Atlantic Provinces Veterinary Conference Halifax Marriott Harbourfront Hotel, Halifax, Nova Scotia Saturday, April 22, 2017 Lynne Seibert DVM, MS, PhD, Dipl ACVB Veterinary Behavior Consultants, LLC, Roswell, Georgia USA Email: email@example.com, Ph, 1-678-878-4410 Behaviour-Friendly Practice Strategies Lynne Seibert DVM, DACVB Replace non-scientific interpretations of animal behaviors with scientific knowledge Make assessment of behavioral health as much of a priority as assessment of physical health Risk factors for relinquishment of cats to shelters (Patronek et al., 1996) Unrealistic expectations Allowing cat outdoors Owning a sexually intact cat Inappropriate elimination Reducing Pet Relinquishment Predominate age group being euthanized: Adolescent and older animals that have been in homes but are no longer wanted Addressing pet fertility alone will not solve the problem Scarlett JM et al., JAVMA 220(3), 2002 Shelter Relinquishment Behavior problems cited as reason for relinquishment (Salman MD et al., J Appl Anim Welfare Sci 2000, 3:93-106) 40% of dogs Veterinary intervention: Most pets have been taken to the veterinarian at least once in the year preceding relinquishment: 70% of dogs Only 25% of dog owners report routine veterinary behavioral advice Incidence of behavior problems Feline house-soiling In about 10% of households with cats there is a house-soiling problem Aggression New et al., J Appl Anim Welfare Sci, 2000, 3:179-201 National survey of >3000 pet-owning households 16% of households have aggressive dogs 13% of cat-owning households Veterinary visits for cats Almost twice as many cats than dogs never visit veterinarian 86 million cats; 78 million dogs 41% of cat owners visit vet only for vaccinations 39% of cat owners only take their cat to veterinarian if cat is sick 60% of cat owners report that their cat hates going to vet 2011 Bayer Healthcare, L.L.C., Brakke Consulting, Care Usage Study, American Pet Products Association 2011-12 Pet Owners Survey Cat friendly practice program American Association of Feline Practitioners www.catfriendlypractice.catvets.com CATALYST Council www.catalystcouncil.org/about Vision: raise level of care and welfare of cats by cat owners – one that any owner will embrace through human-animal bond and can achieve – supported by highest quality veterinary care, preventative medicine, and cat specific products www.catalystcouncil.org Partners for Healthy Pets www.partnersforhealthypets.org/practice_feline.aspx Many of your “active” clients are, in fact, NOT active! Data from practice management systems of over 5,000 companion animal practices revealed that over 50% of pets considered “active” had not been in for visit of any kind in over 18 months Behavior Issues in General Practice Avoidance of cat carrier Stress during veterinary visits Difficulty handling Difficulty administering medication Reactivity in waiting area Anxiety during boarding Clients will limit non-emergency veterinary visits Provide Educational Resources Realistic expectations Pet selection counseling Behavioral needs of pets Prevention and socialization Humane and effective solutions to common problems Identification of problem behaviors BEHAVIOR TEXTS Puppy's First Steps: The Whole-Dog Approach to Raising a Happy, Healthy, WellBehaved Puppy by Faculty of the Cummings School of Veterinary Medicine at Tufts University, Lawrence Lindner, and Nicholas Dodman 2007 Behavior Cost Center Preventive counseling Puppy classes Training sessions Behavior consultations Recheck appointments Behavioral medications Diagnostic testing Product sales Total Team Approach How will you involve the entire team? Technicians, assistants, Receptionists, Kennel staff, Office managers, Veterinarians How will you handle staff training? Receptionists Recognize owner comments and complaints Schedule appointments with behavior needs in mind Identify anxious pets as they enter hospital Manage owner and pet traffic to minimize stress Kennel staff Interpret species-specific signals Reduce stress and arousal Use humane handling techniques Note problem behaviors that occur within the hospital Assistants Obtain behavioral histories Offer basic behavior advice Answer general behavior questions Model good handling and interactions Technicians Offer basic behavior counseling Complete diagnostic tests requested by doctor Communicate doctor’s discharge instructions to client New pet checklists Behavior history Complete behavioral history essential for early recognition of medical problems Often the first sign of medical condition will be change in pet’s behavior Behavior checklist Since your last appointment… have your pet’s elimination habits changed? has your pet had an increase in anxiety or fear? has your pet’s personality changed? has your pet destroyed anything? has your pet begun to vocalize excessively? are you concerned about any other behaviors? Treatment considerations Medical interventions Pain management Environmental management Avoidance Behavior Modification Pharmacotherapy How to refer Provide timely referrals Be clear to client that referral is necessary Ensure that behavior consultant is qualified Client’s experience with referral resource reflects on referring DVM What about obedience classes? Completion of an obedience class does not protect against behavior problems Adverse effects of inappropriate training, especially if physical force is used, can result in significant morbidity and mortality Hospital Design Separate entrances for dogs Cubicle layout in reception area Sound-absorbing materials Towels draped over cages of frightened animals Surfaces with traction Reactive animals taken immediately to exam room Species Segregation 120 shelter cats in 4 different shelters Cat stress score Urine cortisol-creatinine measurements Extent of exposure to dogs biggest factor affecting cat stress level Enclosures - Enriched Soundproofing Natural light Elevated kennels Perches Hiding areas Resources Blackwell's Five Minute Veterinary Consult: Clinical Companion: Canine and Feline Behavior with CD; Debra F. Horwitz and Jacqueline C. Neilson 2007 Handbook of Behavior Problems of the Dog and Cat Gary Landsberg, Wayne Hunthausen, and Lowell Ackerman 2007 HUMANE HANDLING DURING VETERINARY VISITS Lynne Seibert DVM, DACVB GENERAL SAFETY PRINCIPLES In the veterinary hospital, animal bites and injuries associated with animal handling are the two leading sources of workers’ compensation losses. According to the AVMA PLIT, in a recent analysis of 605 veterinary workers’ compensation losses, 50 percent were due to animal bites. Cat bites are the most frequent and costly bite injuries. The average cat bite cost $757, while the average dog bite cost $495. Educating staff about animal behavior, and how to approach, handle, and safely restrain patients, will result in less expense, fewer injuries, safer procedures, and happier clients. It is critical that each hospital have an established training protocol for new employees regarding animal handling protocols. Waiting areas should have signs posted requiring owners to keep pets on leashes or in carriers. Separate waiting areas may be designated for dogs and cats and smaller exotic species. Difficult patients should be taken to an examination room as quickly as possible, since prolonged delays in the waiting area can exacerbate the patient’s anxiety. Scheduling difficult patients for the beginning or end of the day to reduce their waiting time may also be prudent. It is strongly recommended that employees hold or restrain all animals during examination or treatment procedures to prevent injury to owners. Patients with a history of aggression during the veterinary visit should have notes in their files detailing the specific concerns. Patient file notes are most helpful when they detail specific interventions that were successful for that particular patient in the past. For hospitalized patients, cage cards should be labeled with client-friendly stickers that alert the staff to potential problem areas. Most aggression in the veterinary hospital is due to fear or pain. Hospital staff may also see territorial, possessive, irritable, or drug-induced types of aggression. It is important to recognize when an animal is uncomfortable and likely to act defensively. Understanding the animals’ postural signals will help to determine the type of restraint that is indicated. Restraint must be safe for the humans as well as the patient. Avoid excessive neck pressure and do not position the animal in such a way that it could fall or be injured as a result of restraint. APPROACHING ANIMALS The way staff members approach the patients can set the tone for the subsequent examination. Dogs are often highly sensitive to unfamiliar individuals reaching toward or over their heads, particularly if they are cornered or restricted by a leash. Hospital staff should avoid standing over, staring at, and reaching over canine patients. Any canine patient that shows excessively submissive postures (ears pinned back, caudal retraction of lip commissure, avoidance of eye contact, submissive urination) can potentially become frightened enough to bite. Dogs that are trembling, hiding, urinating, defecating, expressing anal sacs, yawning, or panting excessively, or any combination of these behaviors are frightened and could become aggressive. Patients that are hiding under chairs or tables can be removed with their leashes before being restrained. It is never advisable to reach under a table or into a cage to remove a fractious patient. Cat carriers can be disassembled to safely remove the cat with a towel. HANDLING CATS Friendly cats greet with their tails straight up, ears forward, and back straight. Cats that are exhibiting an arched back, curved or tucked tail, or pin their ears back are frightened and may defensively bite or scratch. No single approach will work for every patient, but most fractious cats can be wrapped in thick towels for a cursory examination. Gloves, collars, cat bags, squeeze boxes, muzzles, or chemical restraint are options if the cat is too fractious to examine otherwise. All employees should be instructed on the proper handling of cats for transport (with forelimbs held to prevent scratching), restraint for venipuncture, and restraint for examinations. HANDLING DOGS For examination of difficult canine patients, towel holds, head collars, and/or muzzles can be used. If the patient is extremely fractious, the best approach might be to send the owner home with instructions for acclimating their dog to a basket style muzzle, and attempt the examination at another time, when the dog can comfortably return wearing the muzzle. Basket style muzzles do not restrict the dog’s ability to breathe, but will prevent injury to handlers. Larger examination rooms are preferred for difficult patients. Kennels and cages can aggravate defensive or territorial/protective responses, so patients may need to be removed from cages before handling is attempted. Be cautious with chemical restraint. There is no perfect medication to address fearinduced aggression, unpredictable reactions can occur, and some medications can disinhibit aggressive tendencies. Good Restraint Informed Compassionate Attentive Technique, not strength Techniques to Avoid Scruffing Verbal reprimands Pinning, alpha rolls Frontal approaches Muzzle grips High Stress Areas Head and neck Legs and extremities Abdomen Painful areas What’s the harm in using force? Forceful restraint breaks your promise to “do no harm” Can lead to aggression Can lead to poor veterinary care Examine the pet where it is most comfortable Use Rewards and Treats Record Exam Details Note in record what works best With or without owner More or less restraint Problem areas On or off table Encourage Friendly Visits to Hospital PREVENTING BEHAVIOUR PROBLEMS IN DOGS AND CATS Lynne Seibert DVM, DACVB Prevention of feline behavior problems Behavior problems can result from environments that are not compatible with cats’ needs Common problem behaviors Destructive behaviors Scratching Urine marking House soiling Jumping on counters Play, prey-related activities Aggression Nocturnal playfulness Environmental enrichment Environment must provide sufficient outlets for species-typical behaviors: Play Scratching Marking Climbing Exploration Scratching Functions of Scratching Nail grooming Muscle stretching Marking territory Use of Scratching Post Desirable surface Place near sleeping areas Confine kitten with scratching post initially and supervise when not confined Food rewards for approaching and using post Textures Rope or woven sisal Back of carpet Cardboard scratchers Nubby or pile carpet Smooth wood Mounted driftwood Non-toxic branches Orientation Stable, tall, vertical scratcher 30” or taller unobstructed post height Horizontal scratching area Flat on the floor scratchers Sisal-covered boards Carpet remnant Cardboard scratchers Scratching Deterrents Play Behavior Cats are hunters” avoid using hands or other body parts as toys Toy Time Chase toys Chew toys Hide and stalk toys Toys with treats inside Avoid coverings or stuffing that are easily shredded Fibers could prove fatal if swallowed Long threads, large diameter fibers, synthetics fibers Toys with string parts should be available only under supervision to avoid tangling or swallowing Rotate toys and games to maintain novelty! Prevention of canine behavior problems Housetraining Do not punish your dog, unless you catch her in the act If you catch her in the act, made a loud noise to interrupt the behavior, then take her outside Walk your dog outside on leash and take food treats along so she can be immediately rewarded for eliminating outside o Go outside shortly after feeding o Go outside every 3-4 hours for young and/or small dogs Increase supervision of your dog while inside Keep her confined to a smaller area of the house Crate her when you cannot watch her Use a long leash to keep her near you Teach an elimination command by saying the word, or short phrase, every time she eliminates, and follow it with a reward Treat affected areas with good odor eliminating product Chewing Puppies chew on whatever they can get their mouths on for any number of reasons: they are bored, they have a lot of energy, they are teething, or they are just curious. Dogs learn through their mouths. It is their tool; it is how they receive a great deal of information. They are naturally inclined to use their mouths whenever they can. Fortunately, most destructive chewing behavior can be prevented or controlled. To prevent problem chewing and to direct your pup's natural inclination to chew toward appropriate objects CRATE TRAINING A PUPPY Confining a puppy to a crate is a simple and humane way of preventing unwanted elimination and destruction around the house when you are unable to supervise your puppy. The key to crate training is making it a very pleasant and positive experience for your puppy. The crate should not be used as punishment. The crate should be a haven for the puppy. Before getting the puppy accustomed to the crate, make sure you purchase an adequately sized crate to house your growing puppy. The crate should be large enough so that when your puppy reaches adult size, it can still stand up and turn around without any difficulties. If the crate is too large, your puppy may eliminate at one end and stay at the other end. Crate training is based on the principle that a dog will not eliminate where he/she sleeps. For large breed dogs, plan to partition the crate or get a series of different sized crates. A cardboard crate should not be used to house a puppy as he/she may destroy it by chewing. Once you have purchased the crate, you can begin with the training exercises. Place the crate in an area of the house that you spend a lot of time, but not where there is a lot of household traffic. 1. Place tasty food treats in the crate and allow the puppy to go in and eat the treats and come back out. Keep the crate door open or off entirely. When the puppy walks into the crate, say a command, such as “kennel up,” “crate,” or “house.” Over time the puppy will learn to associate the command with going into the crate. Have the crate available with the door open for several days. 2. Once your puppy is comfortable going into the crate, you can begin leaving him in the crate for very short periods of time. The next time your puppy goes in the crate, close the door. Let the puppy stay inside the crate for 15-30 seconds before allowing him to come out. Be sure to let your puppy out when he/she is not crying, whining or acting anxious. 3. Very gradually leave your puppy in the crate for longer periods of time. You can provide your puppy with toys stuffed with food treats to keep her occupied. You can also place a pad or cushion to make the crate more comfortable for the puppy. 4. If you are using the crate for housetraining, do not expect your puppy to control its bladder or bowels for an eight-hour day. A reasonable time period is staying 2-4 hours in the crate before giving your puppy an opportunity to go outside to eliminate. 5. If your puppy is consistently eliminating in the crate, even if you are taking him outside frequently, you should have your puppy examined by your local veterinarian. RELAXATION EXERCISES The relaxation exercises are the foundation for further behavior modification. The purpose is to teach your dog to sit, stay, or lie down, while relaxed, in a variety of situations. The obedience command is not the goal – it is simply a tool that allows your dog to earn a reward for an appropriate behavior. It also teaches your dog to rely on you for all cues as to the appropriateness of its behavior in a variety of situations. Since the purpose is relaxation, and not strict adherence to obedience commands, it is important to be able to recognize when your dog is relaxed. It is normal for your dog to turn its ears to the side or back as you reach for it. It is not acceptable for your dog to keep its ears pinned back or held to the side. You must get your dog to bring its ears forward prior to giving the reward. If your dog is reluctant to do this, you will need to become less “threatening.” You can accomplish this by avoiding direct eye contact with your dog, crouching or swatting, dropping the reward rather than reaching directly toward the dog, or speaking more softly. If your dog still seems anxious, contact the behaviorist for further advise. Your dog’s favorite food treat will be used in the exercises. This is a reward or salary – not a bribe. Treats should never be used to bribe a problem dog. Food rewards should be tiny, easily consumed, and highly palatable. They should be given only during exercises so the dog’s motivation for them is maintained. Dog biscuits may not provide sufficient motivation, but some foods are so desirable that the dog is too stimulated to relax. Something between the two extremes is preferred. Teaching “Sit” Ask your dog to sit. If it will not sit immediately, raise a treat slightly and ask again. Do not tug on the leash, raise your voice, or push it into the sitting position. As soon as your dog sits, with its ears perked forward, say “good dog” and give the food treat. If your dog jumps up prior to receiving the treat, then withhold the reward, and ask it to sit again. Remember that you are rewarding the behavior or behaviors that are occurring immediately prior to the reward. IMPROVING COMPLIANCE WITH BEHAVIOR MODIFICATION PLANS Lynne Seibert DVM, DACVB Compliance can only be achieved when a specific and consistent recommendation is made by the veterinary team, the client accepts that recommendation and the practice follows up with that recommendation. What? Veterinarians report that client compliance with behavior modification is poor So, What? 230,000 pets were euthanized in veterinary practices in 2006 for behavior problems. By comparison, approximately 244,000 dogs were diagnosed with heartworm disease. So, What? The average veterinary practice loses up to 15% of the patient base each year to euthanasia due to behavior problems What Next? Train your team Keep it simple Focus on the positive Make behavior modification plans simple to follow Focus on positive reinforcement Use rewards and treats Keep It Simple Chunk and Check Information should be provided to clients in short, digestible chunks. Give a portion of the discharge information, then check in with the client to gauge their understanding. Handouts Less is more Be tight and concise Cut out all unnecessary items Stick to key messages Make every word, phrase, sentence count Learning Concepts CLASSICAL CONDITIONING Classical conditioning is a form of learning that occurs when a neutral stimulus is paired with an unconditioned stimulus over one or more trials. The neutral stimulus comes to elicit a response that it would not naturally elicit. The UCS (Unconditioned Stimulus) is any non-habituating stimulus that elicits a response without prior training. The CS (Conditioned Stimulus) is the stimulus that does not initially elicit a particular response (neutral), but will elicit the response as a result of pairing with the UCS. An UCR (Unconditioned Response) is a reflex or autonomic response (physiological or emotional) to a stimulus that occurs without the necessity of prior conditioning. The CR (Conditioned Response): response is the response made to the conditioned stimulus during classical conditioning. Classical conditioning is often involved in the development of fear responses in pets, and can also be used in behavior modification programs. Extinction of Classical Conditioning If the conditioned stimulus is repeatedly presented without being paired with the unconditioned stimulus, we can break the association between the CS and UCS, and the conditioned stimulus eventually reverts to being a neutral stimulus. This can be applied to behavior modification plans. Many dogs with separation anxiety will display anxiety during the caregivers’ predeparture routine (picking up keys, putting on shoes, setting the house alarm). Because the pre-departure cues are temporally associated with prolonged owner absences, these dogs develop classically-conditioned fears of the elements of the pre-departure routine. Thus, anxiety begins before the caregiver ever gets out of the door. These classically conditioned fears can be extinguished by disrupting the pairing of the conditioned stimulus (keys, shoes, alarm) with the unconditioned stimulus (extended absences). This process of extinction can be accomplished if the owners will repeat elements of their pre-departure routine, and stay home instead of leaving (pick up keys and put them down, put on shoes and stay home with the dog instead of leaving). Another application of extinction applies to veterinary hospital visits. Painful or uncomfortable veterinary procedures can result in conditioned fears of the examination room, the doctor’s white coat, and the sights and smells of the hospital. By encouraging caregivers to bring their pets to the veterinary hospital for atraumatic visits (visit hospital, get a treat, and leave), the conditioned fear of the hospital may be lessened. Inhibitory Classical Conditioning Conditioned inhibition is a technique that can be used to teach dogs with separation anxiety to relax during their owner’s absence. These exercises involve using a safety signal (inhibitory conditioned stimulus) during ultra-short practice departures. The safety signal should be a signal that has never previously been associated with an extended owner absence, and will be presented during brief departures. Over time, as the dog learns to associate this special signal with short, safe owner absences, the length of the practice departure can be gradually extended. Conditioned inhibition does not involve reward-based training. It simply relies on the dog’s ability to learn an association between the safety signal and the absence of the UCS (extended owner absence). OPERANT CONDITIONING Operant conditioning, also called instrumental conditioning, is a form of learning in which behaviors are affected by their consequences. An eliciting stimulus, or antecedent, gives information that there will be a specific consequence to a specific action at that time. Eliciting stimuli may be deliberately presented to a pet as part of a training program (command, request), but are not always intentional. The eliciting stimulus prompts a response or behavior, and the response results in a consequence, or controlling stimulus. There are four paradigms in operant conditioning: positive reinforcement, negative reinforcement, positive punishment, and negative punishment. Reinforcement means that the probability that the behavior will recur is increased. Punishment means that the probability that the behavior will recur is decreased. The term ‘positive’ means that the controlling stimulus, or consequence, is present or occurs as a consequence of the response occurring. The term ‘negative’ means that the controlling stimulus is absent or is removed as a consequence of the response occurring. Positive Reinforcement Positive reinforcement is very important when working with anxious dogs. The caregiver must first be able to recognize activities and body language that are consistent with a confident, non-anxious pet, and offer rewards specifically at those times. Food rewards are highly motivating for most dogs. During times of anxiety, attention-seeking, whining, pacing, pawing or jumping, owner attention (reinforcement) should be minimized. It is natural for owners to inadvertently reinforce anxiety unless they are instructed otherwise. Owner attention, reinforcement, and reassurance during departures and arrivals should be minimized in cases of separation anxiety, as these are times of heightened anxiety. Shaping is a training exercise that can be used to teach anxious pets to be more confident. Positive reinforcement is used to reward activities that are successive approximations of the desired result, until more confident postures are elicited. Basic obedience cues can be used for confidence-building exercises, but the focus should be the overall attitude of the learner (ear and facial postures), and not simply the ability to obey the commands. Negative Reinforcement In negative reinforcement, the probability that a behavior will recur increases as a consequence of the controlling stimulus being absent or removed if the behavior occurs. This becomes a problem when fearful pets are cornered or forced into uncomfortable situations. If a dog is afraid of children, and a child is allowed to corner the dog causing the dog to bark defensively, the barking is likely to cause the child to leave the dog’s vicinity. The dog learns that the barking display will successfully get the child to leave. It is always in the best interest of all involved to avoid eliciting fearful or defensive behaviors in our pets. Positive Punishment Positive punishment, usually referred to as punishment, means that the probability that a behavior will recur decreases as a consequence of a specific stimulus occurring immediately subsequent to the behavior. For punishment to be effective, three conditions must be met: the punishment must occur immediately, the punishment must be consistent (occur every time), and the punishment must be an appropriate intensity for the individual. If these three conditions are not met, use of “punishment” is unlikely to be successful. For owner-absent misbehaviors, such as those that occur with separation anxiety, it is never acceptable to attempt to punish the pet when the owner returns home. This does not meet the requirement for immediacy. Also, the use of the aversive stimuli typical of punishment introduces the risk of causing or worsening fearrelated problems. DESENSITIZATION AND COUNTER-CONDITIONING Desensitization is an exercise that results in a decrease in responding produced by gradual exposure to the stimulus eliciting a given response. Stimulus exposure proceeds at such a low level that the response is not elicited. The stimulus intensity is gradually and steadily increased over time, and response does not occur. To use effectively, you must be able to identify the stimulus that elicits the fear response, find a level of the stimulus to which the pet does not respond, manipulate the intensity of the stimulus, and then gradually increase the stimulus intensity (increase volume, proximity, length of owner absence). Counter-conditioning is often used in combination with desensitization. This is a conditioning procedure that reverses a previous response to a stimulus by associating that stimulus with a different UCS (one that promotes an opposite type of reaction). In practical terms, we teach a behavior that is incompatible or interferes with the undesirable behavior. Advantages of desensitization and counter-conditioning include a minimal risk of adverse outcomes, excellent responses if done correctly, and positive interactions between pet and owner. Desensitization and counter-conditioning for separation anxiety will involve teaching the dog to exhibit relaxed postures on a cue for rewards. Once the dog has learned to be calm on cue, independence training can be practiced with the dog maintaining a stay command while the owner moves gradually further away for increasingly longer periods of time. Desensitization and counter-conditioning for noise phobia involves exposure to a gradually increasing volume of audio-recorded noise. Desensitization and counterconditioning to fears of objects or people will involve gradual decrease in the distance between the dog and object.