psychotic manner or verging on self-harm.

When it comes to handling animals for exams and procedures, physical "restraint" is an everyday term and practice in veterinary medicine.  The problem, though, is that most animals who come in to vet hospitals are unlikely to act psychotic or assault anyone.  The majority are either unfazed, skeptical or reversibly frightened.  In other words, these animals (especially cats) would benefit from more reassurance and less domineering "restraint."

I have always preferred to do my own patient handling, and from my first month out of school, I was surprised by how often I heard, "I can't believe how good he's being with you", "I've never seen her so calm at the vet's", or "You really have a knack for making him comfortable."  On other occasions, clients expecting something different than what I was doing would insist their animal was going to hurt me... and then act stunned when it didn't happen.

Was I really doing something unusual?  After some observation, I realized I was.  I was not adhering to the conventional methods of animal restraint, because they contradicted what I innately knew about empathy, dogs and cats.  While most of the restraint practices we engage in are for "safety first" purposes, I found the typical spin on restraint actually made many animals defensive, even if they weren't initially.  If it's not broke, why fix it? If it's not broke, why break it?

When I started my house call practice, I was a-ok with not having an assistant for most things.  However, I knew there was one thing I could not do alone: feline blood draws.  Believe it or not, my inclination was to find an assistant who had no veterinary experience whatsoever and therefore no preconceived notions about how a cat or dog "should" be held.  That person turned out to be my other half, and I can't tell you how pleased I've been with the outcome.  In the last two years, we've handled the most difficult cats out there (in-home ferals, semi-ferals, cranky geriatrics and the ones who never even make it into carriers).  So far, there has only been one cat from whom we did not successfully draw blood (and it was because he seemed to completely defy physics; we still refer to him as "that elusive snake-cat").

I've always hesitated to write on the topic of animal handling, because I feel much of the finesse of reading animals through their eyes, voice and body language stems from innate empathy; it's difficult to teach.  But, here is my attempt to describe in detail "what I do", albeit most of it reflexively and subconsciously.  I hope this is helpful to clients, veterinary technicians and other vets.  If you don't already do these things...give them a go!
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1.) Cat Exams: First and most importantly, I do not engage in abrupt movements with any cat.  No yanks on the scruff, no sudden grabbing, no pulling on a tail when inserting a thermometer, no heavy placement or banging of my implements onto the table, no slamming doors, no dragging the cat out of its carrier.  I give the cat a chance to come out of the carrier on its own, while I talk to its person.  If it doesn't come out, I tilt the carrier (as much as perpendicular to the table if necessary) until it does.  I never shake the carrier--and most cats will not adhere to the walls like Spiderman unless you shake the carrier.  If it's a top-opening carrier or bag, I make my first physical contact with the cat (usually a few soft pets on the head or upwards strokes on the bridge of the nose) while it's still in the carrier. Then I gently lift the cat out.

Once the cat is on the table, I spend a minute petting its head and saying hello.  You wouldn't want a doctor coming into an exam room and just shoving his stethoscope up your shirt; you would expect a cordial exchange and a greeting first, wouldn't you?  Once that's settled, I then perform my whole exam with the cat facing away from me.  Many cats are flattened on the table in an "I have no idea where I am right now" stupor and are quite malleable for this.  Some of them are more "dog-like" and walk around the table exploring.  I don't try to pin the latter cats too long in one place.  I might examine their head, let them walk around while I talk to their person, then listen to their heart and lungs, then let them walk a few paces this way or that way...for the most part I move with them, and whenever I need them to hold relatively still, I periodically give them something they want--pets or a little slack perhaps--and they are generally cooperative. I have never scruffed a cat for an exam.  Contrary to popular belief, a mother cat firmly carrying a kitten by the scruff is not the same as an adult cat having its scruff pulled on by a human. It's just not.

2.) Cat blood draws: I always try to trim nails beforehand, provided the client wants it done.  I then give each cat the chance to "choose" between the neck (jugular) blood draw position or rear leg (medial saphneous) blood draw position.  A common pet parent misconception: unlike humans, cats and dogs rarely care about the needle or its insertion--what cats primarily dislike is someone forcibly holding them down.  So, I merely position them first and see which scenario they are more comfortable with.  I find that if held correctly, most cats actually prefer the leg over the jugular. Once gently placed onto their side, the scruff must be held gently but firmly and the head tilted back. The scruff should NOT be yanked or pulled.  The hand holding the cat's head should be as immobile as their head, and if you're doing it with empathy rather than undue dominance, it will be.  Your forearm should be as flush as possible along the length of the cat's back.

Now, all of the aforementioned advice for holding the cat during a blood draw is sound IF AND ONLY IF the second requirement is met: the person drawing blood (FOR THE LOVE OF CATS!) must not PULL on the leg.  There is a HUGE difference to a cat between gently, slowly extending its leg and pulling on its leg.  Yanking on a cat's leg is the single most common reason why things go south up in the head area, because the cat is struggling backward to get you to somehow stop pulling on its leg.  They DESPISE it--it's the fastest way on the Earth to agitate a cat other than forcibly pulling on its scruff or jabbing it in the abdomen.

During a blood draw, I have never rapped on a cat's forehead, bopped its head repeatedly against the table to "distract" it, or even tapped it between the eyes.  Why?  Because it's not necessary if you're doing everything else right--and I wouldn't want anyone doing it to me.  I have repeatedly pet cats gently on the bridge of the nose, however; this is calming and distracting, as opposed to annoying and distracting.  I also talk calmly and encouragingly to all animals while I'm doing procedures; it makes for a more "normal" experience, since most animals are accustomed to being talked to while being touched.

3.) Truly fractious cats: I find that most defensively aggressive cats behave that way because they have an illness that makes them irritable (pain, hyperthyroidism, etc) or because they've been goaded/overstimulated at some time (perhaps the present!) by someone (a child or rough-handed adult, for example) who probably does not realize that their handling is too rough and well...unacceptably violating in the mind of a cat.  Cats like things done on their terms...and believe me, it's much more constructive to work with them than against them.

All that said, I consider a truly fractious cat to be one who responds to any handling, no matter how gentle and respectful, with aggression.  Often these cats are striking and spitting before you've even approached.  The most empathetic thing you can do for these animals is a quick rear limb IM injection of sedative with a towel placed (not thrown) over the rest of their body--because no amount of cat whispering is going to win back that animal's trust in a day, let alone in an hour or 20 minutes. Attempting to physically restrain, or worse--dominate--this type of cat will only worsen its fear-based aggression and its temper.  I have never in my life tried to emotionally dominate a cat, and good luck to you if you choose to do so. Even if you feel like you've "won", every person who handles the cat after that is going to lose.  Leave your ego on the sports field, champ.

4.) Dog exams: Have you ever noticed that the higher-pitched and more excited one's voice is, the faster many dog tails seem to wag?  The secret to dog exams is definitely talking--happily--to the dog.  Staring a dog in the eyes, looming over it, standing statuesque and especially not talking to it, are the most surefire ways to creep out a dog.  If someone you didn't know stared at you without saying anything, you'd be creeped out too.  This is the simple explanation for why dogs can "sense fear"; they normally enjoy (non-threatening) activity and reassuring voices, but resent an absence of those things.  So they get suspicious when everyone's looking at them but not engaging them in any positive way.  Even if a client thinks I'm completely nuts, I cannot and will not suppress my doggie voices for anyone or anything.  Anybody who knows me personally is probably laughing or nodding knowingly right now.

I prefer to examine dogs on the floor if they are over about 40 pounds, but even before I've come down to meet them, I've acknowledged them and put them more at ease with my voice.  As with cats, I obviously don't make sudden lunging motions towards a dog or its person.  Many dogs will come to you readily, but if they are timid, approach them respectfully and while talking.  Though most dogs are open and need less personal space than we do, don't put your face directly in front of a dog's face, unless you know the dog very well...it's not your prerogative to immediately assume the dog has limited need for personal space.

Most dogs are receptive of exams, as long as talking and/or petting occur periodically throughout.  Also, talking to their person usually makes them less uncomfortable. It's a more normal experience for them to hear human conversational exchanges, and in their mind, it dissipates a lot of the "something unusual is happening" sentiments. 

When I take a dog's temperature on the floor, I crouch so the length of my left leg above my knee is entirely under the dog's abdomen, right in front of its knees... so it's not moving backward or forward.  For dogs on the table, you can use your non-dominant forearm in the same manner. While holding the base of the tail (not yanking it!), I then ever so gently and slowly insert the graciously-lubed thermometer (stop laughing).  Seriously though, I wish I had a dollar for every time I saw someone ram a thermometer into a dog's rear and then act surprised when the dog resented it.

5.) Dog nail trims (because, let's face it, they hate this more than any other procedure): Unless you want them to become increasingly unruly beasts, large dogs with thick, black or overgrown claws should either have twenty-plus minutes on the schedule allotted for their nail trim, or they should be sedated.  If they're awake, I prefer getting dogs like this to lie on their side and having someone give firm, distracting tummy rubs while I focus on one nail at a time.  Treats are good too.  Regardless of whether or not you can see the quick or a change in contour of the nail, you can always give a little "test" squeeze with the clipper; if the dog doesn't react and the nail feels hard and more brittle under the metal of the trimmer, it's unlikely you're on the quick.  No matter how large dogs are held for nail trims (often it's multiple ways before you're victorious), the main technique is pure patience.  Manhandling or tethering a dog to quickly bang out a nail trim still rarely results in it getting done quickly. But it does more often result in "quicking" and typically makes the dog's aversion to nail trims worse.

6.) Potentially aggressive dogs: If a person tells me their dog has bitten or has tried to bite a person, (not usually including puppy teething/mouthing), I always put a soft muzzle on the dog--the reason not only being safety, but also that I'm not going to be appropriately focused on reassuring the dog if I'm necessarily guarding myself against a warning snap or a bite.  I will also muzzle dogs if they're displaying warning signs, like low growling or the "whale-eye". 

Since most dogs behaving aggressively in a vet hospital are coming from that place of fear-driven defensiveness, the last thing I want to do is add to the fear. So once any dog like this is properly muzzled (usually it's less threatening to have the dog's person put on its muzzle), its important to examine the dog more slowly, more gently and with even more voice reassurance than you would with the average dog.  Otherwise, they'll forever associate the appearance of that muzzle with "bad things", their view will get worse instead of slightly better, and it will be increasingly difficult to put a muzzle on next time around.

When a muzzled dog is being examined, this is not a time I find it constructive to be punitive or use harsh, scolding tones of voice, especially if the dog is giving a low, fear-based growl.  Some of these dogs are so poorly socialized that they will actually growl more with sweet talk--in that case, just remain as quiet as possible. Most defensive dogs are much better in the company of their person or family, so in hospitals I was never a proponent of taking fearful dogs "to the back", unless their person was the mentor for their neurosis (insert knowing vet professional chuckle here), or if they were trained/otherwise inclined to "protect" their person in the presence of strangers.  The latter, in my opinion, is actually rare and an overstated reason for taking dogs away.

I do not believe tying dogs' heads to exam tables is ever a good idea, except in the last-resort case where an aggressive dog brought in on a leash cannot be muzzled by anyone and absolutely requires an IM sedative for some necessary procedure.  We already know that dogs tend to become more reactive when tethered, chained or even when people choke up on their leash while walking.  I've seen dogs become phobic of things they normally don't tend to mind (vaccines, for one) if they have a history of being tethered during the procedure.  It's similar to how humans find tickling to be much more, at least psychologically, when being forcibly held down and tickled. Seriously.
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I think most of this advice is straightforward, but sometimes veterinary businesses can be so concerned with moving at a fast pace that the patient's experience is not properly prioritized. Sometimes this is for economic efficiency or so as not to disappoint clients.  However, just like the lowest quality food is dished out in "fast food" restaurants, unfortunately the lowest-quality medicine and patient care is often found in vet hospitals where there is an overemphasis on a rushed pace.  That said, I did almost everything the same in hospitals as I do now, so it's definitely doable to be efficient while keeping the patient's stress at the lowest possible level.

I don't know if the word creates the action or if the action called for the word, but much of the forcible "restraint" used on animals is not conducive to their health, comfort or our safety.  I do think something about that word "restraint" tends to puts us in a weird psychological position, where we imagine ourselves to be in a defensive scenario, whether or not we need to be.  After all , many of the animal behaviors we complain about in vet hospitals were unnecessarily set in motion at previous veterinary visits.  Just like most dis-eases, these behaviors are easier to prevent than to deal with once they've developed.

This is why I think veterinary "restraint" would be better replaced with compassionate "handling" anywhere it has not been already. Compassionate handling is indeed an art.  But I can't imagine doing my job without it. It is a very, very worthwhile art.

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