Welcome to the inaugural edition of Behavior Bytes, the free quarterly newsletter for petcare professionals. Whether you’re a veterinarian, technician, groomer, shelter worker or otherwise involved in caring for pets, if your goal is to provide better overall care by taking the animal’s behavior and welfare into account, this newsletter is for you. Feel free to share this with your friends or visit the website where archived newsletters will be stored. And of course, we welcome feedback as well as ideas for articles.
Dr. Sophia Yin, DVM, MS
One-Person Cat-Handling Technique for Injections
Everyone knows that when vaccinating or giving other injections to cats you should ideally have two people involved — one to restrain the cat so she doesn’t squirm or escape or try to scratch and bite you and one to give the injection. Realistically, sometimes we have to get the job done with just one person playing both parts. Here’s a nifty toweling technique for doing just that in the average or fearful but not-yet-fractious cat. This technique was shown to me by Dr. Jill Orlando, a veterinarian who frequently works at vaccine clinics.
|1.) Start with a bath towel. A thick 30 x 50 inch bath towel is ideal. Hold the cat in place as she is lying down by placing your hand on top of her shoulders and neck and holding your arm over her spine. If she’s likely to squirm, then also snug her body against yours so she has little room to wiggle.|
|2.) Next fold the short end of the towel over her head, neck and shoulders. It should extend approximately to the caudal (back) portion of her rib cage. This towel fold will prevent her from suddenly spurting out forwards.|
|3.) Now to provide some stability on each side, fold the sides of the front portion of the towel over her back. Start with the side further away from you. Note that while you are doing this, your arm is still holding the cat in place.|
|4.) Once you’ve folded the first side up, place your stabilizing arm over the towel so that you can use it to keep the towel snug.
Then fold the side of the towel that’s closest to you.
|5.) Now the cat is controlled somewhat from moving forward or to the side. Be sure to hold the towel closed so that it doesn’t loosen allowing the cat to slip out. The goal of the wrap though is that the cat feels comfortable and secure and is not trying to struggle.|
|6.) Hind leg injection: To give a hind leg injection, control the cat’s front end by using your “front” arm to keep her against your body. With that front hand you can give the injection while you tent the skin with the other hand.|
|7.) Epaxial injection: An epaxial injection can be given in a similar manner as the hind leg injection shown above. Or, if the cat seems likely to back out of the towel, you can wrap your “back” arm around the rear of the cat.|
|8.) Front leg injection: For this injection you’ll need to unwrap one side of the front of the towel and control the cat more with your arms. Wrap your “back” arm around the cat to help control the rear end while also using the arm to snug the cat against your body. You can inject with the “rear” hand while holding the skin with the “front” hand.|
|9.) Another way to gain more control of the cat’s rear end is to wrap the back of the towel over the cat in a manner similar to how you wrapped the front.|
|10.) Then unwrap a portion of the front of the towel so you have access to the injection site.|
|If the cat you are working with does not remain calm and stationary with this towel-wrapping technique then either get help, use sedation (such as an oral sedative if you can’t give an injection), or try one of the other techniques in Low Stress Handling, Restraint and Behavior Modification of Dogs & Cats. The general guideline or rule is that if a cat struggles for more than 1-2 seconds repeatedly, then it’s time to try a different technique or approach. For more information see the book Low Stress Handling, Restraint, and Behavior Modifications for Dogs & Cats.|
by Dr. Sophia Yin, DVM, MS
While veterinarians have a broad array of behavioral drugs at their disposal, did you know that only three of these drugs are licensed for use in pets? Anipryl® (selegiline) is licensed for use in dogs diagnosed with cognitive dysfunction, and both Clomicalm® (clomipramine) and Reconcile® (fluoxetine, a.k.a. Prozac) are licensed for use in dogs diagnosed with separation anxiety. Reconcile® and Clomicalm® are explicitly licensed for use only in conjunction with behavior modification.
So what are the implications? For one, the extra-label use requires a veterinarian-client- patient-relationship. That means that the prescribing veterinarian must have personally examined the patient, and based on the physical examination, history, and behavioral status, come up with a general or preliminary diagnosis. The veterinarian then assumes responsibility for choosing the appropriate drug — one that may be beneficial. According to the FDA, the practicing veterinarian must also be available for follow-up in case of adverse reactions or treatment failure.
In English, this basically means, when someone comes in demanding a drug, you don’t just hand it out like it’s a muffin, or something out of a vending machine. Take this scenario for example: A client comes in and says, “My dog recently started urinating on the carpets and she’s already potty trained. My breeder says she has a urinary tract infection and needs Clavamox.”
As a veterinarian it would be negligent to provide the antibiotic without making an informed decision regarding whether the dog actually had an infection or some other medical cause of urination such as renal disease, diabetes, or uroliths. And if it were a bacterial infection, you would most likely choose to perform a urinalysis plus culture and sensitivity to be sure the antibiotic you were using was appropriate for the type of bacteria. You would also want to be aware of possible adverse effects of the drugs you might use. For instance if a sulfa drug is your best choice you’d be aware of any immune-mediated type of reaction that could occasionally occur.
Similarly, with the behavioral disorders, it’s up to the prescribing veterinarian to have a reasonable diagnosis based on a thorough history and the pet’s clinical signs rather than the word of someone who has no veterinary license at stake.
What makes the situation complicated compared to other extra label drugs is that behavior modification is part of the overall package. We don’t just send owners home with insulin without showing them how to store and use the insulin correctly because without doing so, the insulin will not work effectively. The same goes for behavioral issues. Veterinary behaviorists use behavioral drugs only in conjunction with appropriate modification plans.
Technically behavioral drug use requires modification plans that are overseen or approved by the prescribing veterinarian. The veterinarian must realize that both the drugs and the behavior modification can be associated with adverse effects, especially in cases where any type of force, punishment or coercion are used. Consequently it’s up to the prescribing veterinarian to have a clear picture of the behavior modification plan, know what types of modification techniques are inappropriate, and be aware of any side-effects that might occur.
The take-home message is, the next time a client comes in pressuring you to provide behavioral medications, your best bet is to fall back on the law and require they schedule a session where you can take a clear, thorough history and make sure they are set up with an appropriate behavior plan. This plan can be carried out by a behavior technician or a trainer, but it must be one that is in line with your views and is in line with the current practices in veterinary behavioral medicine. Another option for prescribing behavioral medications is to send the client to a veterinary behaviorist or to consult with a veterinary behaviorist yourself. Most veterinary behaviorists and clinicians focused on behavioral practice will provide such information gratis to veterinarians. Most veterinary behaviorists will provide such information to referring veterinarians.
Click here to download a sample extra-label client consent form for use of psychopharmacology drugs.
Click here for some good reference materials on psychopharmacology in dogs and cats.
Selecting Psychoactive Medications for Behavior Problems by Sharon L. Crowell Davis.
Compendium of August 2006 p 581-585.
Veterinary Psychopharmacology by Sharon L. Crowell-Davis and Thomas Murray. Blackwell Publishing, 2006. Ames, IA
Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine & Feline Behavior
Debra Horwitz and Jacqueline C. Neilson ed. 2007, Ames, IA Blackwell.