Ilona Rodan

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

Rationale: The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge. Relevance: Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian–client–patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. Approaches: The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. Evidence base: The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

AAFP and ISFM Feline-Friendly Handling Guidelines

Background The number of pet cats is increasing in most countries, often outnumbering pet dogs, yet cats receive less veterinary care than their canine counterparts. 1 Clients state the difficulty of getting the cat into a carrier at home, driving to the clinic, and dealing with the fearful cat at the veterinary clinic as reasons for fewer visits. 2 Educating and preparing the client and the veterinary team with regard to respectful feline handling is necessary in order to avoid stress and accomplish the goal of good health care. Without such preparation, feline stress may escalate into fear or fear-associated aggression. The resulting stress may alter results of the physical examination and laboratory tests, leading to incorrect diagnoses (eg, diabetes mellitus) and unnecessary treatments. 3–5 Without compassionate and respectful handling by the veterinary team, clients may feel the team lacks skills and compassion, or does not understand cats. Injury may occur to the cat, client and/or veterinary team. 6 Clients who want to avoid stress for their cat may avoid veterinary visits or choose another practice instead. Goals The use of feline-friendly handling techniques should reduce these problems. Handling is most successful when the veterinary team adapts the approach to each individual cat and situation. The goal of these guidelines is to provide useful information for handling cats that can lead to: Reduced fear and pain for the cat. Reinforced veterinarian—client—cat bond, trust and confidence, and thus better lifelong medical care for the cat. Improved efficiency, productivity and job satisfaction for the veterinary team. Increased client compliance. Timely reporting and early detection of medical and behavioral concerns. Fewer injuries to clients and the veterinary team. Reduced anxiety for the client.

AAFP-AAHA Feline Life Stage Guidelines

Background and goals Cats have become the most popular pet in the United States, yet statistics about veterinary care for cats remain troubling. 1 Although most owners consider their cats to be family members, cats are substantially underserved, compared with dogs. In 2006, owners took their dogs to veterinarians more than twice as often as cats, averaging 2.3 times/year, compared with 1.1 times/year for cats, and significantly more dogs (58%) than cats (28%) were seen by a veterinarian one or more times/year. 2 Cat owners often express a belief that cats ‘do not need medical care’. Two reasons for this misconception are that signs of illness are often difficult to detect, and cats are perceived to be self-sufficient. 2 One role of the veterinarian is to develop a partnership with cat owners that will pave the way for a lifelong health care plan. These guidelines aim to outline an evidence-based life stage wellness program to aid the veterinary medical team in delivering the best comprehensive care for cats. Specific goals are to provide: Recommendations for optimal health care for cats throughout the different life stages. Practical suggestions and tools to facilitate improved veterinary visits and to enhance the client-veterinarian clinical encounter. A foundation from which to access sources of additional information. Life stage classification Distinct life stages (age groups) in cats are not well defined, in part because individual animals and body systems age at different rates, a process that is influenced by many factors. These guidelines follow one convenient classification (see box below). These age designations help to focus attention on the physical and behavioral changes that occur at different stages (eg, congenital defects in kittens, obesity prevention in the junior cat). It must be recognized, however, that any age groupings are inevitably arbitrary demarcations along a spectrum, and not absolutes. Evidence-based health care Supporting references for specific recommendations are supplied where possible, and any previously published guidelines on particular topics are referred to where relevant. Readers should note, however, that the guidelines panel was hampered in its efforts by the relative paucity of disease incidence data by age group that is available, and there is an urgent need for research to guide the future of evidence-based feline health care. 3

AAFP and ISFM Feline Environmental Needs Guidelines

Guidelines rationale: A cat’s level of comfort with its environment is intrinsically linked to its physical health, emotional wellbeing and behavior. Having a basic understanding of the cat’s species-specific environmental needs and how cats interact with their environment will provide a foundation for addressing these fundamental requirements. Environmental needs: Addressing environmental needs is essential (not optional) for optimum wellbeing of the cat. Environmental needs include those relating not only to the cat’s physical surroundings (indoors or outdoors; in the home environment or at the veterinary practice) but also those affecting social interaction, including responses to human contact. Five ‘pillars’ framework: The authorship panel has organized the Guidelines around five primary concepts (‘pillars’) that provide the framework for a healthy feline environment. Understanding these principles and the unique environmental needs of the cat will help veterinarians, cat owners and care-givers to reduce stress, the incidence of stress-related disorders, and unwanted behavior in their feline patients and pets. The recommendations in the Guidelines apply to all pet cats, regardless of lifestyle.

Feline behavior guidelines from the American Association of Feline Practitioners

Z oonotic diseases are defined as being common to, shared by, or naturally transmitted between humans and other vertebrate animals (Evans 1997). Transmission of zoonotic agents from animals to people can potentially occur by direct contact with the animal, indirect contact with secretions or excretions from the animal, and contact with vehicles like water, food or fomites that were contaminated by the animal. For many agents, infection of the animal and human occurs from a shared vector or environmental exposure. Most zoonotic agents can infect anyone regardless of their immune status. However, when immunosuppressed people are infected the clinical illness is often more severe. For example, primary Toxoplasma gondii infection of an immunocompetent person is usually inapparent whereas infection in an immunosuppressed person can cause life-threatening disease. Examples of immunosuppressed individuals include those with acquired immune deficiency syndrome (AIDS), those on immune suppressive drugs for immune-mediated disease, cancer, or organ transplantation, the fetus or other young people without fully developed immune systems, and older individuals with decremental deterioration of the immune system. When immunodeficiency is detected or suspected in a family, it is often recommended that cat ownership be discontinued due to potential health risks (Burton 1989, Spencer 1992). Because there are many infectious agents that infect both cats and humans, it is sometimes assumed that zoonotic diseases are commonly acquired from cat contact. In actuality, humans are unlikely to acquire infectious diseases from healthy, adult,

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats . The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care.

Feline zoonoses guidelines from the American Association of Feline Practitioners

Z oonotic diseases are defined as being common to, shared by, or naturally transmitted between humans and other vertebrate animals (Evans 1997). Transmission of zoonotic agents from animals to people can potentially occur by direct contact with the animal, indirect contact with secretions or excretions from the animal, and contact with vehicles like water, food or fomites that were contaminated by the animal. For many agents, infection of the animal and human occurs from a shared vector or environmental exposure. Most zoonotic agents can infect anyone regardless of their immune status. However, when immunosuppressed people are infected the clinical illness is often more severe. For example, primary Toxoplasma gondii infection of an immunocompetent person is usually inapparent whereas infection in an immunosuppressed person can cause life-threatening disease. Examples of immunosuppressed individuals include those with acquired immune deficiency syndrome (AIDS), those on immune suppressive drugs for immune-mediated disease, cancer, or organ transplantation, the fetus or other young people without fully developed immune systems, and older individuals with decremental deterioration of the immune system. When immunodeficiency is detected or suspected in a family, it is often recommended that cat ownership be discontinued due to potential health risks (Burton 1989, Spencer 1992). Because there are many infectious agents that infect both cats and humans, it is sometimes assumed that zoonotic diseases are commonly acquired from cat contact. In actuality, humans are unlikely to acquire infectious diseases from healthy, adult,

Feline Vaccination Guidelines

The 1998 Report of the American Association of Feline Practitioners and Academy of Feline Medicine Advisory Panel on Feline Vaccines was developed to help veterinary practitioners formulate vaccination protocols for cats. The current panel report updates information, addresses questions, and speaks to concerns raised by the 1998 report. In addition it reviews vaccine licensing, labeling, and liability issues and suggests ways to successfully incorporate vaccination protocol changes into a private practice setting.

Chapter 20 – Providing Feline-Friendly Consultations

The adoption of “feline friendly” protocols and procedures can have a profound effect on the overall experience of the veterinary visit for everyone involved. Many clients will avoid coming to the practice with their pets because of a previous negative experience and this is detrimental to the cat’s welfare. For many cat owners their perception that their pet “hates” to go to the veterinarian significantly influences their own emotional response to the experience and they report that they get stressed just thinking about a visit. The frequency of visits to veterinary practices is significantly lower for feline than canine patients. By developing a better understanding of the cat and its emotional responses, veterinary practices can create an environment that encourages clients to return regularly and to be more receptive to pursuing the veterinary care that the cat needs. Injuries sustained during cat handling have been shown to be the leading cause of reported employee insurance claims in a veterinary practice. Preventing negative feline emotion is the key to reducing unwanted behavioral responses in the veterinary practice, including aggression, and thereby decreasing the risk of injury and stress for clients, patients, and practice staff.

Framework for a healthy feline environment

We are honored to present in this issue the Feline Environmental Needs Guidelines,1 developed through the joint efforts of the American Association of Feline Practitioners and the International Society of Feline Medicine, and most recently endorsed by the American Animal Hospital Association. The Guidelines address the needs of pet cats in any environment, including home, veterinary hospital and shelter. Signs of stress in cats are often subtle and, therefore, difficult to recognise. But cats do indeed experience stress and this is frequently caused by their needs not being met, usually inadvertently because of a lack of understanding of those needs, which differ vastly from our own. Unfortunately, this has resulted in an increase in stress-associated disease such as lower urinary tract disease and obesityassociated diabetes mellitus. It is a sad fact that, in the United States, 58% of cats are overweight or obese,2 and there was a 16% increase in feline diabetes mellitus between 2006 and 2010.3 Additionally, when cats’ needs are not met, we see an increase in abnormal behavior, or normal behavior considered undesirable by the owner. Behavior problems are a common cause of the breakdown of the bond between owner and pet, and the surrender and euthanasia of pet cats.4,5 It is vitally important, therefore, to meet cats’ needs and allow them to express their natural behaviors, to prevent stress and undesirable behavior, and to improve feline health and welfare. The Guidelines are organized around five primary concepts (‘pillars’) that provide the framework for a healthy feline environment regardless of the cat’s lifestyle. Tips for applying the Guidelines are also provided. Panelists from the US and UK were selected to offer different perspectives, and address the needs of both the indoor and indoor/outdoor pet cat. The wide range of expertise included that of two veterinary behaviorists, a scientist specializing in feline behavior and welfare, an internist, two practitioners in companion animal practice, and two in feline practice. Huge thanks go to our co-panelists for all their efforts in making these important guidelines available to all veterinarians. We also appreciate the support of Ed Kanara, facilitator, and Mark Dana for their wisdom and help with the compilation of these Guidelines over the past several months. Incorporating these Guidelines into your practice and client education can help reduce unwanted behaviors, illness and feline stress, and enhance the relationship that cat lovers have with their cats and with your practice. Incorporating the Guidelines into shelters increases feline adoption rates by providing an environment where cats are more active and less fearful. It’s as fundamental as that.