The Italian Language Dictionary defines both being admitted to a hospital and hospitalism (syndrome identified by R. Spitz in children admitted to a foundling hospital and characterised by a delayed development and the presence of affective disorders/set of psychological disorders or illnesses that can arise during a long period in the hospital) as Hospitalisation. The term Hospitalisation means a transfer to a place of treatment and care where one can find refuge, safety and protection. Hospitalisation is a critical point within the patient recovery process. In order to carry out the treatments required by the disease present and draw a sample of blood or other organic material, dogs and cats must be easily handleable throughout the entire duration of the hospitalisation. Behavioural Medicine, which takes into consideration the ethological characteristics of the species being examined starting from the time the patient arrives at the waiting room, not only promotes the physical well-being but also the psychic well-being of dogs and cats.
PAIN, AN EMOTIONAL EXPERIENCE
Pain and suffering are unpleasant, disagreeable and aversive mental states. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage; the inability of a patient to express this state does not negate the existence of the state itself, nor should it preclude the possibility of appropriate pain-relieving treatment”.The Psychology Dictionary defines both physical pain and psychic pain. From the physiological standpoint, pain originates from excessive stimulation of the different receptors situated both on the outer surface and in the internal tissues of the body and from here it is transmitted via the neural pathways to the upper centres of the cerebral cortex. Similarly to physical pain, psychic pain causes a narrowing of the field of consciousness on distressing and depressing events. For Freud, psychic pain, in terms of subjective personal experiences, is entirely on a par with corporal pain. All subjects experience pain differently, as it is closely dependent on the previous painful experiences through which the individual has created a mental representation and an emotional personal experience of the pain. In his reflection on pain, Wittgenstein (1967) maintained that humans control and confine pain through language. By expressing it, we place the painful event in a place and assign a meaning to it.
The emotions, as indicators of the animal’s inner state and of the favourable or unfavourable aspect of a situation, are an integral part of the cognitive state of mind. To convince ourselves of this, it is sufficient to recall how frontal affections of the cortex disturb the perspectival organisation of behaviours and, inversely, how emotional disorders are susceptible to the calling into question of our representations of the world. Each experience of a dog and cat is marked by an emotion that puts the body in the best conditions for facing it. A bond exists between representation and emotion: each one can evoke the other, and vice versa. Furthermore, there is a memory of fear: the fact that fear cannot be erased is a double-edged sword. It is useful for our brain to preserve the recordings of the stimuli and situations associated with a danger in the past, however these powerful memories formed under typically traumatic circumstances can push their way into daily life and interfere with situations that can overwhelm normal mental functions. An S – S learning takes place, triggering a negative biofeedback mechanism.
We infer from this that illness (malaise, pain) puts dogs and cats in a state of difficulty marked by emotional hypo- or hyperreactivity. In addition, the presence of behavioural disorders already underway at the time of hospitalisation contributes to the deterioration of the patient’s emotional state.
DISTRESS INVALIDATES PHYSICAL RECOVERY
By stress we mean a state of altered homeostasis, which can be caused by physical or psychic factors, called stressors. The body reacts by activating mechanisms that trigger a series of physiological, immune and behavioural functions in order to adapt to the new situation and restore the initial homeostasis. This is a highly adaptive physiological mechanism that allows the animal to react quickly to an event that may threaten its survival. In such a situation, the body activates those resources which allow it to respond to the change with an optimisation of the state of alertness and reactivity and with activation of the immune system in order to defend itself against possible pathogens and stressors. The stress response is the result of the close communication between the Central Nervous System, the Stress System and the Immune System. This response may become problematical when an animal is incapable of controlling the situation or of avoiding the stressor through a correct behavioural response. In these cases a negative effect on the physical and emotional health of the individual may be observed, characterised by both an alteration in the immune function and consequent greater susceptibility of the body to diseases, and by inappropriate or abnormal behavioural responses whose purpose is to reduce the harmful effects of a prolonged stress response.
The presence of several elements that cause stress in kennel environments has been reported in numerous studies (Hennessy et al., 1997; Beerda et al., 1999; Marston and Bennett, 2003; Coppola et al., 2006), including:
- high noise level;
- continuous exposure to new elements;
- isolation/separation from attachment figures;
- prolonged confinement (in restricted spaces and lack of exercise);
- reduced interaction with conspecifics and people;
- change in daily routine (no study has ever made an in-depth analysis of the effects of changed routine, but it is presumed to be a source of stress for the animal).
Hospitalisation involves the presence of all of the above-mentioned elements and, consequently, they can be identified as stressors. Furthermore, since stress can also be caused by pain, the disease becomes itself a stressor and contributes to the increase in stress in the patient. Based on all the above it may be concluded that housing healthy animals in cages intended for hospitalisation, as if the veterinary facility were a boarding house, is a significant source of ethological maltreatment.
THE VIEWPOINT OF BEHAVIOURAL MEDICINE
Behavioural Medicine, taking into consideration the ethological characteristics of the species being examined starting from the time the patient arrives at the waiting room, not only promotes the physical well-being but also the psychic well-being of the dog and cat. In order to increase the patient’s tolerance and acceptance of handling at the time of hospitalisation, a series of factors are to be considered:
- the stay in the waiting room;
- the entrance to the examination room;
- the conduction of the clinical examination;
- the Veterinarian;
- some elements of the clinic (rooms, microclimate, cages, examination table);
- the dog and cat (puppies, aggressive patient).
Indeed, by fostering as much as possible the perception of positive emotions by the dog and cat, the doctor-patient relationship can start on the right track. It is necessary to point out that when a dog or cat arrives in critical condition, the emergency medicine procedures aimed at saving its life will be able to take the preceding considerations into account only once the patient’s clinical conditions have been stabilised.
THE STAY IN THE WAITING ROOM
The perception of sudden noises and brusque movements may frighten both dogs and cats (which can be both prey and predator). In addition, the presence of other animals (conspecifics and not) and of unknown humans may contribute to the expansion of the patient’s field of aggression. The alarm pheromones left by other animals that have recently passed through the waiting room may contribute to changing a dog or cat’s emotional state.
In order to allow the animal to associate a “good memory” with the prehospitalisation physical examination, it is advisable to improve the stay in the waiting room:
- cleanse the floor several times per day with warm water and mild soap to eliminate alarm pheromones;
- try to limit the emission of noises, such as slamming doors and sudden movements of the staff (e.g. running or gesticulating);
- reserve some seats (indicating them with a sign) for cat owners, to prevent the presence of pheromones of other species in the reserved area;
- make structures available (such as stools) for setting the pet carrier down;
- when possible, a room should be set aside (even inside the Clinic) dedicated only for cat owners, where a synthetic feline facial hormone diffuser can be set up;
- the owner should be notified about the possibility of making an appointment for a visit for the cat/dog in order to limit as much as possible the stay in the waiting room.
THE EXAMINATION ROOM
The examination room should be inviting from the dog and cat’s “point of view”. Rooms with natural lighting are preferred, as well as those in which the patient can be left free (when clinical conditions allow it) while talking with the owners. Dogs and cats are “curious” and enjoy exploring unknown places. It is good to remember that sudden noises and brusque movements frighten cats, which can be both prey and predator. The examination table should have a comfortable, soft and nonslip top. In addition, the alarm pheromones left by other animals during previous visits may change the patient’s emotional state, inducing avoidance and escape behaviour.
The entrance to the examination room should be done with great care in order to receive the patient correctly:
- cleanse the table with warm water and mild soap to eliminate alarm pheromones;
- detergents and disinfectants may be applied after the table has been washed but it must be then cleaned again with water and mild soap just before receiving a new patient (otherwise the chemical composition of the pheromones might change);
- using a vaporiser, spray synthetic analogues of feline facial pheromones or of dog appeasing pheromones on the table (2-3 nebulisations);
- wait a few minutes and then set the pet carrier on the table;
- give cats time to observe the environment, without forcing them to come out;
- it is advisable to let dogs and cats explore the room (after having blocked any blind passages that could serve as a hiding place) before beginning the physical examination;
- it is opportune to leave a dispenser (or drinking fountain) with fresh water at the patient’s disposal.
THE PHYSICAL EXAMINATION
The objective structured clinical examination obliges the Veterinarian to perform the clinical procedures in a specific order: inspection, palpation, percussion, auscultation and temperature measurement.
It should be recalled that temperature measurement is undoubtedly the “most annoying” procedure. To reduce discomfort as much as possible in the dog and cat during the examination, it is best to start with inspection and auscultation, continuing with temperature measurement and ending with palpation. In this way it is possible to end the visit leaving a “positive” memory. Carrying out forced handling by performing a “rodeo” with dogs and cats induces a negative emotional situation that will affect the entire stay in the hospital. In addition, performing instrumental examinations on the patient when pain symptoms are present will make the situation worse.
Knowing how the patient communicates is essential for conducting a correct clinical examination. Pupil dilation, tremors, foot pad exudation, nose licking, polypnea, yawning and emotional urination/defaecation are stress signs that indicate to the Clinician the end of the patient's willingness to collaborate.
In order to handle the patient correctly, the physical examination must be done with great care:
- handling should begin when the patient has finished exploring the examination room (dogs sit near their owner, cats crouch down near the pet carrier – left open, on the floor – or, more commonly, on the desk);
- before handling the animal, wait until the dog/cat initiates contact, since the patient has to observe and explore the Clinician before accepting physical contact;
- it is necessary to wash hands and forearms with water and mild soap just before handling the patient to remove alarm pheromones of previous animals;
- it is advisable to use a clean gown after having examined an especially fearful patient (cat or dog) since alarm pheromones might have remained on the fabric.
- handling should be gentle, using short movements (limited to the head and neck) and, especially in cats, continuous (almost rhythmically, like a massage);
- during the visit it is good to reward dogs with an appetising snack (when the patient’s clinical conditions allow it) or with a verbal reward (“Good boy/girl!”) especially before, during and after painful handling;
- do not lift cats by the scruff of the neck! This can be done to perform a behavioural evaluation test up to 7 months of age;
- once started, physical contact should be maintained until the end of the examination otherwise the cat’s field of aggression could expand, preventing subsequent handling;
- when the patient emits stress signals (panting, chewing, yawning and so on), it is advisable to stop handling the animal and begin, for example, palpation in a different spot;
- at the end of the examination the patient will be invited to get into the pet carrier, rewarding it with an appetising snack (when the patient’s clinical conditions allow it) or with a verbal reward (“Good boy/girl!”)
- it is advisable to close the pet carrier only a few seconds before accompanying the owner to the exit so that the cat does not become agitated, vocalising and trying to get out;
- each handling episode should be preceded by a verbal announcement (“Now I am going to …”).
THE VETERINARIAN
According to the Author, the staff (the Veterinarian and the nursing staff present) that deals with hospitalised patients should be trained/specialised in the specific sector of Hospitalisation, since clinical routine differs profoundly from hospitalisation practice. It is essential to remember that the veterinary profession falls under those defined as Helping Professions: the Veterinarian establishes a relationship with the client and with the patient based on alliance, understanding and support. The emotional work is very hard, since it involves taking on the suffering. Since pain manifests itself most during hospitalisation, it is necessary to watch out for the burnout syndrome (the pathological outcome of a stress-inducing process which affects the people who exercise helping professions since they have to withstand their own stress and that of the person they are helping).
The staff should also be trained in Behavioural Medicine in order to:
- correctly use paraverbal (posture, proxemics, kinetics), coverbal (tone and volume of voice, rhythm) and verbal communication (words) when interacting with dogs and cats;
- know the physiological and ethological requirements of the hospitalised species (environmental enrichment).
Furthermore, it is also necessary to properly manage the return home of the patient, in order to prevent a possible conflict should the dog or cat live together with other animals of the same species. The notions of Behavioural Medicine will not only allow a more in-depth knowledge of the patient but will also help establish a relationship between the animal and the staff.
PARAVERBAL, COVERBAL AND VERBAL COMMUNICATION
Theelements that can contribute to changing the emotional state of a dog/cat are posture, proxemics, kinetics, gestural expressiveness and the tone/rhythm of the voice. Standing in front of the animal (especially in the case of dogs), moving quickly, gesticulating and talking in a loud voice frighten the patient, encouraging the expansion of the field of aggression.
It is necessary to assume a neutral position (Fig. 1) (not positioning our body in frnt of the patient) and to direct our gaze away from the dog or cat’s face. To get the dog or cat to come out of the cage, it is advisable to approach the animal following a curvilinear (not rectilinear) path and to stop near the cage, standing to the side of it (our shoulders should be perpendicular to the cage). In the case of dogs, the doctor should assume a low stance, lowering herself/himself by bending her/his knees. Furthermore, it is necessary to move slowly, trying to gesticulate as little as possible and to speak softly with a singsong and continuous rhythm in order to calm the patient down.
Facial expressions are also a form of communication: a raised eyebrow conveys a message of irritation! In the majority of cases, once the cage is opened, the dog will come out of its own accord. Otherwise, a leash can be showed, and in this case it is advisable to take the dog for a short walk (when the patient’s clinical conditions allow it) so that coming out of the cage may be associated with a positive event. To put the collar and harness on one should bend over the dog laterally, to avoid towering over it (for example, leaning over the animal’s head or back). If the patient is recalcitrant, the food bowl can be placed outside the cage waiting for the animal to come out.
With regard to cats, it is advisable to begin the interaction with visual and verbal contacts at first, waiting for the patient to convey its willingness to collaborate. Once the cage is opened, such interaction should be continued until the cat approaches the doorway of the cage, beginning to rub its cheeks on the bars.
PHYSIOLOGICAL AND ETHOLOGICAL REQUIREMENTS OF DOGS AND CATS
Theawareness of dealing with different species involves the knowledge of the different needs of dogs and cats. Food, water and shelter are considered primary physiological requirements for all living beings. Being subjects with a mind, dogs and cats also have safety and behavioural requirements, with aptitudes and emotions capable of shaping their own experience in the world.
Dogs and cats divide the environment in which they live into zones, in which they carry out different activities: zones for eating, resting, elimination, playing and so on. In addition, cats deposit F3 facial pheromones by rubbing their cheeks on the objects placed along the paths that connect the different territorial fields to each other and F4 pheromones on the living beings (animals or humans) with whom they live.
Dogs are social animals; this nature stands out above all others to the point that humans have always used the wolf – dog code when they have wanted to describe loyalty and identification in the group. Having a propensity for group relationships means much more than the simple recognition that dogs love to be in company. The dog’s sociality is its life dimension: to be a social and socio-referred animal means, first of all, to build some very close relationships and some affinities; in other words dogs constantly look for mutual understanding and define their position accordingly.The dog’s social-reference leads it to become interested in the group: dogs are interested in everything that we do, they do not lose sight of us, they capture every variation in our mood or lifestyle and they know our habits and our gestures.
The observations made in recent years on the behaviour of cats have highlighted that the image of a solitary animal does not in fact correspond to reality. Living with human beings drives the cat to create one or more social relationships with family members, even though the preferential relationship (involving, for example, the sharing of the resting place) is often directed at a single person.
The dog/cat-owner relationship is composed of several factors called relationship dimensions. Dogs show a preference for the social and collaborative dimensions that are created, especially during outdoor walks, through encounters with human beings, other dogs and the carrying out of activities that are part of their daily life (stopping at the end of the pavement, coming when called, etc.). Cats show a preference for collaboration and play - cognitive dimensions that are created, in the majority of situations, in the domestic environment since they are not taken out for walks.
During hospitalisation, the cage should be considered as the patient’s residence, a place where they can feel safe (Fig. 2). Furthermore, the staff of the Clinic should carry out the role not only of therapist but also that of substitute of the owner, in order to compensate for the temporary absence of social contact. Comfortable bedding can be put in the cage to make it comfortable (the owner may bring the bedding usually used by the animal), when the patient’s clinical conditions allow it. Or it is possible to remedy with absorbent pads or perforated plastic horizontal surfaces when the animal is not capable of controlling its bodily functions.
With regard to cats, a species which is both prey and predator, it is essential to put a refuge within the cage, such as the pet carrier (without the door). In fact, most cats need to get away from the gaze of other animals and of the staff in order to rest peacefully. Using the pet carrier allows the animal to enjoy a protected resting place and the staff to observe it through the front opening without the door. In the absence of a correct rest area, cats may choose to take refuge in the litter box, maintaining a state of hypervigilance which could lead to an expansion of the field of aggression. The use of a horizontal surface (made of stainless steel in the majority of cages) makes it possible, if the cat’s clinical conditions allow it, to obtain a three-dimensional space which allows a better subdivision of the zones (the feeding zone can be placed up high).
In addition, cats require a litter box (complete with litter) for their bodily functions. In the absence of this structure, the animal might urinate and defecate in inappropriate places upon returning home, having developed a preference for a substrate other than litter. When the patient’s clinical conditions allow it, a toy can be put in the cage (the owner can bring the one usually used by the dog or cat).
Walks play an essential role for dogs and cats during the hospitalisation period as they allow the animal to "distract itself" and to recover a known routine. When the patient’s clinical conditions allow it, dogs can be taken outside with the help of the clinical staff or of the owner. It is necessary to avoid walking in front of cages housing animals of the same species in order to limit barking and aggressive behaviours. The Author advises using a harness instead of a collar, when possible, as it makes it easier to restrain the dog during the walk and allows the animal to explore the outside environment without having its neck tugged. Cats also need to have brief outings within the clinic environment.
A FEW STRUCTURAL ELEMENTS
TheAuthor did not find anything in the currently available scientific literature regarding the size and number of rooms with which to set up a hospital. For this reason, the solutions developed in veterinary clinics are the most disparate! The rooms intended for hospitalisation should be separated based on the species housed in them, properly cleaned (the literature offers several indications on the matter) and equipped with a synthetic pheromone diffuser. When it is not possible to separate the species, dogs should be put in the lowest part of the row of cages and cats in the highest part. In the Author’s opinion, a good solution is to have four rooms set up for hospitalisation: one for dogs, one for cats, one reserved for infectious patients and one set aside for the examination and treatment of the hospitalised animals.
The microclimate is defined as “the set of components (e.g. temperature, humidity, air speed) that regulate the climatic conditions of a closed or semi-closed environment, like a work environment”. The Manual of Nursing Techniques takes temperature, aeration, lighting and noise into consideration, dealing with these topics from the viewpoint of human beings. The Author did not find anything in the currently available scientific literature regarding the impact of the microclimate on the hospitalised patient’s psychophysical conditions. Music therapy, on the other hand, is cited as bringing about well-being and this appears to be scientifically demonstrated with regard to dogs and cats. In the majority of the clinics visited by the Author, the temperature of the rooms intended for hospitalisation is the same as that in the other rooms, aeration is often obtained with the aid of air conditioners or by opening windows (which allows insects to enter), there is no air extraction system (the smell in the room is often strong and annoying for the patient, the visiting owner and the staff), lighting (especially artificial) is present day and night and the noise level is impressive (cries and howls of hospitalised patients, yelling and laughing of the staff, metallic noises caused by the opening and closing of the cages and by the tools set on the examination table placed in the room).
The Author did not find anything in the currently available scientific literature with regard to the selection of cages (position, dimensions, materials). From the Behavioural Medicine viewpoint, cages should not face each other, so that the animals cannot see each other and display aggressive behaviours. Furthermore, with regard to dogs, the cages should be placed in such a way that the patients taken for a walk do not have to pass in front of other cages, in order to prevent displays of aggressive behaviour on both sides. In addition, to give the staff better visual control, the cages should be placed strategically with respect to the entry door of the room intended for hospitalisation. Several models have an additional horizontal surface which, once positioned, allows the cat to divide the territorial fields, thus aiding in the satisfaction of some ethological characteristics of this species. The alarm pheromones deposited on the bottom and on the walls of the cage must be removed before putting the patient in, and synthetic appeasing pheromones should be used. These substances should be reapplied approximately every two hours, with the cage empty: due to the presence of an alcoholic based solvent, a few minutes should pass before putting the dog or cat back in the cage. Where clinical conditions allow it, a collar with synthetic pheromones can be put on dogs, which allows a long duration of the appeasing effect (four weeks).
The patient should consider the cage as a safe place: handling and treatments (except for intravenous perfusion) should be performed outside this space, otherwise the animal will feel constantly threatened, without any place of refuge, and will expand its field of aggression. To foster the patient’s long-term cooperation, intravenous or oral therapies should be chosen over intramuscular or subcutaneous ones (often quite painful), and a body suit should be preferred over the Elizabethan collar. Handling and treatments should best be carried out at specific times, allowing the animal to easily understand when they will occur: the predictability of the day has an important tranquillising effect. The Veterinarian and the nursing staff will communicate what is about to happen to the patient. It is advisable to enter the room and greet (verbally) all hospitalised patients. Then, maintaining verbal contact, the first cage can be opened and the animal informed about what is about to happen (“Now I’m going to …”). One should then wait for the dog or cat to issue a signal indicating their willingness to be touched. It is advisable to give a food reward at the end of the physical examination and of the treatment, and not while handling the animal or performing clinical examinations since the patient might associate food with the perception of pain and refuse the normally administered ration of food.
The examination table should have a comfortable, soft and nonslip top. In addition, the alarm pheromones left by other animals during previous visits may change the patient’s emotional state, inducing an avoidance and escape behaviour. For this reason, it is necessary to cleanse the surface with warm water and mild soap and, after having dried it, to apply one or two sprayings using a synthetic pheromone based vaporiser. After a wait of a few minutes the patient can be placed on the table.
PUPPIES AND KITTENS
Thehospitalisation of puppies and kittens (often isolated in the infectious ward) should be followed carefully since often these patients have not yet completed all of the behavioural development phases. In addition, the absence of the owner or of a reference figure fosters deterioration of the patient's emotional state since, if afraid, the puppy or kitten will not be able to appease its discomfort. Social isolation (sporadic contact with humans) and the absence of daily contact with conspecifics and external stimuli foster the onset of phobias that may manifest themselves with avoidance, escape or aggressive behaviours.
It is necessary to:
- increase the frequency and duration of the interactions with the Veterinarian and the clinical staff;
- increase the frequency and duration of the visits of the adoptive family;
- allow the kittens and puppies to take several walks inside the room where they will be hospitalised, making toys available (balls, soft toys, cardboard boxes and so on);
- when the patient’s clinical conditions allow it, socialisation with individuals of the same species, both babies and adults, should be fostered.
THE AGGRESSIVE PATIENT
Hospitalisationof an aggressive patient poses several problems within the hospital: often the handling required to perform the treatments is complex and the instrumental tests difficult to perform. All of this hinders the recovery of both the patient and of the animals in nearby cages because of the vocalisation during the examinations and the continuous release of alarm pheromones. In dogs, there are significant behavioural differences between the different breeds since humans have changed the aptitudes and motivations of these animals based on the work that they had to carry out or on the aesthetic characteristics required by some competitions. For this reason, some subjects belonging to specific breeds may be characterised by a low social profile (socialisation, sociability) and come across as distrustful of unknown human beings. Any doctor prefers to deal with a Labrador Retriever rather than with a Maremma-Abruzzo Sheepdog!
The presence of behavioural disorders that existed before hospitalisation, characterised by symptoms linked to insufficient socialisation with humans (Sensory Deprivation Syndrome, Secondary Desocialisation) or to self-control deficit (Hypersensitivity – Hyperactivity Syndrome) could be at the basis of the aggressive behaviour. It is necessary to remember that the existence of pain symptoms may also cause aggressive behaviour due to irritation. The memory of a negative event connected with the doctor, with the examination table or with the cage (caused, for example, by forced and painful manipulation during a previous clinical examination or hospitalisation) may trigger an aggressive behaviour.
Means of restraint (towel, muzzle, Elizabethan collar, restraint cage and so on) are not a long-term solution as by rapidly modifying the patient's emotional state and leaving the memory of a negative experience they will hinder subsequent handling even more.
In this case it is opportune to make use of chemical restraint, pharmacological treatment or the owner‘s help. As a matter of fact, whenever the dog/cat-owner relationship is based on trust, it is possible to involve the person as technical support when administering drugs by mouth, applying dressings or taking the animal for walks. The Veterinarian often has to use neuroleptics or arylcyclohexylamines to “tranquillise” the patient.It should be recalled that some sedative neuroleptics have a dose-dependent effect: at a low dose, for example, acepromazine is capable of improving behaviour owing to an anti-deficit effect. These molecules bind to the presynaptic (D2) and postsynaptic (D3) dopaminergic receptors, with an antagonist action (the receptor is blocked). The greater affinity is for the D2 receptors: the neuroleptics, initially and if at low dosage, will bind with the presynaptic autoreceptors and, blocking them, will inhibit the negative retrocontrol process, consequently increasing the release of dopamine. When the dosage of neuroleptics increases, the D2 receptors are saturated and the molecules begin to interact with the postsynaptic D3 receptors, blocking the action of dopamine and decreasing transmission. This is the neuroleptic’s anti-production action. The paradoxical effect is thus an anti-deficit effect linked to the dose.
Arylcyclohexylamines stimulate the limbic system and the reticulated substance, while they depress the activity of the thalamus and of the cortex. Administration of these molecules (ketamine, tiletamine) causes a dissociation between sensory perception and cortical integration. The animal appears unconscious, but external stimuli (especially noises and variations in brightness) are perceived and trigger intense emotional responses. Upon awakening, the animal may present photophobia and behavioural changes induced by the emergence of a state of anxiety linked with the presence of hallucinotic eidolia (visual hallucinations) while, when the dog finds itself in a hypostimulating environment, avoidance or aggressive behaviours may appear in response to any interaction (Pageat P.).
With regard to pharmacological treatment, a behavioural examination before hospitalisation is to be performed. The Veterinarian may then begin a preventive pharmacological and behavioural treatment in order to improve some behavioural symptoms. Some Authors (Mège C, Beaumont-Graff E, Béata C, Diaz C, Habran T, Marlois N, Muller G.) have pointed out the usefulness of the administration of non-selective serotonin reuptake inhibitors (clomipramine) during hospitalisation. Besides its use for behavioural disorders in the strict sense of the word, clomipramine can be prescribed during the postoperative stay (orthopaedic surgery, mammary tumours, and so on) with the intention of increasing the animal’s well-being and limiting the consequences connected with pain (agitation, attempts to pull off dressings, licking). If used during the postoperative period, the dose is 4 mg/Kg in dogs divided into two daily administrations from the first day of hospitalisation until the sutures (or orthopaedic device) are removed. In cats, instead, the dose is 0.2-0.8 mg/Kg total in one or two administrations per day. To reduce the frequency and intensity of aggressive behaviours, the Author considers it possible to also use an SSRI (fluoxetine) at a dose of 2-4 mg/Kg in dogs and 0.5-1 mg/Kg in cats in a single administration in the morning.
The secondary effects detected are basically due to the synaptic adjustment and appear at the beginning of treatment. Cases of urinary retention, even of a certain severity, have been found in cats. A decrease in the dosage is recommended in this case, and if the undesirable effect still persists, treatment should be suspended.
According to the Author, the use of anxiety-reducing molecules of the benzodiazepine family should be opportunely considered. Benzodiazepines should not be used to treat aggression since their disinhibiting action could lead to hostile or even aggressive behaviours. Disinhibition, sometimes violent (see the orexigenic effect, called rebound), is especially contraindicated in situations of social conflict (within the family group) since it can lead to sudden and brutal aggressive behaviour by the animal (Colangeli R, Giussani S.). Cats treated with diazepam to stimulate their appetite have shown an increase in episodes of predatory aggressiveness most likely associated with changes in the lateral hypothalamus (Overall K.).
CONCLUSIONS
According to the Directorate General of Health Decree No. 5403 of 13/04/2005 (Identification Act. no. 302), it is possible to set up hospitalisation (the Clinic and the Hospital) and day hospital facilities. Both hospitalisation and the day hospital are critical points within the patient recovery process. Behavioural Medicine helps the clinic to perfect and streamline “hospitalisation procedures”. According to the Author, home care can be considered suitable for some types of patients (some untreatable subjects, elderly individuals, terminally ill patients) and when the clinical conditions allow it. The owner can lease the necessary materials (e.g. cage, infusion pump) and the doctor will follow the dog or cat step-by-step during daily visits.
The Manual of Nursing Techniques includes the moral obligations of the Veterinarian: towards the client, colleagues and the profession, towards society in general and towards her/himself. The Author believes instead that the moral obligations towards the animal should be put at the top of this list, since the animal is the patient. The doctor is thus obliged to respect the patient and to attempt to the best of her/his ability to resolve the dog or cat’s illness as quickly and efficiently as possible.
Suggested reading and references
- C. Arpaillange - “Gestion de l’animale hospitalisé: approche comportamentale – Le nouveau praticien vétérinaire, hors série hospitalisation, 2002, 13-19;
- C. Arpaillange - “Particularité de l’hospitalisation du chat: approche comportamentale – Cours de Base du GECAF Nantes 2005;
- S. M. A. Caney, 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;
- N. H. Dodman, L. Shuster, Farmacologia comportamentale veterinaria, Masson s. p. a., 2000, Milano;
- B. Gallicchio, - “Lupi travestiti, le origini biologiche del cane domestico” -, Edizioni Cinque, Biella 2001;
- S. Giussani, R. Colangeli,, F. Fassola – “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;
- S. Giussani, R. Colangeli,, F. Fassola – “Approccio clinico all’utilizzo della feromonoterapia nel cane.” – Rivista di zootecnia e veterinaria pp 35 – 45 Volume 30 n° 2 Luglio – Dicembre 2002;
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