Photos courtesy Claire Primo
As veterinary medicine continues to advance, and pet guardianship becomes more common than ever, our needs for conscious handling and restraint for our patients continues to evolve.
Concepts like "feline-friendly"1 and "Fear Free practice" are taking over veterinary clinics. Safe and stress-free patient handling are arguably the most important considerations when utilizing new approaches to animal restraint.
Many times, this means replacing old restraint methods with new, less adverse control of animals. The goal is successfully achieving a desired patient outcome, creating a more positive experience for the clients and patients involved, increasing overall safety, and ultimately improving patient and client compliance for continued care. At the forefront of this thoughtful handling is the concept of "scruffing" cats. Is this approach for handling cats good or bad? Why? Are there other options?
Scruffing refers to a restraining technique involving firmly grasping the loose skin of a cat's back, located between the shoulder blades. While scruffing is often meant for safely controlling and settling a cat, research shows the contrary. The scruffing method is often counterproductive, causing many cats to resist or even fight back more aggressively than when alternative handling is performed.2
As we become more considerate in our physical approach to feline patients, the classic scruffing has, and will continue to become, less common. Replacing this restraint technique with more integrative handling considerations is a fairly easy transition that should be considered and implemented by all veterinary professionals.
Understand body language and behavioral cues
Signs of stress in feline patients goes beyond the obvious hissing or swatting. There are many subtle changes that occur, such as ear positioning, tail placement, or eye shape, that can be excellent indicators of how stressed a cat is. Becoming comfortable in reading a cat's body language is not only important for veterinary professionals, but also for the pet parents themselves.
Like people, every cat is an individual and should be treated as such. There's not a one-size-fits-all approach for every cat. Taking a holistic approach and onboarding clients to evaluate their own cat's signs of fear and anxiety before, during, and after a veterinary visit can be paramount for determining how to approach their cat, and how to build respectful relationships for future handling.
"Less is more" restraint
When it comes to the actual physical restraint of a cat, many cats feel more comfortable, and are therefore more receptive to veterinary treatment, when they have increased control.
"Less is more" restraint may include a gentle towel or blanket swaddle, or may be covering their head to reduce visual and noise stimuli (often a trigger for fear and stress in cats). Other ways to reduce noise stimuli include playing classical music in the treatment, kennel, or exam areas to drown out other hospital noises.
Considerations such as where to place a cat for a procedure, how to transport a cat through the hospital, or what area of the hospital is being utilized should all be considerations for reducing stress and increasing compliance when handling a cat.
Stocking the clinic with high-value treats (such as meat baby food) is often an easy way to distract food-motivated cats for simple veterinary procedures. All of these considerations will keep fight or flight responses down, improve patient compliance, and therefore allow a successful implementation of the "less is more" approach.
Consider the entire clinic
For example, use a staff member's lap for basic procedures, such as nail trims or ear cleanings. Utilize the cat's traveling carrier (perhaps they don't even leave the carrier for the entire exam because it has become a "safe space" for them), or provide non-slip surfaces for examining cats, eliminating cold and slippery stainless-steel exam tables.
Let other clinic staff know you are entering an area with a cat, and recon that area and route before relocating. Prepare the procedure area with all of your procedural needs prior to bringing the cat to the area. Perform as much care in the exam room with the client as possible, and make these rooms as comfortable as possible. Perhaps these rooms have a fish tank, cat-friendly plants, or wall perches.
Whatever you do, consider all of the ways in which you can ease the stress of both the client and the patient being seen. A calm and collected client will be more present and capable at handling their cat.
Utilize a touch gradient
According to the Fear Free Certification Program, a "touch gradient" during physical examination acknowledges both a considerate approach and gentle control of a patient, and begins with constant physical contact.
This thoughtful touch is not only a great moment for a cat to acknowledge human presence, but also for the veterinary professional to assess the cat. For instance, does the cat appear startled or reactive? Does it tense up or cower? Does it attempt to flee? All of these insights help team members determine next steps, including a better understanding the fear and anxiety level of each patient.
Once physical touch is made and maintained, the level of touch slowly intensifies.3
For example, when giving a vaccine, a veterinary nurse may start by touching the cat's back and slowly petting. They may move their fingers around the injection site, increasing gentle pressure. From there, they could begin tenting the skin and releasing, until finally they administer the vaccine.
Implement pre-visit protocols
The "fear cascade" or "defense cascade," also known as fight or flight, is a natural response for dogs and cats when presented with a perceived threat.4 Understanding it is easier to manage fight or flight in veterinary patients before they are triggered is critical when managing restraint in cats using alternative means.
Intervening prior to the fear cascade can help reduce adverse handling once at the veterinary clinic, or while preparing for further chemical restraint, and often begins at home. This means educating clients on the possible use of a pre-visit pharmaceutical and explaining expectations. There may be a natural resistance from the client, especially if, from their perspective, their cat is not notably aggressive or stressed. However, explaining this will allow for a quicker and more successful management of their cat's case (including less forcible restraint) and may allow them to see the positive aspects of pharmaceutical intervention.
In addition to pharmaceutical intervention, clients may be trained to support their cat with desensitization to their cat carrier, car rides, and body handling.
Complementary, alternative approaches
For many feline patients that appear only mildly stressed with the various components of veterinary care, more natural approaches may be taken. Examples here include synthetic pheromones (like diffusers, sprays, or wipes), L-Theanine (a green tea derivative), lavender, Melatonin or music therapy. These natural approaches may all be onboarded by a pet parent prior to transporting their cat to a clinic, or upon arrival.
Some alternative approaches, such as pheromone or L-theanine use have proven studies showing a reduction in adverse reactions to transportation or veterinary care, whereas others require further review.
Conclusion
There are great organizations, such as the Fear Free Certification Program and the American Association of Feline Practitioner's (AAFP) Feline Friendly Certification, that give veterinary professionals easy access to education and certifications alike, providing a more comprehensive understanding of emotionally and physically-conscious handling of veterinary patients. These programs go beyond the conversations of alternatives to scruffing and include a very multi-faceted look at the entire veterinary experience for dogs and cats, beginning before they even enter a clinic.
When we look at alternatives to scruffing cats, we are challenged to look at the big picture. Utilizing this holistic approach can only deepen the human-animal bond. By respecting feline patients and using techniques that allow veterinary care to be successful, we are taking the stance that all species' needs are valid and important.
Claire Primo is a veterinary nurse and certified animal massage therapist residing in Lyons, Colo. She offers animal massage therapy, laser therapy, hospice and palliative care and veterinary nurse needs through her practice, Peak Animal Wellness & Massage, while also managing a holistic veterinary house call practice, Boulder Holistic Vet. She specializes in senior pet care, holistic veterinary nurse care, and empowering guardians with all the appropriate tools and guidance needed for a healthy and nurturing relationship with their pets. In her spare time, she can be found in her small mountain town playing and connecting with her husband, two-year old son, two dogs and cat.
References
- Group, M. C. I. (n.d.). American Association of Feline Practitioners. Retrieved May 16, 2022, from https://catvets.com/cfp/cat-friendly-certificate-program
- Taking the "pet" out of "petrified" for all animals. Fear Free Pets. (n.d.). Retrieved May 16, 2022, from https://fearfreepets.com
- Pledge to go 'Scruff Free'. International Cat Care. (n.d.). Retrieved May 16, 2022, from https://icatcare.org/our-campaigns/pledge-to-go-scruff-free
- Fear Free℠ techniques for common veterinary procedures. WSAVA 2017 Congress. (n.d.). Retrieved May 16, 2022, from https://www.vin.com/apputil/content/defaultadv1.aspx?pId=20539&catId=113435&id=8506358&ind=412&objTypeID=17
- From the Disciplines of Psychiatry (Drs. Kozlowska and McLean) and of Paediatrics and Child Health (Dr. Kozlowska). (n.d.). Fear and the defense cascade: Clinical implications and Management. Harvard Review of Psychiatry. LWW. Retrieved May 16, 2022, from https://journals.lww.com/hrpjournal/Fulltext/2015/07000/Fear_and_the_Defense_Cascade_Clinical.3.aspx
