Tag Archives: low stress handling

Four years ago, I met Kris Chandroo - a veterinarian with a passion for cats and low-stress handling (not to mention also a scientist and musician)!! I interviewed him previously on my blog about his program (Stress to Success) on medicating "challenging" cats. We became fast friends, and since then it's been exciting to watch where he has taken cat (and dog) care. I spoke with him last week about his new mobile practice, 100x Vet because I was so impressed with their approach to practicing medicine in the time of coronavirus. It's a long read, but I hope you will enjoy it!!

It’s been FOUR years since I first interviewed you about Stress for Success! A lot has happened since then…

I’ve changed how I’m interacting with people and their pets. When I did STS I was still working in a brick and mortar clinic. Now we are mobile and on the road!

First, I’d love to hear about the Cuban Experience. What is the purpose – to bring supplies to the vets there, to provide training for vets, provide medical service?

It started with my dad – he loves the country, he’s not a vet, he sells cars, but he has a super soft spot for cats and dogs. So he was going there twice a year, had met vets, connecting people. I’d never seen my dad do anything like this! One year he invited me to come down, and he invited me to meet the vets there. The experience we had, oh my god, bringing it back to…what’s it all for. How do people in a different culture feel about cats and dogs when they have so many of their own problems? Turns out they feel the same way we do.

In Cuba, to get ahead, you open your own shop. Everyone’s hustling. The second they make a little more, the first thing they go to access is veterinary care. There are these pop-up clinics, in a garage, no sign. Then a line of people with dogs and cats.

Were the needs for veterinary care basic, like vaccines and spay/neuter?

Even though internet is highly controlled there, people will still google everything about their pet, and they had questions about supplements, and medical disease. They had high expectations and in-depth questions, even though they couldn’t get food regularly for themselves with shortages. I assumed it would just be antibiotics, parasites, skin issues. Soon we’re bringing down equipment, microscopes, doing diagnostics, medical problem-solving.

What are your goals for the veterinarians who participate?

The team is everything from human nurses, vet techs, students, and vets of course. Everyone finds their role and expands on it. We’ve even had clients come with us. It’s unspoken teamwork. We form a unit. We would go to 3-5 clinics a day, drop off supplies. It might be a surgery day. So many people from different walks of life. There’s so much to reflect on. I haven’t met anyone who didn’t come back from that and didn’t reevaluate their own situation of where they were back home.

It sounds like you’re going in – integrating with the community, not just like “step aside, we’ll take care of your problem”

That was my dad – his question was always, how can I help? He built all that trust. It is to serve their needs, not any other agenda.  

Where can people go to learn more?

They can go to: iwillhelpyourcatcourses.com. This year, we were set to go, we had a sponsor, we had a crew of 10 or 12 of us ready to go down on April 19th and then life happened with coronavirus. We are planning to pick it up in 2021. I’m so sorry we can’t bring supplies there this year.

What I’ve been itching to ask you about is your mobile practice 100x Vet. What made you and Tarra decide to leave your brick and mortar practice to go in a different direction?

The inspiration was coming to a new awareness – I had a medical issue where my retina blew out. Everything suddenly looked crooked in one eye. I went to the optometrist in the mall. She got quiet and said, uhmmm, you should go to the hospital. Friday my eye went bad, Monday I was in surgery. I had some ideas about approaching medicine differently and the eyeball took me there in a hurry. I was out of it for months and couldn’t work at the clinic. I’d get headaches when I moved by head, and I looked like a zombie. I decided to just go with the flow, we got the mobile made and licensed, and went for it.

Tarra and Kris are 100x Vet

What was the inspiration for the name 100x Vet?

For every pet we see in real time, we strive to help 100 more through education, making videos, and working in Cuba.

You and Tarra worked together at a clinic.

Yeah, we met each other at a clinic we both worked at in Ottawa. We also worked together on Stress to Success, which was our acid test for working together in close quarters for long periods of time. It worked.

What made you decide to go mobile instead of opening your own clinic?

As vets in a clinic, you’ve got 15-30 minutes to assess a pet and try to not make it scary for them. Cats don’t live in that time zone. It can take them that long for their heart rate to slow down and for their pupils to stop dilating.

I was interested in how I could take the way I practice medicine and evolve it to the needs of people and their pets. Our philosophy is we don’t treat animals, we treat relationships, and that takes time. Now, I can show up and sit in your living room, have coffee, talk for 15-20 minutes before I even LOOK AT your pet. And that kind of thorough discussion in and of itself reveals so much about what challenges their cat is facing. Their cat might come up to me. Step by step we can bridge that gap. Then any diagnostic exam and low stress approaches – I enjoy it, and my client enjoys it so much more. Instead of inherent stress and conflict, it’s about growth and evolution. It’s changed the practice of medicine for me on all levels. And the ways that cats and dogs feel about it is different as well.

So much of what triggers fearful behaviors at the vet – are these learned associations – the carrier, the drive to the clinic, the smells and sounds at the clinic. Those things are telling the cat or dog you are about to have a bad experience, so prepare for fight or flight now.

As vets, we are trying to get this done whether the cat is ready or not. Many vets are compassionate about that, but there are four people waiting in line. Mobile care allows the time that fits the psychology of the pet. We are working toward their needs instead of forcing them to work within the institution’s needs. It’s like children in school, there can be problems, but it’s not that the child has a problem. It’s the institution.

I can’t tell you how many people come to us in tears because their pet has been banned from a hospital, I get it, not blaming the hospital, I get the pressure cooker. I have x amount of time to solve a problem, the pet is already red-lining, and I have 2 more critical pets in line. But pets go from being muzzled, called “mean”, “aggressive” to coming up to you, and then you can start counter-conditioning to touch.

What have you learned about clients from going into their homes? What informs you as a doctor?

All of a sudden, if you think you’re on a pedestal, that will go out the window. You are a guest in someone’s home, which is going to affect how you conduct yourself and how it feels. The environment fosters an appreciation of who the pet is, when you’re coming to the pet from a perspective of wholeness, versus problem-solving and a lack of time, it changes how the interaction feels for EVERYBODY.

I’ve learned from talking about this with you before – the term enrichment is crappy – what does it really mean? Deconstructing that – what does it mean from the cat’s perspective? Nothing brought that together in a more impactful way than walking into my first consult in a client’s home for behavior. When you’re in someone’s home, you can walk around, see it all. We now do the “pee and poop tour”, we do a vantage point check off. I put it terms of natural behavior from your cat’s perspective, and does your home support that?

I think that reflects where the field is going. The term enrichment implies that it’s a bonus, instead of environmental requirements. If we call a toy enrichment, therefore it’s not as essential, like litter boxes and food and water.

Exactly. It’s not a bonus. It’s the base layer of naturalized behavior and care.

I was trying to do a research project that involved home veterinary exams. I was trying to find guidelines or protocols for a home visit, and I couldn’t find anything. The vet schools don’t bring this up. Even simple things, like having an ID or taking your shoes off, or working with another person. The only resources were the hospice and in-home euthanasia practices. Given that there isn’t much information out there, how did you figure out how to make this work? Some vets who do a home practice treat it like a regular clinic visit. The cat is confined in the bathroom, you go in and get it done. Do you have any suggestions for other vets who might be interested in doing a mobile practice?

You’re right, there are zero resources on how to do it. The only training you get in vet school is related to equine and dairy.

The easiest thing to do would be to say, I’m just going to take what I did in my practice and convert that to being in someone’s home. But that’s a missed opportunity in terms of where medicine can go for pets. We’re working with a relationship with a non-verbal pet who has opinions. We can respect that.

The other thing was, what did we want for ourselves? Did we want to be 30 minutes in and out, then running around town, 10-15 times a day? That’s a recipe for burn out. If we burn out, then we can’t be present in mind for our patients.

Our standard now is 90-minute appointments, and it goes by fast. And we need to remember that every veterinary appointment should be treated like a behavior appointment. The industry isn’t there yet. Fear Free is trying. Why did it take so long for us to have something like Fear Free? The veterinary institution thinks about what we do in a very specific, hierarchical way. You can feel it in the words we use, like “compliance.” Switching to a non-judging, non-labelling look at the individual’s internal need, and putting our philosophy about life at the top.

When we started, people assumed all we could do was vaccines and euthanasia. It took some marketing and video to let people know that’s not just what we do. It’s about 80% medicine, problem solving and coaching.

So you decided to do a YouTube channel!

I love making videos. We decided that if someone needed help, and they had a relationship with their pet, and they couldn’t afford our rates, we decided we wanted to help. If that person agreed to have that experience filmed, we could create something educational that would let people know that you might be experiencing the same problems, you can get help. People became more aware of what a house call could be like. It isn’t clinical, we’re not taking your pet out to our car. We stay in your home where your pet wants to be.

What is easier and harder about having a mobile clinic?

If I talk about technical things – blood pressure is easier and more accurate. But I would say EVERYTHING has gotten easier, from initial conversations to meeting pets and people where they are at, no time crunch…what is harder? Logistically, man if you had food intolerances you will sort them out real fast! I mean for Tarra (my RVT) and I. You want a gut that is feeling good. Peeing in someone’s home…I had one experience where I had to go pee and the client had a big problem with it. She didn’t want me to go unless I would sit down on the toilet seat. I politely just held it in lol.

Taking a cat's blood pressure during a home visit.

You only have to live with one guy with bad aim. Guys are slobs. You know those weird rugs around the toilet…there’s a reason those exist and it’s bad.

It’s true. Guy bathrooms are notorious.

So now we’re in a pandemic. How are you keeping your business going, assuring clients that their pets will get medical care while staying safe in this scary time?

It was mid-February, I saw the word exponential being tossed around. As a vet, thinking about infectious disease control, you need to have protocols ready. It had nothing to do with politics, or managerial opinions. It was midnight, and I just started researching, what would I do to keep going? What could I do to keep my family safe?

I made a few assumptions, that fit in line with what I would do anyways. Accepting asymptomatic transition was one. How could I provide care to others, AND keep them safe and vice versa? So I started ordering PPE, hats, gowns, eyewear. At that point all of the N95 respirators were already gone. But I found I could get NIOSH approved P100 respirators, with reusable, washable masks that could be disinfected.  

Then I thought about aerosolization of droplets. That means no contact. We are going to help your pet but we’re not going to see you. And the third way – touching something in your environment, then touching your face. People were freaking out about getting hand sanitizer, but the gold standard is hand WASHING. We built a handwashing station for the back of our mobile, so we could wash on the streets, instead of someone’s home or a fast food joint.  

When things started to heat up a few weeks ago, things got real for so many people. The most tragic way was, we got a lot of calls for euthanasia, and people who were quarantined and couldn’t leave their home. Or people who could leave their home but knew the last time they would see their pet would be in a carrier as I pass it through their car door. That hit people in a way that was rough.

Tarra and I were like, this can’t happen. We figured out step-by-step how we could do a euthanasia with dignity, the animal is with their people, while Tarra and I are absent. It involves phone calls, 8-foot IV lines, other equipment. The pet is inside with their person and we are on the other side of a door administering medication from a distance. We walk in, we give sedation, we leave the room. We call the owner and they can be with their cat as he falls asleep. As far as the cat knows, nothing has changed. All they know is all they’ve ever known, there’s nothing new or stressful.

Kris gowning up

To innovate solutions like that is so great.

People have appreciated it. Euthanasia is the first thing to have suffered because of this. It’s super emotional. The pandemic has hit, how do we problem solve as a society to preserve relationships? And my advice to everyone – it’s 20% being prepared in all the ways you can, and the realization that for all the rest, it’s hands off the wheel. No resistance to change. Children and pets are masters of this. Not having anxiety for the future, not regretting their past. Just being present, in the moment. Whatever that moment brings. 

So for us, we wash our hands frequently. When in doubt, wash them out. It’s not controversial for us to wear masks. It’s just basic science. We have a protocol for anything coming in or out of our homes, including vet supplies, mail or groceries. Clothing, cellphone, keys. Anything that could act as a fomite. Once all of that is in place, the rest of life is still here. Just ask any cat.

All photos provided by Dr. Kris Chandroo.

If you’ve ever worked in a shelter or veterinary setting, there’s a pretty good chance that you’ve spent some time scruffing cats. Maybe you’ve taken your cat to the vet and the veterinary staff placed your cat in a “scruff-hold.” For those of you who have no idea what I’m talking about, scruffing is a way of restraining cats, by holding them firmly by the loose skin at the back of the neck. For some cats, this type of handling restricts their movement, which can facilitate handling and various procedures like getting a blood sample. Although scruffing is still a common way to handle cats in veterinary clinics, there is increasing resistance to using this type of handling.

Mother cat carrying kitten. Photo by Margo Akermark via Wikimedia Commons.

Scruffing likely came into fashion because it resembles the way that mother cats handle their kittens – carrying them by the back of their neck. When the momcat does this, kittens are immobilized and likely easier for mom to relocate. Immobility in other species (such as rabbits and rodents) when scruffed is attributed to anti-predator behavior. Scruffing adult cats can have similar effects (induced immobility), although not in all cats. Because the lack of movement experienced by cats during scruffing may be due to fear, rather than a relaxed state, many individuals and organizations are calling for veterinary staff to embrace other handling techniques for cats.

International Cat Care and the American Association of Feline Practitioners have released statements that scruffing should either not be performed, or should not be the routine, “default” method of handling cats who visit a vet clinic. Other organizations, such as the ASPCA, emphasize other methods of cat restraint. Various certifications are now available for training in low-stress handling, fear-free veterinary practice, and cat-friendly practices.

Now this is all well and good, but as can happen, sometimes people endorse a practice without a strong evidence base. Until the past few months, there have been few published studies related to cat restraint, and whether or not certain handling methods are truly stressful to cats. Dr. Carly Moody devoted her dissertation research to the exploration of various aspects of cat restraint. I blogged about two of her other studies recently, and now she’s got a new paper, hot off the presses, looking at three types of cat restraint.  In “Getting a grip: cats respond negatively to scruffing and clips” published in Veterinary Record, scruffing, clipping, and full-body restraint were compared with passive restraint to see whether they led to stress responses in cats.

Fifty-two shelter cats were tested; all cats experienced passive restraint as a control and ONE of the other forms of restraint. Some cats were held with passive restraint first, and others received the experimental condition first, to control for any order effects of being handled. Cats were first assessed as either friendly or unfriendly (I’d prefer a term like avoidant!) by measuring their approach and response to a stranger and being petted, before the restraint methods were tested.

Photo by Moody et al, from the published manuscript.

In passive restraint (a), cats were handled with minimal pressure and were allowed to stay in the position they preferred. Full-body restraint (b) involved holding the cat on its side, while holding the legs and not allowing much movement. In the scruff condition (c), cats were held by the skin at the back of the neck and was allowed only minimal movement. Finally, in the clip conditionm(d), two Clipnosis clips were applied to the back of the cat’s neck. Clipnosis clips resemble binder clips, and are a way to scruff “hands-free.” All cats were restrained by the same person in the animal shelter’s clinic facility.

The stress measures included ear movement, respiration rate, pupil dilation, lip licking and vocalizations. The results showed that cats undergoing full-body restraint had a higher respiration rate and more vocalizations. Full-body restraint and clips led to more pupil dilation, and all three tested restraint methods led to more ear movements when compared with passive restraint. To summarize, full-body restraint and clips were the most stressful, and scruffing also led to more stress responses when compared to passive restraint. Three indicators of stress (respiration rate, pupil dilation, and ear movements) were consistent with the previous work from this lab. Based on this study, the authors recommend that people do not use full-body or clip restraint, and that scruffing should not be a default method of handling cats.

A few potential weaknesses of the study include the fact that they did not do any medical procedures on the cats to see if there was any relationship between the type of restraint and cat’s behavior during an exam. The full-body restraint involved laying the cats on their side, which was different from the other three conditions, where the cat was typically upright. It is difficult to say whether it was the restraint or the body position that might have led to the stress response.

An example of scruffing plus full-body restraint.

Finally, MY personal experience, is that most handlers who scruff cats, simultaneously place them on their sides in some type of full-body restraint. So it is possible that some people will think that because scruffing was not as stressful as the other tested modes of restraint, that it’s perfectly fine to utilize this form of handling with nary a second thought. It would be great to include this type of handling (scruff + restraining the body) in a future study – it is possible that combining the two techniques is even more stressful than just using one alone.

Scruffing doesn’t prevent biting; many veterinarians have been bitten by cats in practice, and since most clinics (perhaps until recently) likely use scruffing to restrain cats, it is obviously therefore not a guarantee of safety. However, it is a habit that many may find hard to break, especially if they are used to and comfortable scruffing, and not as experienced or comfortable using other methods, such as towel-wrapping or chemical restraint (drugs). Many years ago, when I worked in an animal shelter and handling a lot of cats, I was doing a lot of scruffing! That was the norm. In my current work situation, I’m not routinely restraining cats anymore. But if I were back in that position, I’d be ready to try something different.

At the School of Veterinary Medicine at UC Davis, we teach a cat handling lab to first year students, and the mantra is “EBY – Even Better Yet” – what can we do better to handle animals safely, and in a manner that is likely to reduce stressful responses in the present and during future veterinary visits. These students have typically been trained to scruff cats by default. Sometimes they express resistance to trying something new; but hopefully with practice and increasing evidence that scruffing increases stress, they will get more comfortable with other, less-stressful techniques.

Kitty in a towel wrap. Photo by Kerri Lee Smith via Flickr/Creative Commons License https://www.flickr.com/photos/77654185@N07/26719456934

I was recently inspired when my friend Ellen Carozza, LVT told me that her veterinary practice has been “scruff-free” for almost 20 years. And she still has all of her fingers! She has been a strong advocate for providing cats with a safe and low-stress experience at the vet clinic, and has excellent videos of how the staff at her clinic handle “difficult” or “aggressive” cats, including several types of towel wraps. It’s hard to argue with 20 years of proof that it’s not necessary for effective treatment of cats (when we tell the first year vet students that there are scruff-free cat clinics, it blows their minds!). But think of it this way – if aversive restraint techniques were just not allowed or available to you – what would you do instead? And now it’s hard to argue with the mounting scientific evidence that when it comes to handling cats, “less is more.”

 

Reference

Moody, CM.Mason, GJ.Dewey, CE.Niel, L.
(2019) Getting a grip: cats respond negatively to scruffing and clips

For many cat owners, there’s nothing more stressful than getting their cat to the vet. And it’s not necessarily the vet visit the pet parent minds so much as getting their cat into the cat carrier. In one study, the stress of getting cats to the veterinarian was cited as a reason many people don’t EVEN BOTHER taking their cat to the doctor for a regular checkup.

Perhaps this is where your cats like to hang out when it's time to go to the vet? Photo via Creative Commons at https://www.flickr.com/photos/jon_a_ross/3215684326

Make one move toward the closet, or the garage door, perhaps you’re already sweating bullets…your cat picks up on the signs…and then before you know it, they have tucked themselves deeply underneath your bed, just out of reach. If you’re lucky, perhaps you can grab and pull out your cat without being bitten or scratched; some of you might even resort to scaring your cat out from under the bed with a broom or vacuum (I wish I was kidding, but all the above happen all too frequently). You might even have to just cancel that vet appointment at the last minute…

How did we get here? Why are so many people resorting to such heavy-handed, fear-inducing, traumatic methods to put a cat in a box (I thought cats loved boxes?). Methods that no doubt will make the whole process even harder next time around?

The first challenge is the pervasive disbelief that we can train cats at all, much less train them to willingly go into a cat carrier. Second, is getting information on training techniques to cat owners so they can know where to start!

A new study tested the effects of a carrier training protocol on signs of stress in cats while being transported in a car and then examined in a veterinary office. The study, Carrier training cats reduces stress on transport to a veterinary practice, conducted at the University of Veterinary Medicine in Vienna, Austria, was recently published in the journal Applied Animal Behavior Science.

Researchers tested 22 cats. Each cat was individually taken into a new room and given 5 minutes to adjust. Next the carrier was placed on the floor and the cat was given 3 minutes to enter voluntarily, at which point they were placed in the carrier. All cats were given treats during the 10-minute car ride across campus to the veterinary exam. The cats were kept in a waiting room for 5 minutes, then brought into a separate room for an exam. Cats were given 3 minutes to exit the carrier on their own, at which point the carrier was dismantled and the examination was conducted in the bottom half of the cat carrier.

You can get your cat cozy in their carrier!

The cats were split into 2 groups, with half of the cats receiving “carrier training” which consisted of 7 steps. To summarize the steps:

  1. Presenting the cat with just the bottom half of the carrier, and giving the cats treats when they approach or get in the carrier; luring them closer to carrier with treats if they wouldn’t approach on their own
  2. Repeating step one with the top and door added, with the door open, rewarding any approach or entering, as well as any calm behavior in the carrier
  3. Moving and closing the door while the cat is inside, tossing treats into the carrier through the front door
  4. Picking up the carrier for short periods at first, gradually increasing the time the carrier is lifted with the cat secured inside, rewarding the cat for calm behavior
  5. Carrying the cat to the car, offering tuna while in the carrier in the car
  6. Turning on the engine, offering tuna
  7. Short car rides, gradually increasing the time in the car (up to 3 minutes), paired with food, petting and verbal praise

Each cat was given a total of 28 training sessions over the course of 6 weeks. Three of 11 cats made completed all seven stages, with six cats getting to stage 7 and two cats to stage 6.  The control group of cats did not receive any type of training before the second veterinary exam, which was the next part of the study.

The researchers measured stress using the “Cat Stress Score,” a commonly used measure of feline behaviors and postures that suggest whether a cat is relaxed, tense or fearful. A camera was placed in the cat carrier to observe the cats’ behaviors during the car ride, and temperature, heart rate, and respiratory rate were measured during the vet exam. It was also noted whether cats entered their carriers willingly, whether they left the carrier by themselves during the exam, and whether they showed fearful or aggressive behaviors during the veterinary exam.

Photo by David Martyn Hunt via Creative Commons license at https://www.flickr.com/photos/davidchief/5912515514

Results showed that all cats had a lowered stress score during the car ride to the second veterinary exam; but cats in the training group experienced a much larger reduction in stress scores. Cats in the training group were more likely to show behaviors such as kneading or rubbing against the carrier. Cats with carrier training were able to be examined more quickly, although they were not more likely to leave the carrier on their own.

Not all behaviors were affected by the training; for example, there were no differences between groups on any of the physiological measures of stress (respiratory rate, heart rate, temperature). There were also no differences between the two groups in stress scores during the time in the waiting room or during the exam. It should also be noted that even though the cats were randomized into either a training or control group, 7 out of 11 of the cats in the training group went into the carrier on their own right from the get-go, whereas only 4 of the cats in the control group did, suggested that there may have been some personality differences or different experiences or associations with carriers between the two groups. Finally, because the study used laboratory cats, we don’t yet know how precisely this would apply to cats in homes…is someone getting on that study???

But, THIS study does provide evidence for the power of positive training! With just a few weeks of short training sessions, cats showed less stress during a car ride in a carrier and were easier to examine by a veterinarian. Those sound like two major improvements for cats to me! If you need more advice on how to train YOUR cat to love their carrier, here are a few resources I like:

Reference: Pratsch, L., Mohr, N., Palme, R., Rost, J., Troxler, J., & Arhant, C. (2018). Carrier training cats reduces stress on transport to a veterinary practice. Applied Animal Behaviour Science.

This blog post is part of the 2018 #Train4Rewards Blog Party. See what the fun is all about by clicking on the image below!