Jan 16 2017

Don’t Let Them Hurt – Understanding Pain In Our Dogs & Cats

But my dog (cat) is not in pain.” I bet every veterinarian hears this statement every day. I know at the Fraser Valley Animal Hospital this is a common conversion within the walls of my exam room despite the fact that I just watched a dog walk in limping or examined a cat having such a severe case of pancreatitis that we as humans would be hospitalized and begging for morphine. Now don’t get me wrong this statement doesn’t come out of the mouths of the neglectful pet parents. Nope, I bet I spend 30% to of my time trying to convince the loving and diligent pet parents that yes their pet is in pain. Why is this? Well I have come to the conclusion that there are at least 3 factors that play a roll.

  1. Dogs, and especially cats, are extremely stoic. They are still wired that it is an eat or be eaten kind of world out there and so they hide their illness, and their pain, until they cross that magic threshold and can no longer hide their suffering (this is why to us they often seem to have become seriously sick overnight).
  2. People have an aversion to pain medication. Somehow we now have developed a mindset that we are “heroes” because we suffered through and did not need any pain medication. Did you know that healing times actually improve when we are not in pain? Where did our aversion to pain medication occur? Likely because we hear the news and people dying from buying drugs off the street laced with Fentanyl or about people’s lives being ruined because of their addiction to pain medication and so the pendulum has swung from overuse to underuse and we tend to avoid all pain medication. With this mindset we apply our beliefs to our pets’ medical care and are nervous around the use of pain medication. The funny thing is that clients ask for antibiotics for their pet without proof of any infection and yet inappropriate use of antibiotics is causing world health concerns (Antibiotic Resistance – A World Health Crisis) as inappropriate use is resulting in resistance and in the human medical world they are already starting to see an increase in the number of deaths due to diseases we were once able to treat. So physicians and veterinarians alike know we need to change our mindset and use antibiotics when we know we have an infection from the results of our tests and for our pets we must allow the pendulum around pain medication to swing back to the middle and use the pain medication to avoid pain wind up and improve quality of life.
  3.  I think the third reason I often see resistance to the comment, “Your pet is in pain.” is the fact that we have one word to describe all levels of pain. Living in Abbotsford, B.C. we have at least 4 different words to describe rain so you know if it is a light soft rain our a heavy down pour where you will be soaked just running out to your car. But if you tell me you are in pain without knowing anymore of your story I cannot tell if your pain is the level of a paper-cut or a fractured femur. So the word pain itself does not describe one’s level of hurt, and in fact in human medicine a common question asked is, “On a scale of 1 to 10 how is your pain?”. Now here is where I think in our pet world we run into a roadblock. Most owners think 9 or 10 when I bring up the fact that their pet is in pain and thus the next statement I commonly hear is, “But he is not in pain as he never cries or whimpers.” Just a heads up, whimpering tends to be a poor indication of pain (Cat) (Dog). I have seen many animals with horrific wounds and fractures never whimper; Brutus never whimpered despite his fractured femur, my Griffon never whimpered when he was attacked and lost his left ear and 1/3 of the skin on his neck, and not a peep was heard from Lewis as he sat in his kennel with his jaw at a 90-degree angle. In fact when I reached in to examine the boy he proceeded to purr and rub his head against my arm, no crying or vocal signs of pain, but we know fractures hurt, and so we know these guys hurt. But chronic pain at a level of 2 or 5, which is common with arthritis, is also not okay for long-term health and quality of life. This level of pain tends to be the most frustrating to deal with, as it tends to be the easiest to miss as our pets hide it so well. Why my concern? I have one dog that will forever haunt me. He came in as he was favoring his forelimbs and his radiographs revealed that he had such severe arthritis in his elbows that my elbows hurt. He was put on pain medication but it wasn’t enough. The owner bought him splints to try and support his weight. Sadly the owner didn’t want to pursue alternative treatments such as physiotherapy, laser treatment or acupuncture. He wanted a magic pill and I did not have it and so the dog was euthanized. This dog haunts me because we did not catch his pain when his pain was a level 2 or 3 and thus allowed the pain to go on for years creating what is known as pain wind up and I had limited options available for this boy to help relieve his pain.

After many sleepless nights I decided that I had to try and not allow other pets to suffer in silence.  Therefore, pain prevention had become my mission. So, I went back to school and became certified in osteoarthritis, became a member of the International Veterinary Academy of Pain Management and the International Association for Animal Hospice and Palliative Care. Now for the exciting part…. In the new PAW Centre (Positive Animal Wellness Centre) we will be opening Abbotsford’s first Comfort and Compassion Centre whose main focus will be quality of life and pain prevention & control. Here we focus on end of life care and pet hospice as well as the treatment of osteoarthritis. Despite not being in our new building yet we have slowly started implementing our new programs. And I am so excited!! We had a happy lab come see us just before Christmas. She was walking around the house dropping small poop presents. The owners were frustrated, not surprisingly, and wanted to discuss quality of life and the idea of potentially euthanizing her. Our typical pain dialogue occurred and as this happy lab didn’t whimper it took some convincing that she actually was hurting, but in the end we started her on pain medication. Now this is where is can be difficult as we have to guestimate pain levels based on disease and exam. Our first medication had a small improvement, but it was not enough. So, we added to our treatment plan but the owners felt the dog was too groggy on the new medication and it wasn’t helping her quality of life. So, another discussion about pain occurred, and having to find the right fit for each patient and so we opted to stayed on the same medication and just lowered the dose… AND BAM … we found her magic combination to relieve her of her pain and prevent the fecal incontinence. For me all those nights taking the extra courses paid off because whether she lives another 2 months or 2 years I will know we helped her, we made her comfortable and we saved her life as her owners were not willing to live with her dropping stool around the house. We made a difference for both the dog and the people and that is why I am excited and love doing this!

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ntaylor | Life behind the exam room doors

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