Examination of puppies is an essential part of clinical practice for both general veterinarians and specialist ones. In order to be able to measure an animal’s temperature accurately, palpate it or withdraw blood or other organic material, it should be possible to handle the patient easily and, if necessary, for long periods of time. Some critical steps associated with the clinical examination can be optimised in order that the puppy associates this examination with a positive feeling and, therefore, has a “good memory” of this experience:
• the journey (journey by car);
• the waiting room;
• the examination room (table, exploration);
• the veterinarian (tone of voice, movements, hands and gowns);
• the clinical examination (manipulation, food treats).
THE JOURNEY
The journey starts when the owner puts the puppy into the carry box or in the car. This operation should not be transformed into a chase, otherwise the patient will associate this event with a negative experience which may then lead to aggressive behaviour when handled during the examination. The journey in the car is another critical period. Vocalisations, emotional micturition and defecation, polypnoea, sialorrhoea and vomiting are all signs of an extreme sense of unease and may contribute to the development of a phobia. In fact, as a result of a biofeedback mechanism, neurovegetative manifestations may become progressively more intense and in the future may appear just on seeing the car. Transportation phobia and “car sickness” compromise the emotional state of the animal which leads not only to memorisation of a negative experience but also to an increased irritability of the puppy
In order to make the journey in the proper way, both the entry of the puppy into the carry box and its journey in the car should be optimised.
Entry into the carry box:
• use a plastic carry box;
• spray synthetic pheromones into the carry box (2-3 puffs, done outdoors to favour the evaporation of the solvent present in the product);
• wait a few minutes and then leave the box open in the room of the house which is most frequently used by the puppy;
• put some food treats in the carry box in order to encourage exploration of the box;
• these operations must be repeated daily until the puppy readily enters the box and stays in it for long periods;
• the carry box should remain accessible for the entire life of the animal;
• it is worth repeating the application of synthetic pheromones before every journey;
• once back home the carry box should be carefully cleaned with tepid water and a neutral soap in order to eliminate the alarm pheromones deposited by the puppy during the journey and the examination;
• it is advisable to repeat the application of the synthetic pheromones after each journey.
The journey by car:
• spray synthetic pheromones in the area of the car where the puppy is going to be put (2-3 puffs, done leaving the doors open so as to facilitate evaporation of the solvent present in the product);
• wait for a few minutes and then put the patient into the rear seat of the car using the safety belt or in the carry box, in the trunk, with a pet barrier;
• during the first journeys it is preferable not to put the puppy into the trunk, far away from the owner;
• avoid braking suddenly or accelerating repeatedly because the sense of unease resulting from the journey could trigger neurovegetative manifestations (sialorrhoea, vomiting);
• a journey by car should be repeated on a weekly basis (for example, going around the block), at least during the first year of life of the puppy, so as to allow the animal to get used to the car;
• it is advisable to repeat the application of synthetic pheromones before each journey.
THE WAITING ROOM
The presence of other animals (conspecific or not), sudden noises and abrupt movements may frighten the puppy. Alarm pheromones deposited in the waiting room by other dogs and cats in the preceding hours may contribute to modify the patient’s emotional state.
In order to associate the clinical examination with a “positive recollection”, the stay in the waiting room should be optimised (Fig. 1):
• the floor should be cleaned several times a day with tepid water and a neutral soap in order to eliminate the alarm pheromones;
• noises, such as those from doors which close violently, and abrupt movements of staff (for example, running or gesticulating) should be limited;
• the owner should be informed about the possibility of booking an appointment for the puppy beforehand, so as to limit the time spent in the waiting room as much as possible.
THE EXAMINATION ROOM
The examination room must be hospitable from the point of view of the puppy.
Rooms in which the patient can be left free to roam during the conversation with the owner are to be preferred. Puppies are curious and explore unknown places with pleasure (Fig. 2).The surface of the examination table must be comfortable, soft and slip-proof. The presence of alarm pheromones deposited by other animals during previous visits may have an impact on the emotional state of the patient inducing avoidance and flight.
In order to receive the patient correctly, the entry into the examination room should be optimised:
• clean the table with tepid water and a neutral soap in order to eliminate alarm pheromones;
• after this, detergents and disinfectants can be used, although the table should then be cleaned again with water and a neutral soap just before receiving the patient (otherwise the chemical composition of pheromones could be altered);
• spray synthetic pheromones on the table (2–3 puffs);
• the cat should be allowed to explore the room (having first blocked any opening which could be used as a hiding place) before the physical examination is started;
• the patient should have access to a fresh water dispenser (or drinking fountain) (Fig. 3);
• the presence of perfectly sociable adult dogs may help the puppy in interacting with the environment and with the veterinarian.
THE VETERINARIAN
The factors that can contribute to altering the emotional state of the puppy are the veterinarian’s tone of voice and movements. Talking with a loud voice, moving abruptly and gesticulating frightens the patient and favours the expansion of its field of aggression. In addition, alarm pheromones on the hands and gown of the veterinarian may cause a flight reaction in the puppy, jeopardising the physical examination. The manipulation of the patient should start only when the puppy has finished exploring the examination room (the puppy sits next to the owner or starts playing).
The following points are important in order to optimise the approach to the patient:
- use of a low tone of voice tone and a continuous singsong rhythm tranquillises the patient;
- movements must be slow, with as little gesticulating as possible. Remaining still at the desk favours exploration of the room;
- just before starting manipulation of the patient, the veterinarian should wash his or her hands and forearms with water and a neutral soap, so as to remove any alarm pheromones;
- after the examination of a particularly fearful patient (cat or dog) it is advisable to use a clean gown as the fabric could be impregnated with alarm pheromones.
THE CLINICAL EXAMINATION
A structured clinical examination obliges the veterinarian to carry out the clinical manoeuvres in a well-defined order: inspection, palpation, percussion, auscultation and temperature measurement. It is worth remembering that measuring the temperature is undoubtedly the “most annoying” of these interventions. In order to minimise the puppy’s discomfort during the examination it is advisable to start with the inspection and auscultation, then measure the animal’s temperature and conclude with palpation (Fig. 4).
By doing this, the examination can be completed while leaving the puppy a “positive” memory of the experience. In order to carry out a proper clinical examination it is also essential to understand “how” the patient communicates (Fig. 5). Dilatation of the pupils, tremors, exudation of the footpads, nose licking, polypnoea, y
awning, emotional micturition/defecation are all signs of stress indicating to the clinician that the patient’s “collaboration” has come to an end.
In order to manipulate the patient in a proper way the clinical examination must be optimised:
• before starting to manipulate the patient it is necessary to wait for the puppy to take the initiative and establish the first contact, as the cat must observe and explore the clinician before accepting any physical contact;
• the manipulation must be done with soft, short movements (limited to the flanks and to the ventral side of the neck), repeated over time (almost rhythmically, like a massage);
• during the examination it is advisable to reward the puppy with a tasty treat (on sale in pet shops), especially before, during and after a painful manoeuvre;
• each manoeuvre should be preceded by a verbal explanation: “Now I will…”.
CONCLUSIONS
Optimising the clinical examination by paying attention to the above mentioned five steps will allow the veterinarian to examine the patient whenever necessary. The puppy will in fact associate the experience with a “positive memory” and will accept repeating the examination again in the future. It should be highlighted that the time necessary to complete the examination following the five steps will be longer than the time usually reserved for such a task. To keep up to date, the clinician must increasingly set the wellbeing of the patient as the goal and give priority to the quality of the examination rather than to the quantity of such examinations.
Suggested readings
- Caney S. M. A., BVSc, PhD, Dipl SAM (Feline), MRCVS, RCVS Spec in Feline, Emsworth, UK, Cos’è e come impostare una “cat friendly practice”, Estratti delle relazioni, 55° Congresso di Medina Felina, marzo 2007, pp 14 – 24;
- Colangeli R. & Giussani S., (2004), “Medicina comportamentale del cane e del gatto”, Poletto Editore, Gaggiano;
- Giussani S., Colangeli R., Fassola F. – “L’uso dei feromoni nella terapia comportamentale del gatto. Esperienze cliniche.” – Rivista di zootecnia e veterinaria pp 13 - 34 Volume 31 n° 1 Gennaio - Giugno 2003;
- Giussani S., Colangeli R., Fassola F. – “Approccio clinico all’utilizzo della feromonoterapia nel gatto.” – Rivista di zootecnia e veterinaria pp 35 – 45 Volume 31 n° 1 Gennaio - Giugno 2003;
- Giussani S. - “La visita clinica del gatto: 5 consigli per perfezionarla”; Estratti delle relazioni, 56° Congresso Internazione Multisala SCIVAC; Rimini 2007; Pp 255 – 257;
- Giussani S., Colangeli R., Fassola F. – “L’uso dei feromoni nella terapia comportamentale del cane. Esperienze cliniche.” – Rivista di zootecnia e veterinaria pp 13 - 34 Volume 30 n° 2 Luglio – Dicembre 2002;
- Giussani S., Colangeli R., Fassola F. – “Approccio clinico all’utilizzo della feromonoterapia nel cane.” – Rivista di zootecnia e veterinaria pp 35 – 45 Volume 30 n° 2 Luglio – Dicembre 2002.