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Mental stimulation as a tool to enhance canine patient mental wellbeing

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Abstract

A kennel environment has been shown to elicit a stress response in animals. This response has been seen in patients during a visit to the veterinary practice. Studies have shown how various aspects of the veterinary experience result in both physiological and behavioural stress responses in dogs. This stress response has also been proven to enhance immunosuppression and increase wound healing time. This article looks at why it is important to understand the potential effects of stress on patients. It also offers a method of reducing stress in patients based on previous research.

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Part 1 explored the effect stress can have on our patients and some practices which can be implemented to reduce stress whilst at the hospital. Part 2 evaluates how well we can measure and perceive levels of stress and further ideas on how to limit and prevent stress, based on evidence-based research.
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This article will discuss the ethical issues concerned with the euthanasia of aggressive dogs in practice and where veterinary nurses (VNs) stand within this debate. Ethical theories will be discussed and, specifically, how these relate to the euthanasia of aggressive dogs in practice. The role that VNs play in the euthanasia of these patients and where VNs stand within the law when assisting with the euthanasia of aggressive dogs will also be discussed. Last, the article will look at the Code of professional Conduct for both veterinary surgeons and VNs and how it can be used to gain guidance when dealing with ethical dilemmas.
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During their second or third day in public animal shelter, juvenile/adult dogs were exposed to a venipuncture procedure. Then the dogs were either not petted or were petted in a prescribed manner by either a man or a woman; 20 min later, a second blood sample was collected. There was a clear increase in cortisol levels 20 min after the first venipuncture in juvenile/adult dogs that were not petted, but not in dogs that were petted by either a man or a woman. Additional comparisons showed that the petting procedure also inhibited the cortisol response following venipuncture in puppies. However, petting did not reduce the cortisol response to housing in the shelter per se. During petting, dogs made few attempts to escape, frequently were observed in a relaxed posture, and panting was common in juvenile/adult dogs. When dogs were petted immediately following removal from the living cage, those petted by women yawned more often and spent more time in a relaxed, head-up posture. Together, these results indicate that a previously observed sex difference in the effectiveness of petters in reducing the cortisol response was not due to some difference in odor or other nonbehavioural stimulus quality of men and women. Subtle aspects of petting technique appear to have pronounced effects on physiological and possibly behavioural responses of dogs confined in a shelter. Petting may be an effective means of reducing the cortisol responses of dogs to other common aversive situations, such as routine medical examinations and vaccination procedures at veterinary clinics as well as shelters.
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Six weeks of social and spatial restriction were used as a model to induce chronic stress in Beagles. Behavioral and physiological measurements were performed during a period of enriched spacious outdoor housing in groups (GH) and during a subsequent period of solitary housing in small indoor kennels (IH). Behavioral parameters that may indicate chronic stress in dogs are reported. During IH, the dogs showed significantly (comparison-wise error rate <0.05) lower postures than during GH. IH induced enduring increments in frequencies of autogrooming, paw lifting, and vocalizing, and was associated with incidents of coprophagy and repetitive behavior. So far, we interpret the behavioral changes as signs of chronic stress. Relatively low levels of walking, digging, intentions to change from one state of locomotion to another, and increments in circling are conceived as obvious adaptations to the specific features of the IH system. By challenging the dogs outside their home kennel we tested whether the dogs’ coping abilities were affected by IH. Dogs that were challenged were introduced into a novel environment, given the opportunity to escape from their home kennel, restrained, walked down an unfamiliar corridor, presented a novel object, exposed to loud noise, given food, or confronted with a conspecific. During IH, challenged dogs exhibited higher postures, showed more tail wagging, nosing, circling, urinating, and defecating, and changed more often from one state of locomotion (or posture) to another than during GH. These behavioral changes were observed across the different types of challenges, with the exception of the noise administration test. In the presence of conspecifics, the socially and spatially restricted male dogs behaved more dominantly and aggressive than during the time that they were kept in groups. Such behavior manifested as increased performances of raised hairs, growling, paw laying, and standing over. Both sexes showed increases in paw lifting, body shaking, ambivalent postures, intentions to change from one state of locomotion to another, and trembling in any of the challenges, excluding the walking down the corridor test. In short, during a variety of challenges, socially and spatially restricted dogs exhibited a heightened state of aggression, excitement, and uncertainty. Behavioral differences between dogs that had experienced pleasant and bad weather conditions during GH, suggested that “pleasant-weather individuals” had experienced early stress during the control period, and, as a result, responded to the subsequent period of IH differently. Regardless of the housing conditions, challenged bitches showed stronger indications of acute stress than male dogs. Gender did not affect the chronic stress responses to social and spatial restriction. A low posture and increased autogrooming, paw lifting, vocalizing, repetitive behavior, and coprophagy may indicate chronic stress in dogs, and as such, can help to identify poor welfare. When challenged, chronically stressed dogs may show increased excitement, aggression, and uncertainty, but the nonspecificity of such emotional behavior will complicate its practical use with regard to the assessment of stress.
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Four groups of dogs, which had been subjected to housing conditions of varying quality for years, were assumed to experience different levels of stress. The groups were compared for behavioural and hormonal parameters in order to identify measures that indicate chronic stress in the dog and which may help to identify poor welfare in this species. As a standard for comparison, one of the four groups was composed of privately owned dogs; we assumed that chronic stress levels were relatively low in this group (GI). The three remaining groups of dogs (GII, GIII and GIV) were kept under conditions of low to relatively high austerity, and had basal urinary ratios of cortisol to creatinine, adrenaline to creatinine and, to a lesser extent, noradrenaline to creatinine, that varied from low to high, respectively. Significant differences (P < 0.05) were found in cortisol to creatinine ratios when comparing GI to GII, GIII and GIV and when GII was compared to GIV. Statistical analyses indicated that the mean adrenaline to creatinine ratio in GI differed from that in the remaining groups and that the ratio in GII differed from that in GIII. Noradrenaline to creatinine ratios differed significantly only between GI and GIII. Dopamine to creatinine ratios and noradrenaline to adrenaline ratios did not differ significantly between groups. When dogs were not disturbed, those that were kept under the most austere conditions typically had high levels of locomotor activity, nosing, urinating and paw lifting. After mild disturbance by a slamming door or in the presence of a researcher these animals reacted actively, with increased locomotor activity, circling and nosing, and they showed high levels of behaviours that have previously been associated with acute stress: body shaking, yawning, ambivalent postures and displacement behaviours. Chronic stress in dogs may be identified by increased paw lifting when animals are not disturbed and by ample behavioural expressions of arousal when they are mildly stimulated. Since some behaviours may occur in contexts not related to stress, behavioural data are easily misinterpreted with regard to chronic stress. Interpretation will only be meaningful when physiological measures such as urinary adrenaline to creatinine ratios and, especially, urinary cortisol to creatinine ratios are also determined.
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Too often, veterinary services in practice are perceived as making a diagnosis, applying or administering effective treatment and that recovery from a disease or injury is an indication of success. However, to be fully responsive to their patients' welfare, veterinarians should view each patient in the context of its total environment. Enhancing animal welfare and well-being in practice requires evaluation of the animals' interaction with their daily surroundings as an integral part of clinical medicine. Animal health in this sense would be to create an equilibrium between the animal and its environment. A clinical diagnosis alone can be described as the smaller diagnosis, while a contextual diagnosis can be described as the larger diagnosis. The linear approach of diagnosis, treatment, success should be changed to the holistic approach of comprehensive care. Only then can veterinarians claim that they pursued fully their patients' welfare as part of everyday practice.
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Poor housing conditions, harsh training sessions and uncontrollable or unpredictable social environments are examples of the situations that may lead to reduced welfare status in dogs. Individuals that suffer from poor welfare presumably experience stress and may consequently exhibit stress responses. In order to evaluate stress responses as potential indicators of poor welfare in dogs, we review studies dealing with dogs subjected to stressors. The reported stress responses are categorized as being behavioural, physiological or immunological, and demonstrate the various ways stress is manifested in the dog.
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Physical and emotional stresses are known to increase the production and secretion of glucocorticoids by the adrenal cortex in both humans and experimental animals. The urinary corticoid: creatinine (C:C) ratio is increasingly used as a measure of adrenocortical function. In this study we investigated whether a visit to a veterinary practice for vaccination, a visit to a referral clinic for orthopedic examination, or hospitalization in a referral clinic for 1.5 days resulted in increases of the urinary C: C ratio in pet dogs. In experiment 1, owners collected voided urine samples from 19 healthy pet dogs at specified times before and after taking the dogs to a veterinary practice for yearly vaccination. In experiment 2, 12 pet dogs were evaluated in a similar way before and after an orthopedic examination at a referral clinic. In experiment 3, 9 healthy pet dogs were hospitalized for 1.5 days and urine samples were collected before, during, and after this stay. Basal urinary C:C ratios in all experiments ranged from 0.8 to 8.3 × 10-6. In experiment 1, the urinary C:C ratio after the visit to the veterinary practice ranged from 0.9 to 22.0 × 10-6. Six dogs had a significantly increased urinary C:C ratio (responders), but in 5 of these dogs the ratio was ≤10 × 10-6 In experiment 2. 8 of 12 dogs responded significantly with urinary C:C ratios ranging from 3.1 to 27.0 × 10-6. In experiment 3, 8 of 9 dogs had significantly increased urinary C:C ratios, ranging from 2.4 to 24.0 × 10-6, in some or all urine samples collected during hospitalization. In 4 dogs urinary C:C ratios 12 hours after hospitalization were still significantly higher than the initial values. Thus, a visit to a veterinary practice, an orthopedic examination in a referral clinic, and hospitalization can be considered stressful conditions for dogs. A large variation occurs in response, and in individual dogs the increases in urinary C:C ratios can exceed the cutoff level for the diagnosis of hyperadrenocorticism. Therefore, urine samples for measurement of the C: C ratio in the diagnosis of hyperadrenocorticism should be collected in the dog's home environment, to avoid the influence of stress on glucocorticoid secretion.
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This article looks at the existing evidence-base by which veterinary surgeons can make welfare-focused treatment choices. Narrative and structured reviews were conducted. Papers were categorised under headings based on (1) themes in the UK Animal Welfare Act (AWA 2006) - behaviour, environment, nutrition, company and health; (2) iatrogenic harm induced by treatment; (3) decision-making methods, and (4) the subjects' context (e.g. home versus laboratory). There is more information available about 'overt' problems (e.g. acute disease), than 'covert' issues (e.g. chronic pain, lack of company and obesity). Forty of 109 papers covered pain, suffering, injury and disease, compared to 69 across four other themes in the AWA. Twelve papers were identified as focusing on welfare assessment and clinical decision-making. Veterinary surgeons should consider each of the five welfare themes described in the AWA in both veterinary practice and in determining veterinary research priorities.
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Converging and replicated evidence indicates that psychological stress can modulate wound-healing processes. This article reviews the methods and findings of experimental models of wound healing. Psychological stress can have a substantial and clinically relevant impact on wound repair. Physiologic stress responses can directly influence wound-healing processes. Furthermore, psychological stress can indirectly modulate the repair process by promoting the adoption of health-damaging behaviors. Translational work is needed to develop innovative treatments able to attenuate stress-induced delays in wound healing.
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Stress parameters that can be measured noninvasively may help to identify poor welfare in dogs that live in private homes and institutions. Behavioural parameters are potentially useful to identify stress, but require further investigation to establish which behaviours are appropriate. In the present study, behaviours were recorded and analysed for signs of acute stress in dogs. Simultaneously, saliva cortisol and heart rate were measured to support the interpretation of the behavioural data with regard to stress. Ten dogs of either sex, different ages and various breeds were each subjected to six different stimuli: sound blasts, short electric shocks, a falling bag, an opening umbrella and two forms of restraint. Each type of stimulus had been selected for its assumed aversive properties and was administered intermittently for 1 min. The stimuli that could not be anticipated by the dogs, sound blasts, shocks and a falling bag, tended to induce saliva cortisol responses and a very low posture. The remainder of the stimuli, which were administered by the experimenter visibly to the dog, did not change the cortisol levels but did induce restlessness, a moderate lowering of the posture, body shaking, oral behaviours, and to a lesser extent, yawning and open mouth. Pronounced increases in the heart rate were nonspecifically induced by each type of stimulus. Heart rate levels normalized within 8 min after stressor administration had stopped. Saliva cortisol levels decreased to normal within the hour. Correlations between behavioural and physiological stress parameters were not significant. From the present results, we conclude that in dogs a very low posture may indicate intense acute stress since dogs show a very low posture concomitant with saliva cortisol responses. Dogs may typically show increased restlessness, oral behaviours, yawning, open mouth and a moderate lowering of the posture when they experienced moderate stress in a social setting. The nonspecific character of canine heart rate responses complicates its interpretation with regard to acute stress.
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In general, an animal's inability to perform specific behaviours (for example, due to a lack of suitable stimuli or physical restraint) is often viewed as a cause of reduced welfare of animals kept in captivity. There is increasing evidence that the opportunity to display more species-specific appetitive behaviours is beneficial to captive animals. The present pilot study aimed to investigate the effects of feeding enrichment toys on the behaviour of domestic dogs (Canis familiaris) housed under laboratory conditions.
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Quality-of-life (QOL) assessment is a novel field in veterinary medicine. It shares similarities with the more established fields of human QOL assessment and animal welfare science and could prove similarly useful. This paper draws on existing literature on human QOL assessment, animal welfare, philosophy and animal QOL assessment. It provides practical recommendations for QOL assessment in veterinary practice and in veterinary research on what should be assessed, how it should be assessed and who should assess it. These should assist veterinarians intending to develop their use QOL assessment.
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To investigate further the occurrence of fear-related behaviour in dogs in veterinary practice and to evaluate associated factors, 135 dogs were observed under practice conditions within the framework of a standardised test examination and the owners interviewed using a questionnaire. Most dogs exhibited fear reactions, particularly on the examination table, with 78.5% (106/135) categorised as 'fearful' based on their behaviour. Unlike weight and castration, age, gender and previous experience were significantly (P<0.05) associated with fearful behaviour. Male dogs were significantly less 'fearful' than females and animals under <2 years were significantly less 'fearful' compared with older dogs. Those with only positive previous experiences in veterinary surgeries were significantly less 'fearful' than dogs that had a previous negative experience. Fear-related behaviour in veterinary practice is an issue of importance.
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There is evidence that psychological stress adversely affects the immune system. We have investigated the effects of such stress, caused by caring for a relative with Alzheimer's disease, on wound healing. We studied 13 women caring for demented relatives (mean age 62.3 [SE 2.3] years) and 13 controls matched for age (60.4 [2.8] years) and family income. All subjects underwent a 3.5 mm punch biopsy wound. Healing was assessed by photography of the wound and the response to hydrogen peroxide (healing was defined as no foaming). Wound healing took significantly longer in caregivers than in controls (48.7 [2.9] vs 39.3 [3.0] days, p < 0.05). Peripheral-blood leucocytes from caregivers produced significantly less interleukin-1 beta mRNA in response to lipopolysaccharide stimulation than did controls' cells. Stress-related defects in wound repair could have important clinical implications, for instance for recovery from surgery.
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Impairment of wound healing is a well-recognized sequelae of conditions that alter immune function, including diabetes, jaundice, and advanced age. There is also growing evidence that psychological stress has adverse consequences for immune function. This study addressed the effects of a commonplace stressor on wound healing. Two punch biopsy wounds were placed on the hard palate of 11 dental students. The first wound was timed during summer vacation, whereas the second was placed on the contralateral side 3 days before the first major examination of the term; thus, each student served as her or his own control. Two independent methods assessed healing (daily photographs and a foaming response to hydrogen peroxide). Students took an average of 3 days longer to completely heal the 3.5-mm wound during examinations, ie, 40% longer to heal a small, standardized wound. Production of interleukin 1beta (IL-1beta) messenger RNA (mRNA) declined by 68% during examinations, providing evidence of one possible immunological mechanism. These differences were quite reliable: No student healed as rapidly or produced as much IL-1beta mRNA during examinations as during vacation. These data suggest that even something as transient, predictable, and relatively benign as examination stress can have significant consequences for wound healing.
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Laboratory studies have demonstrated that psychological stress is associated with slower healing of small superficial wounds. The application of this finding to the clinical environment has not yet been undertaken. In order to do this, we investigated the relationship between psychological stress and wound repair in patients following routine surgery. Forty-seven adults with an inguinal hernia were given a standardized questionnaire assessing psychological stress and worry about the operation before undergoing open incision repair. Wound fluid was collected from 36 participants over the first 20-hour postoperative period. Wound healing was assessed by levels of interleukin-1, interleukin-6, and matrix metalloproteinase-9 in the fluid. Other outcome measures included patient self-reports of recovery, as well as cytokine response to lipopolysaccharide stimulation of peripheral blood. Greater preoperative perceived stress significantly predicted lower levels of interleukin-1 in the wound fluid (beta = -0.44, p = 0.03). Greater worry about the operation predicted lower levels of matrix metalloproteinase-9 in the wound fluid (beta = -0.38, p = 0.03) as well as a more painful (beta = 0.51, p = 0.002), poorer (beta = -0.36, p = 0.04), and slower recovery (beta = 0.43, p = 0.01). Psychological stress impairs the inflammatory response and matrix degradation processes in the wound immediately following surgery. This finding generalizes previous laboratory research to surgical patients and expands the known influence of stress to connective tissue matrix remodelling processes. These results suggest that in clinical practice, interventions to reduce the patient's psychological stress level may improve wound repair and recovery following surgery.
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It is well documented that psychological stress impairs wound healing in humans and rodents. However, most research effort into influences on wound healing has focused on factors that compromise, rather than promote, healing. In the present study, we determined if positive social interaction, which influences hypothalamic-pituitary-adrenal (HPA) axis activity in social rodents, promotes wound healing. Siberian hamsters received a cutaneous wound and then were exposed to immobilization stress. Stress increased cortisol concentrations and impaired wound healing in isolated, but not socially housed, hamsters. Removal of endogenous cortisol via adrenalectomy eliminated the effects of stress on wound healing in isolated hamsters. Treatment of isolated hamsters with oxytocin (OT), a hormone released during social contact and associated with social bonding, also blocked stress-induced increases in cortisol concentrations and facilitated wound healing. In contrast, treating socially housed hamsters with an OT antagonist delayed wound healing. Taken together, these data suggest that social interactions buffer against stress and promote wound healing through a mechanism that involves OT-induced suppression of the HPA axis. The data imply that social isolation impairs wound healing, whereas OT treatment may ameliorate some effects of social isolation on health.
Article
To assess pre-operative behavioral and physiological characteristics of healthy dogs hospitalized for elective surgery. Open clinical observational study. Forty-one bitches hospitalized for elective ovariohysterectomy. While undisturbed in a hospital cage, the behavior of the dog was recorded using a video camera and recorder. From the video recordings, various behavioral variables were registered. Simultaneous measurements were made on heart rates and heart rate variability (HRV) by use of an ambulatory electrocardiogram. In addition, the dog's response to human approach was noted. Different behavioral patterns were found in the dogs studied. Thirteen individuals were regarded as highly active, and were seen to bark or howl, manipulate the environment or attempt to flee vigorously. In 13 dogs (passive dogs) none of these activities occurred. Panting and displacement behaviors, such as snout licking, were observed in nearly all the animals monitored. In general, heart rates were higher and HRV lower with the most active individuals; however, the presence of physiological arousal could not be excluded in two animals with passive behaviors. To some extent, the behavior of the dog while undisturbed in the cage was reflected in the responses to a person entering the cage. The different individual responses detected in this study raise an important question concerning their role and existence throughout the entire peri-operative period, especially during the post-anesthetic recovery phase when behavioral characteristics are commonly used to assess patient welfare. The results also emphasize the need for further investigations to explore the effects of pre-operative stressors on canine surgical patients, and the factors contributing to them.
Article
To describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. Randomized, prospective clinical trial. 20 healthy sexually intact female dogs weighing >10 kg (22 lb). Dogs were randomly allocated to receive conventional OHE or LAOHE. Intraoperative complications, anesthetic complications, total anesthesia time, and total surgery time were recorded. Serum cortisol and glucose concentrations, temperature, heart rate, and respiratory rate were measured preoperatively and 1, 2, 4, 6, 12, and 24 hours postoperatively. Pain scores were assigned by a nonblinded observer at 1, 2, 4, 6, 12, and 24 hours postoperatively. Duration of surgery, pain scores, objective measures of surgical stress, anesthetic complications, and surgical complications were compared between OHE and LAOHE. Age, weight, PCV, and duration of surgery did not differ between treatment groups. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did. Blood glucose concentrations were significantly increased from preoperative concentrations in the OHE group at 1, 2, 4, and 6 hours postoperatively and at 1 hour postoperatively in the LAOHE group. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively in the OHE group. LAOHE caused less pain and surgical stress than OHE and may be more appropriate for an outpatient setting.
Article
In the last 50 years, there has been a growing need for storage and management systems for the production and maintenance of large numbers of dogs. Unwanted dogs and strays, detained in kennels, stay for various lengths of time. Large kennels also produce dogs for sale as companion animals, for the service dog industry (police and guide dogs), for biomedical research, and for use by dog food companies. Across the United States, literally tens of thousands of dogs are born in kennels and spend their lives in kennels. The laboratory dog, the kennel dog, the service dog, and the companion dog are in an evolutionary transition period, accompanied by concomitant adaptation to stresses signaled by a high frequency of genetic disease and behavioral abnormalities. For kennel enrichment programs, such as socialization and exercise, the modern kenneled dog is a genetically moving target. Specific recommendations apply neither to all breeds nor to the variations within a single breed.
Article
Animal shelters are an extremely stressful environment for a dog, most specifically due to social isolation and novel surroundings. The stress response of dogs housed in this environment may be alleviated through human interaction shortly after arrival. During their second day in a public animal shelter, adult stray dogs were either engaged in a human contact session or not. The session involved taking the dog into an outdoor enclosure, playing with the dog, grooming, petting and reviewing basic obedience commands. Each dog interacted with a human for approximately 45 min. Salivary cortisol levels were examined from each dog on their 2nd, 3rd, 4th and 9th day of housing. Animals that engaged in a human contact session had lower cortisol levels on day 3 than animals that did not. Breed type, sex and age did not have an effect on cortisol levels on any day measured. A human interaction session can be beneficial to both animal welfare and adoption procedures. The current study not only utilized the human contact session as a treatment to reduce stress but also as a resource for individual temperament/personality information that could be later used to facilitate compatible adoptions. Human interaction may be an effective means of reducing the cortisol response of dogs in the aversive shelter environment.