Tag Archives: pain management

“Moral distress” in the veterinary profession

This study’s lead author is Dr Lisa Moses.  Back in 2012, Lisa allowed me to follow her at Angell Animal Medical Center as she worked with dogs in her pain management clinic.

Although no one will argue about the rates of suicide in the veterinary profession, I’d also suggest that complementary practitioners also suffer from a level of moral distress – I’ve seen dogs that could have significant improvement but their owners are prevented from pursuing full therapy for a variety of reasons.  My very first tutor in canine massage prepared us by saying, “you will meet clients that don’t share your values or moral compass.”

Kathleen Crisley, Fear-Free certified professional and specialist in dog massage, rehabilitation and nutrition/food therapy, The Balanced Dog, Christchurch, New Zealand


In some ways, it can be harder to be a doctor of animals than a doctor of humans.

“We are in the really unenviable, and really difficult, position of caring for patients maybe for their entire lives, developing our own relationships with those animals — and then being asked to kill them,” says Dr. Lisa Moses, a veterinarian at the Massachusetts Society for the Prevention of Cruelty to Animals-Angell Animal Medical Center and a bioethicist at Harvard Medical School.

Dr Lisa Moses

Dr Lisa Moses courtesy of MSPCA – Angell

She’s the lead author of a study published in the Journal of Veterinary Internal Medicine about “moral distress” among veterinarians. The survey of more than 800 vets found that most feel ethical qualms — at least sometimes — about what pet owners ask them to do. And that takes a toll on their mental health.

Dr. Virginia Sinnott-Stutzman is all too familiar with the results. As a senior staff veterinarian in emergency and critical care at Angell, she sees a lot of very sick animals — and quite a few decisions by owners that trouble her

Sometimes, owners elect to have their pets put to sleep because they can’t or won’t pay for treatment, she says. Or the opposite, “where we know in our heart of hearts that there is no hope to save the animal, or that the animal is suffering and the owners have a set of beliefs that make them want to keep going.”

Distress around choices such as those is pervasive among vets, Moses and her colleagues found. For example, 69 percent said they had felt moderate to severe distress about not being able to give animals what they thought was the right care. Almost two-thirds were bothered by inappropriate requests for euthanasia.

The study’s senior author, Cambridge Health Alliance psychiatrist and Harvard bioethicist J. Wesley Boyd, sees a connection between the study’s findings and daunting statistics about veterinarians’ suicide rates: “My assumption,” he says, “is that the findings from our survey are definitely part of, or even the majority of, the reason why veterinarians have higher-than-average suicide rates.”

And Moses says that while euthanizing an animal is often the right thing to do to end suffering, that doesn’t make it easy.

“I want to make a plea to the pet-owning public to understand that, no matter what you think, odds are the person who’s trying to help you take care of your animal has pretty strong feelings about how important that is,” she says. “And they feel it.”

The study’s authors are calling for better training — in veterinary school and beyond — on self-care and how to cope with moral distress and ethical conflict.

Sinnott-Stutzman defines moral distress as the feeling when the vet determines an optimal treatment course but is blocked from carrying it out — whether because of money, or an owner’s beliefs, or rules about, say, dogs that bite.

“The most poignant example is when a young dog has a fracture — so a totally fixable, non-life-threatening problem,” she says. But an owner neither wants to pay for a proper fix nor have a three-legged dog, and opts for euthanasia instead.

“That’s a really tough thing to go through,” she says. It’s also particularly hard, she says, when owners, caught up in their grief, project their anger onto the vet. “So in this example,” she says, they might say, ” ‘We have to kill our dog because you’re all about the money,’ which is of course not the case.”

In her 15 years doing emergency and critical care, Sinnott-Stutzman says, she has changed how she copes with moral distress. In the past, she would mainly talk tough cases through with colleagues. Now, she often tries to refocus her mind — meditate, take a walk, think about her kids. She might share an experience with her husband — who will focus on her feelings — rather than a colleague, who is likelier to focus on the medical aspects.

She strongly endorses the study authors’ call for better training for vets in how to handle moral distress. Everything she has learned about coping has come from mentors and friends outside the veterinary profession, she says, and “it absolutely needs to be part of how we teach vets.”

Source:  WBUR

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Common signs of pain in dogs

How do I know my dog is in pain?

(It’s a question I get fairly frequently)….

Here’s a list of things to look out for:

  • Decreased social interaction
  • Anxious expression
  • Submissive behavior
  • Refusal to move
  • Whimpering
  • Howling
  • Growling
  • Guarding behavior
  • Aggression, biting
  • Decreased appetite
  • Self-mutilation
  • Changes in posture

If you think your dog is in pain, then a visit to your vet is the first priority.  Once we have a working diagnosis, then consider what complementary therapies can do to manage your dog’s quality of life – often with reduced or no drugs.

Kathleen Crisley, specialist in dog massage, rehabilitation and nutrition/food therapy, The Balanced Dog, Christchurch, New Zealand

A perspective on time, a precious resource

Time is a precious resource.  We only have so much time in our day – you don’t get any more or any less than anyone else.

I have often said that one of the most important things we have to give our dogs is our time.  Time for play, time for love, time for care…That said, since I often work with sick or elderly dogs in my massage practice, I am also very mindful of how time can get away on us.

Our dogs live at a different time scale than we do.  There are many illustrations of the this  – here’s just one:

dog age chart

With our dogs aging at a faster rate than we do,  we don’t always understand the impact of a delay.

For example:

I meet many dog owners who come to see me because they have a fear of putting their dog on medications such as those that are used for arthritis.  Let me be clear on this – although I practice natural therapies – I am not against using traditional medications like non-steroidal anti-inflammatory drugs (NSAIDs).  Actually, quite the opposite.

Many dogs benefit from pain relief just like we humans do.

One of the better ways to assess the levels of pain in a dog is to give it a short course of NSAIDs and simply watch for changes in the dog’s behaviour and levels of activity.   If the dog improves, this is often the best indicator we have about the dog’s level of discomfort.

If pain is managed, then we can do even more hands-on work like acupressure, stretching, acupuncture and massage and this often means dosages of the ‘hard drugs’ can be reduced without sacrificing pain management.

In this example, the owner is hesitating to make a decision on using medication – even with the idea that we go into the arrangement knowing the medications will be used for only a short period – perhaps 2-3 weeks.

The dog weighs 25 kg and is 10 years old.

I start working with the dog and suggest a number of times that I believe the dog is in pain or at a minimum – uncomfortable.

The owner takes 2 months to make a decision before agreeing to try some pain relief.

In human years, since the dog is aging at a rate of 6 years to 1 human year at this life stage… 

The owner has waited the equivalent of one human year to make a decision!

 I will ask– if this was your grandma/grandpa/father/mother –  would you allow them to live like this without pain relief?

The answer has always been ‘no.’

We have a duty to care for our dogs which involves acting in their best interests.  They can’t tell us in words how much pain they are in, it’s up to us to figure it out.  And in deciding what to do, we must always be mindful of how precious time is.

Kathleen Crisley, specialist in dog massage, rehabilitation and nutrition/food therapy, The Balanced Dog, Christchurch, New Zealand

Is my dog in pain?

One of the questions I get asked fairly often by clients is ‘how do I know if my dog is in pain?’

The month of September is Animal Pain Awareness Month.  The International Veterinary Academy of Pain Management has created this one-page poster to help pet owners.

The only thing I would add is that once you have a veterinary diagnosis of your pet’s condition, then it is useful to seek out complementary therapies like massage and laser that can help with pain management.

Kathleen Crisley, specialist in dog massage, rehabilitation and nutrition/food therapy, The Balanced Dog, Christchurch, New Zealand

IVAPM-Pet-Pain-Awareness-Month-Poster-2016

Source:  International Veterinary Academy of Pain Management

Teddy’s journey: pain and anxiety come to the fore

The past week has been a tough one for Teddy and for Jill.

When Teddy first came home from the hospital, he seemed to be adjusting quickly.  He’s always been an independent boy and so he has rejected any support such as a strap or harness when taken out for toileting.

However, this week, Teddy became noticeably withdrawn.  For much of the time, he was restless and would whimper frequently.  We were sure he was in pain.  Because he was so out of sorts, we also felt that he was suffering from anxiety.

When I saw Teddy on Monday, Jill was stressed and Teddy was clearly not himself.  We introduced a hot water bottle (or ‘hottie’ as they are known here) on his back which seemed to provide relief and comfort.  I also gave Jill a CD from the Through a Dog’s Ear range.  This music is designed specifically for dogs to help calm and treat anxiety.  These seemed to assist Teddy in the short term to relax and rest.

But Teddy needed better pain management…

Teddy and his 'hottie'

Teddy and his ‘hottie’

Jill took Teddy back to his vet several times this week to discuss pain relief.  She freely admits, “I didn’t feel that I was being listened to as the owner.  I knew Teddy better than anyone.  Persistence, in my case, finally paid off.”

We seemed to agree on Monday that he was taken off his pain medication too quickly – he was taking only Previcox at the time –  and his body had been left vulnerable.  A Fentanyl patch was re-introduced on Monday and replaced again on Thursday.  Jill also started Teddy on Tramadol on Thursday and Teddy received a ketamine injection, too.

Meanwhile, I could tell that Teddy’s back muscles were stiff; his top line did not seem normal, and he was clearly distressed at being handled along the withers and the back.  Thankfully, since Teddy was too uncomfortable for deep massage, I was able to use the low level laser along his spine and muscles to help with blood flow and pain relief.  I know I want to passively stretch Teddy’s spine but we agreed to wait until Teddy was more comfortable before attempting this.  I was able to do passive range of motion stretching on Teddy’s legs.

Armed with this information Jill took Teddy for acupuncture on Tuesday and an osteopathic adjustment on Friday.  Both his acupuncture vet and his osteopath agreed that Teddy was in pain and that support with traditional veterinary medicines were needed.  The osteopath used gentle traction on Teddy’s back since she found his spine has become compressed.

With his pain properly managed, we can do more to help Teddy’s muscles, tendons and ligaments to adjust to his new gait.  And then true rehabilitation and exercise can begin including a greater focus on core muscle strength.

During this stressful week, Jill took to the Internet for help with Teddy’s condition.  She found a wonderful site – Tripawds Blogs – for owners of amputee dogs.  Owners soon responded with news that helped to assure Jill she had made the right decision for Teddy and gave her information to help her discuss pain management with her vet.

Owners who have been through similar adjustments with their dogs said:

  • Amputees go through an initial ‘good’ period after coming home, only to suffer because they do too much, too soon
  • The muscles of the body are under incredible strain because the body’s mechanics have changed rapidly
  • In Teddy’s case, his amputation was not preceded by a period of pain or dysfunction in the front leg – so his body had no time to adjust (such as would be the case for an osteosarcoma patient, for example)
  • Pain management medication is critical; the switch from Fentanyl to Tramadol was recommended
  • Teddy’s size is a big advantage – he’s a lot smaller than, say, a Labrador with the same conditions
  • Every dog is different and it takes a little time to find the right balance of therapies

Jill says, “In hindsight, we really took things too quickly and allowed Teddy to move around the garden area with enthusiasm.  I wish I had thought of this sooner and we may have avoided him seizing up so badly.  The Tripawds site has been a fabulous resource for me  knowing that there are others who have been through this before us.

I do feel that vets should listen to owners when it comes to understanding their animal.  And if you are not happy with your vet, you need to find someone who you are more comfortable with.  The vet can’t have all the answers when they are not with the dog as often as the owner is.  This proves that vets are not the final word in recovery – and I’m grateful that complementary practitioners are part of Teddy’s healthcare team”

It’s a new week – and we are all hopeful that Teddy is back on track to recovery.  He’s booked for massage and acupuncture this week.

Kathleen Crisley, specialist in dog massage, rehabilitation and nutrition/food therapy, Canine Catering Ltd, Christchurch, New Zealand

Animal-assisted therapy: less pain medication required

Patients recovering from total joint replacement surgery who receive animal-assisted therapy (AAT) require less pain medication than those who do not experience this type of therapy.  AAT has been used in a variety of healthcare settings to improve quality of life and physical, social, emotional and/or cognitive health for patients.

Lazer, a Sheltie, is a Northwest Community Healthcare animal-assisted therapy dog.  He is shown with his handler Dr. Don Lang, DVM.

Lazer, a Sheltie, is a Northwest Community Healthcare animal-assisted therapy dog. He is shown with his handler Dr. Don Lang, DVM.

This retrospective study measured the need for oral pain medication in patients who were exposed to animal-assisted therapy and those who were not. The groups were similar in age, gender, ethnicity, length of stay and type of total joint replacement. The animal-assisted therapy consisted of daily visits from specially trained dogs for an average of five to 15 minutes. The need for oral pain medication was significantly less (28 percent less) in the animal-assisted therapy group (15.32 mg versus 21.16 mg).

This study offers interesting observations about the healing potential of animals,” said Fran Vlasses, PhD, RN, NEA-BC, ANEF, FAAN, co-author and associate professor and chair, Health Systems, Leadership and Policy Department, Loyola University Chicago Marcella Niehoff School of Nursing. “The efficacy of animal-assisted therapy in decreasing the need for pain medication and its effect on patient well-being after surgery deserves further study.”

These data were published in the August/September issue of Anthrozoos by researchers from Loyola University Chicago Marcella Niehoff School of Nursing and Loyola University Health System. Anthrozoos is the official journal of the International Society for Anthrozoology.

Source:  Loyola Medicine media release

Journal details:

Julia Havey, Frances R. Vlasses, Peter H. Vlasses, Patti Ludwig-Beymer, Diana Hackbarth. The Effect of Animal-Assisted Therapy on Pain Medication Use After Joint Replacement. Anthrozoos: A Multidisciplinary Journal of The Interactions of People & Animals, 2014; 27 (3): 361 DOI: 10.2752/175303714X13903827487962

Developing methods in pain management and osteoarthritis

Researchers at Kansas State University are devoting their time to the study of improvements in pain management and the treatment of osteoarthritis in dogs.   (For more information on pain management, see my June 2012 blog)

The projects are led by James Roush, a professor of clinical sciences.

In one study, the research team determined that the maximum effective time for using hot and cold packs for pain management is 10 minutes.   The researchers studied how packing affects tissue temperature in beagles and beagle-sized dogs after surgery because hot and cold packing is a common technique for reducing swelling.   After 10 minutes, the maximum change in tissue temperature has been reached.

In another study, a special mat is being used to study lameness in dogs suffering from osteoarthritis.  When dogs step on the mat, it measures the pressure in their step and the study team can determine in which leg the lameness is worse.

“We’ve designed the study to help improve osteoarthritis treatment,” Roush said. “We will also use it to measure clinical patients when they come in for regular checkups. We can measure their recovery and a variety of other aspects: how they respond to nonsteroidal anti-inflammatories, how they respond to narcotics or how they respond to a surgical procedure that is designed to take that pressure off the joint.”

And in a third study,  Roush is collaborating with researchers to study the effectiveness of a painkiller used to treat dogs to identify potential alternatives.

“To achieve the drug’s effect, the dosage in dogs is much higher than in people,” Roush said. “It also may not be a very good analgesic in dogs. We want to see if there is an alternative that requires smaller doses and does not have not as much of a discrepancy for patients.”

Source:  Kansas State University media release