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Trauma Informed Care in Veterinary Medicine

Trauma Informed Care in Veterinary Medicine

Do you know what Trauma Informed Care is? I first learnt this term from a client of mine. This is an approach by medical professionals that brings compassion as the forefront to their patients with the knowledge that 1 in 4 children in the U.S. have experienced some sort of mistreatment be it physical, sexual or emotional abuse. As this article posted by Harvard Medical School writes, you do not have to ask specific questions about their trauma. The first step is recognition. Approaching every patient as if they have experienced trauma, understanding that trauma can come in any form, and learn to respond to scenarios with empathy and understanding. The Link For some reason, The Link was a fact that stuck with me from a lecture in veterinary school. That Link is: if you see evidence of abuse in an animal patient, that there is a link between animal abuse and domestic violence. And yet veterinary medical professionals are not trained to navigate these complex social, and ethical scenarios.
I have witnessed animal abuse in a veterinary practice. I suspect that I am not the only one who has witnesses this. In trauma informed care we can look at our animals in the light that they may have had previously experienced trauma either through physical abuse, or from neglect.
However, this should not come from a place of judgment. But it should come from a place of empathy and compassion. When we take our veterinary oath, we are the advocates for the individuals that cannot speak for themselves. We also need to be examples for both our colleagues in the medical professional fields, as well as for the pet parents. In a Fear Free veterinary practice, it is not just about seeing fearful dog and offering sedation, chemical restraint, or oral medications to be given at the next visit. It is also about educating the pet parents on how they can train their pets to allow for a physical examination, to train their pets to consent to medical treatments, and also to educate these clients that if we continue to pressure their pet that fear can escalate into aggression. If you do not listen to their communication signals that they are saying no, or worse yet, punish them for showing fear in the form of aggression, such as growling, then this can make future veterinary visits worse. I had talked about single event learning in a recent podcast with Dr. Orion. What single event learning is that a fearful animal goes through a traumatic experience, and then becomes more fearful in that scenario, or generalizes to similar scenarios with increased anxiety and fear. The more that people see their pets as family, the more that we as veterinary professionals need to be trauma informed. Because we are causes of traumatic experience is in our pets.
So when do you report cases of abuse? A topic in one of my support groups recently was about how to identify if abuse is happening to an animal in the home. Some forms of abuse are obvious, but what about for example, neglecting to provide veterinary care such as comprehensive oral health assessment and treatments? A few years back, I had someone bring their dog in for a second opinion because their veterinarian had reported them for neglect due to horrible periodontal disease. My first job as a veterinarian, someone came in with one of those forms that says that they needed to seek veterinary care within 72 hours. So there are cases that get reported by veterinarians, as this is part of our oath. But what do you do when the line is blurred? That it isn't so clear. Well, I found a handbook or guidelines for veterinarians via the BCSPCA website. Most of the 'cruelty' cases we think of are the mass seizures of puppy mill pups or hoarding of cats. But many dogs we see with horrible periodontal disease and even obesity is considered neglectful. We try to give clients the benefit of the doubt. That clients do not realize that just because their pet is still eating does not mean they do not have a painful mouth. The limping or stiff gait without crying out, is a sign of pain. Again, approaching it with our recommendations without judgement so that we can come up with a plan that works for everyone. Pets are so much more resilient than people. The amount of pain and suffering they endure without complaint really is astounding. I hope this information helps those current and future veterinarians who are reading this, but also the pet parents to realize how tough being a veterinarian really is.

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Should you take your puppy to the dog park for socialization?

Should you take your puppy to the dog park for socialization?

Dr. Orion and I had a chat recently about an interaction that I was involved in at the local dog park. If you are one of my clients, you likely have heard me say, don't take your puppy to the dog park. Dog parks are not for socialization of new puppies. You have a mixed bag of neutral dog (dogs who could care less about any other dog), aggressive dogs (ones that attack other dogs), dogs that are over-aroused (too much stimulation that they cannot regulate their emotions) and timid dogs (dogs who are fearful, avoidant, hiding behind their owners). And yet, how hypocritical am I to take Cola to the dog park?? Prior to Cola's final vaccinations, she was in our backyard, I took her to work with me, and I took her to training classes in a controlled setting. Once she was a bit bigger and we had some training under our belts, I ventured to the dog park. Initially I would watch to see what the other dogs did. She then was allowed to interact with some neutral dogs - they didn't care that she was there, or if she wasn't. Cola's personality is of extreme submission. When we were at puppy classes, she was paired with a small breed puppy half her size because she was gentle, took things slow for him and wasn't pushy like the other two frenetic puppies in the class. Dog parks are not for every dog. If you have a young puppy, it will be over-welling for them. Take your puppy to the outside of the park, and work on your relationship with them. See this post on Puppy Socialization for more!

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Puppy Socialization and Vaccine Schedules

Puppy Socialization and Vaccine Schedules

I had this question asked of me by one of my local certified professional dog trainers, which makes me think that other folks have these same questions. Hopefully they are ok with me sharing the question, anonymously. What advice do you give your clients about being around other puppies before they are fully vaccinated? Do you feel they can have limited exposure in clean environments around others that are in good health and are vaccinated after the puppy has their first or second set or wait until they are completed? I personally let clients know that they can socialize with known adult dogs who have been fully vaccinated that they trust (friend's dogs) and puppy training facilities that are able to sanitize (puppy classes that sanitize between classes).  Sanitization of outdoor facilities is not possible unless it is non-porous concrete, therefore this excludes fields and parks; backyards, sniffspots, hiking trails, etc As far as veterinarians in general, MANY of them believe they should be fully vaccinated because of parvovirus. But puppies will become very ill if they acquire parvovirus so if exposed, the pet parent will know very quickly and (hopefully) not bring their puppy to puppy classes. After the second vaccination, the expectation is at least 90% seroconversion (90% of puppies will be protected; with 100% expected after their set of 3), so herd immunity (if all owned dogs are vaccinated) prevents dog-to-dog spread in a controlled environment. Info on seroconversion for vaccination of puppies you can often find in the research links on the manufacturer's websites. Like this page by Zoetis on their Vanguard DAPP vaccine. These puppies are more likely to pick it up from their environment (dog parks etc) than from a puppy class. A study on puppies in puppy classes showed that there was no increased risk of parvovirus of puppies attending puppy classes over puppies who did not attend. For the most part, general practitioners will see new puppies at ~12 weeks when they come in for their second set of vaccinations. Most new puppy parents don't bring their puppy in for a general check up once acquired (unless it is in their breeder contract to do so). Therefore, one week after their second shot they are 90% protected. At that 12 week visit they can also receive their respiratory disease vaccination (Bordetella + Canine Parainfluenza). For more information on the increased cases of coughing dogs throughout the U.S.A. and Canada, please take a look at the updates by Dr. Weese , board certified internal medicine specialist and epidemiologist. Obviously, common sense comes into play. I have mentioned previously, find a certified dog trainer . Ask yourself, would you want someone who is a high school graduate with no other education or training to be working with you and your child? Would you do so with your puppy? We took our puppy Cola to puppy training classes when she was about 13 weeks old. Let's say you don't have a certified professional dog trainer close by, but you know that you need to socialize your puppy. Here are a few tips. Do a tail-gate party! You and your puppy can sit in your vehicle, not touching the ground, observing other dogs at a distance while outside of a dog park Work on having your puppy watch the other dogs, then look at you, because this is more important than your puppy engaging with other dogs Remember that your puppy does not need to meet every dog, you goal is calm, coexistence; and it needs to be a positive experience Invite a friend over! If you have a friend with a neutral dog (a neutral dog is a dog that shows no over-arousal around other dogs), invite them over to help socialize The goal still is not for your puppy to charge up to this dog, but to learn how to read the dog's body language The goal for you as the pet parent is to have your dog remain engaged with YOU! You do not want your puppy getting over-aroused, so if this happens, limit the play to no more than 15 minutes, and rein them in if they are getting over-aroused (dilated pupils, constant zooming, overly mouthy, etc) Over-arousal can lead to your puppy making 'inappropriate' decisions leading to someone potentially getting hurt Do happy visits! Happy visits at your veterinary clinic will help your puppy learn that veterinary clinics also provide treats! Veterinary clinics should be frequently sanitized: All parvovirus positive dogs go in through isolation and not through the main entrance You can sit to the side with your puppy while other dogs are coming/going; again, your puppy can be watching and then re-engaging with you Your veterinary staff will love you for it!
Finally, socialization is also about positive and enjoyable experiences. If they are feeling over-whelmed in the scenario, this will be a negative and less enjoyable experience. Avoid dog parks where there are dogs charging the gates when you approach Avoid getting too close to fast moving objects (bicycles, children running) Avoid getting too close to loud areas (construction etc) If the puppy is showing signs of stress, get out quickly, or increase the distance between your puppy and the stressful stimulus. For veterinarians and veterinary professionals who are guiding pet parents on the appropriate socialization of puppies, also see the below resources. I share the AVSAB handout on puppy socialization for veterinarians. Another one that may be useful to share with veterinarians is the Fear Free information: Puppy Socialization I hope that helps!

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Veterinarian Suicides and Menopause Associated Depression

Veterinarian Suicides and Menopause Associated Depression

It is a well-known fact that veterinarians have a higher rate of suicidal ideation than the general population ( Canada and the U.S.A. , the UK , Germany , and more...). When I was scrolling through my TikTok, another veterinarian was discussing how online complaints really contribute to compassion fatigue and mental health struggles in the veterinary community ---- and it needs to stop. Pet parents rely on their veterinarians to help them with their pet's problems, but veterinary medicine is not publicly funded and only a handful of pet parents have enrolled their pets in pet insurance. Combine this expense with a highly emotional event and you get an irate person trolling the internet, posting rants on social media and leaving reviews online about how horrible veterinarians are. We rationalize this as the person is very upset and feels the need to put the blame on someone else other than themselves. In many cases, if we couldn't save them because they came in too late, or we had our hands tied because cost was a concern. We blame ourselves. We question our abilities and take that home with us. Combine that information alongside the fact that veterinarians are in the top 5 percentile of their education prior to getting accepted into veterinary school. Veterinarians are predominantly perfectionist personality types ( Holden 2020 ). Veterinarians are more likely to be Myers-Briggs ISTJ (introverted, sensing, thinking, judging) ( Kubale et al 2022 ). We pride ourselves on our integrity and when a member of the public questions this by saying we are only in it for the money, we take this very personally. Human interactions are exhausting for introverts, and we work in a field where the ability to communicate with pet parents drains us. Not to mention the 60 hour work weeks (on average) and taking our work home, not just in the literal sense of having to do our medical records at home, but the emotional trauma from our work day also comes home with us. Then when you get home you hear about an awful online review. For every mean thing that someone posts online about us, we would need a minimum of 100 good reviews to counter that. Some veterinarians just never recover from the onslaught of hate. Dr. Shirley Koshi was one of them, when a crazy person decided to posted on Facebook ultimately leading to Dr. Koshi taking her own life. Depression in perimenopausal/menopausal women Having entered my 40's recently and finding out my AMH was lower than normal for my age . Having acute onset severe clinical depression and needing to start taking Zoloft made me start to question whether I was depressed because I have anxiety, was I depressed because of my career, or was something else contributing to my depression. It turns out that when you hit your mid-30's you start to have a decline in your estrogen. My mother doesn't talk much about her personal experiences going through menopause. I just recall my step-dad getting frustrated with the mood swings. But if you know of a woman who is approaching age 45 put the bug in her ear --- If she starts to feel depressed, there is help for her ( Shea et al 2020 )! There are two female veterinarians that stick in my mind who have committed suicide: Dr. Shirley Koshi and Dr. Sophia Yin . That was in 2014 and I graduated from veterinary school in 2016 so this is why these women stood out to me ---- these women unalived themselves while working in a profession that I was training to be. I have this theory that due to their age (Dr. Koshi at 55 years and Dr. Yin at 48 years) depression snuck up on them with the wane of estrogen in their systems. Dr. Koshi was bullied with the use of social media, which can be the final nail in the coffin of a person who may already be suffering from a depressive episode. Dr. Yin's colleagues would have never predicted it with her "enthusiastic" demeanour. Again, just a theory, but if this is the case and my theory is correct, perhaps by drawing attention to this issue it will help women in a similar situation understand that they can ask for help. That help is called hormone replacement therapy. Because I am still on this fertility journey, I cannot take hormone replacement therapy. But when I go through an endo-prep (estrogen supplementation to increase the endometrial lining) I feel really good! I feel energetic and I feel happy . Zoloft helped me regulate my irritability, but it never made me feel happy. Estrogen helps the brain by increasing dopamine and serotonin binding. When we lack estrogen, we can feel like we have brain-fog. We cannot think straight. We end up with insomnia . The insomnia worsens the ability to think straight. We start feeling apathetic. We start having anhedonia. We chalk it up to thinking it is compassion fatigue or burn out. We maybe just need a vacation away from work. We start blaming our work and the people around us. But our lack of estrogen is contributing to our lack of resiliency. The difference between the drop in estrogen that you experience during premenstruation and menopause is that PMS is short lived. Lysis of the corpus luteum sends the feedback to your brain to start producing FSH and the follicles are stimulated to grow. Those follicles produce estrogen and you start to feel good again. During menopause, or leading up to menopause, that estrogen drop is prolonged and it is more substantial. Did you know that I found out through a TikTok video that ADHD medication doesn't work as well in women during their luteal phase?? Now, I always like to get the primary literature on this information ( Haimov-Kochman and Berger 2014 ). Thank God for women in medicine, otherwise this information would be null! I do not have ADHD, but one of my colleagues was recently diagnosed. She hasn't really talked about it much, but I start wondering if I should broach the subject. We're not yet that close, but if you're reading this, I'm always here to chat! So I just want to circle back: if you are, or someone you know is, a woman approaching their mid-40's just have an open conversation about the effect of decreasing estrogen on mood and cognitive processes. You may be saving a life in the process. References: Haimov-Kochman, R., & Berger, I. (2014). Cognitive functions of regularly cycling women may differ throughout the month, depending on sex hormone status; a possible explanation to conflicting results of studies of ADHD in females. Frontiers in Human Neuroscience , 8 , 191. Link Holden, C. L. (2020). Characteristics of veterinary students: perfectionism, personality factors, and resilience. Journal of Veterinary Medical Education , 47 (4), 488-496. Link Kubale, V., Lobnikar, B., & Dvojmoč, M. (2022). The Myers–Briggs Personality Types of Veterinary Students and Their Animal Ethical Profiles in Comparison to Criminal Justice Students in Slovenia. Veterinary Sciences , 9 (8), 441. Link Nett, R. J., Witte, T. K., Holzbauer, S. M., Elchos, B. L., Campagnolo, E. R., Musgrave, K. J., ... & Funk, R. H. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. Journal of the American Veterinary Medical Association , 247 (8), 945-955. Link Platt, B., Hawton, K., Simkin, S., Dean, R., & Mellanby, R. J. (2012). Suicidality in the veterinary profession. Crisis , 33 (5), 280-289. Link Schwerdtfeger, K. A., Bahramsoltani, M., Spangenberg, L., Hallensleben, N., & Glaesmer, H. (2020). Depression, suicidal ideation and suicide risk in German veterinarians compared with the general German population. Veterinary record , 186 (15), e2-e2. Link Shea, A. K., Sohel, N., Gilsing, A., Mayhew, A. J., Griffith, L. E., & Raina, P. (2020). Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data. Menopause , 27 (7), 763-770. Link Stoewen, D. L. (2015). Suicide in veterinary medicine: Let’s talk about it. The Canadian Veterinary Journal, 56(1), 89. Link Walsh, M. J., Gibson, K., Hynd, M., Eisenlohr-Moul, T. A., Walsh, E. C., Schiff, L., ... & Schiller, C. E. (2023). Perimenopausal Effects of Estradiol on Anhedonia and Psychosis Study (PEEPs): study protocol for a neural and molecular mechanistic clinical trial. Trials , 24 (1), 150. Link

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Veterinarians React: Cesar Millan vs Dog Daddy

Veterinarians React: Cesar Millan vs Dog Daddy

I recently had a "discussion" on the comment section of a TikTok video I had posted, questioning my audience as to whether Cesar Millan could cross over. This discussion was stemmed from Zak George's post asking Cesar whether his new TV series would show this. Many laypeople and general practicing veterinarians would say, but Cesar Millan had that TV show on the air for a decade? Surely he is not abusing animals? Dr. T from TikTok even recommended his methods for 'curing' separation anxiety. Let's get to the core features of this discussion. #1 above all, Veterinarians should always advocate for Animal Welfare. Within the animal welfare statements includes the Freedom from Fear and Distress. The Five Freedoms of Animal Welfare were initially developed with farm animals in mind, but that does not mean that pet dogs are excluded from the basic welfare needs of animals. Compulsion trainers use a technique called flooding . Imagine you have a fear of snakes. A therapist says to you, in order to get over your fear of snakes, we will put you in a pit of snakes until you no longer react. Tomorrow, we will do it again. Again and again. The biggest difference between a therapist using flooding as a technique for you to get over your fears and these outdated dog training techniques is called consent. YOU the human get to consent to the treatment. In compulsion dog training, the dog never consents to this type of therapy. A known neurophysiological response to extreme fear, when you cannot flee or fight, is the freeze response, which in humans is the equivalent of dissociation . Dissociation is a mental process of disconnecting from one’s thoughts, feelings, memories or sense of identity. 1 In human psychology, this would be deemed trauma related dissociation . Can I also say this is what rape victims have also experienced? While being raped, because they could not flee, they couldn't fight, they freeze and then dissociate. These victims are also in a position where they did not give consent. I realize this is an extreme example. I even asked my husband if this was too much. I just really wanted to get this point across. Some behaviorists will call this freeze response learned helplessness. This behaviour can very easily be misinterpreted as habituation ( Sarrafchi et al 2022 ) while the emotions behind the behaviour are not addressed. Applying force to an innocent being, whether it is a child or a dog, causes trauma. Children of abusive upbringings can attest to this as they work through the PTSD during their adulthood, if they make it there. When the Dog Daddy is stringing a dog up and the dog is screaming in fear, and he acknowledges that the dog is fearful, but continues to do it anyway... while also trying to justify his methods... is wrong. #2 Veterinarians are held accountable by other Veterinarians. All veterinarians will have a scope of practice, and the general practitioner is the equivalent of your family physician. Occasionally, your family physician will perform minor procedures and prescribe medications for mental health, but when there is a major medical problem, an orthopedic surgical issue or severe mental health issue, your primary care physician will refer you to a specialist. There are currently 22 recognized veterinary specialties in North America. Within this list of veterinary specialties falls the American College of Veterinary Behaviorists. On their website, they have a link for Veterinarians on their recommendations on how to select a dog trainer . When a veterinarian gets a client-patient pair in their office. If the presenting complaint is a behaviour problem, let's say urination in the house, we first do a medical work up to determine if this is a medical issue. When it comes to true behaviour problems, fear, anxiety and frustration are often the emotional responses that are occurring around these 'problem' behaviours. Some are nuisance behaviours due to poor antecedent arrangement. For example, a dog that steals food off the counters. Dogs are naturally opportunistic, so if you don't want your dog to steal the food off the counter, don't leave it there. But let's say a dog is lunging, barking and snapping while on the leash. Without any other history or context, you cannot tell what emotions are behind that behaviour. Is the dog doing this to go towards the target? Is the dog doing this to get the target to move away? Then ask yourself, is the intensity of this behaviour normal in that context for that trigger? Then ask yourself, how long does it take the dog to recover after the incident? Now tell me your primary care veterinarian has at least half an hour to delve into the learning experiences and history of training for that patient and then come up with a detailed treatment plan that includes behaviour modification, environmental management plus-minus medications? Some will! Some are great, but some veterinarians would rather talk about your dog's ear infection than a behaviour problem that you are having. So, your veterinarian may refer you to a dog trainer. Who your veterinarian refers you to is important. I use Veterinary Dentistry as an example. Twenty years ago (early 2000's) it was standard practice to have your dog's teeth cleaned and have the mobile teeth or those with deep pockets extracted without intraoral radiographs. Now, the American Veterinary Dental College advocates for full-mouth intraoral dental radiographs before and after extraction of teeth. If and when a veterinarian has a board complaint from a pet owner who had a dental procedure and afterward the pet falls ill, a board certified veterinary dentist will be asked to review the medical records. If that veterinarian did not perform pre and post-extraction radiographs that veterinarian could be held accountable by their governing board. Now, the American College of Veterinary Behaviorists recommend to refer to certified professionals. So you, the veterinarian who is reading this, if you have a behaviour case and you refer outside of a board certified veterinary behaviorist, you better have a close look at what credentials that individual holds. Ask yourself, would my state DACVB refer this case to that dog trainer? From the ACVB: You will want to interview trainers with whom you are going to affiliate. You can prescreen trainers to interview by selecting those with a certification from an organization that espouses scientifically based, humane training techniques, such as CPDT, IAABC or KPA. Find a Certified Professional Dog Trainer who have had their knowledge assessed (CPDT-KA) Certified Dog Behavior Consultants (IAABC) can be found here Find a Trainer at Karen Pryor Academy of dog trainers (KPA) If you do not recommend a certified professional, despite the behaviour specialists suggesting to do so, you also discount all of the hard work that these professionals have put in to acquiring their certifications! As Dr. Amy Pike, DVM, DACVB said "you have to have a license to cut hair for the love of God but you don't... have to have a license to actually train a dog" (see recent YouTube and Podcast by Sara Ondrako). #3 Being a Celebrity does not mean you are immune to Animal Cruelty Laws. I discussed compulsion trainers recently. The thing is, I am not the only veterinarian who has taken a stance against The Dog Daddy. Punishment based training methods were predominant in the training of military dogs in the early 1900's. Yes, a lot of those methods are still used in the military and law enforcement today. Proponents of punishment and aversive training methods believe that it works better or that 'high-drive' dogs require a heavier hand. When we know that kindness and positive reinforcement work better for children with developmental disabilities, why would we choose to do otherwise? When we know that dogs respond extremely well to positive reinforcement , including the common police dog called a German Shepherd Dog , and Belgian Malinois who is highly biddable , why would we choose otherwise? See Dr. Orion's YouTube channel . See Dr. Em's YouTube: on the Dog Daddy and on Cesar Millan The Dog Daddy is essentially the grand-baby to Cesar Millan. Sorry Cesar, I know you're not that old, do you want him to be your son instead? I do not mean this in a literal sense, I mean it in the descent of learning. Just as you have a professor in college that you really looked up to. When you hear the Dog Daddy's methods (pssstt is the same sound of the tool called a pet corrector which is a "blast of pressurized air" that is meant to deter a dog from performing 'bad' behaviours) that matches Cesar Millan's style psstt. For a young and impressionable entrepreneurial immigrant with no formal education, Cesar provided a guide to success for the young people who grew up with animals. And people will pay you for it. Celebrity Dog Trainers are not the same as a Certified Professional Dog Trainer . Life experience is not a replacement for formal education, sorry Gen Z. The problem with uncertified dog trainers becoming celebrities is that they perpetuate punishment and dominance as their main central ideologies. Then members of the public who are ignorant, lacking the knowledge of learning theory, see the number of followers or years on TV as confirmation of reliability, validity and 'evidence-based' method for training their pet dogs at home. How many people jumped at 'vaccines cause autism' when celebrity Jenny McCarthy said it did ? (FYI, thus far the only thing that is currently linked to autism is older fathers ). I am constantly learning every day. I question myself and my behaviours every day. Sometimes bad things happen that are out of our control, like how Cesar's dog allegedly killed Queen Latifah's dog . I highly doubt Cesar had any control over his dog's mental state at the time. Just like he didn't have control over the dog attacking the pigs . There is an innate releasing mechanism for instinctual behaviours that we have yet to fully understand. Most of these dog owners are taken aback or surprised when this happens as some of these dogs have zero history of 'releasing' this innate behaviour. I'm not saying Cesar Millan is a bad person and I really hold hope that he will comment to Zak George's call on aligning his methods with the scientific community. If Cesar Millan cannot get on record saying that his previous methods were unwarranted and dominance theory has been debunked, we will continue to see dog trainers like those charged last August at Cypress Arrow dog training. There really is only one dog hanging degree of separation between those dog trainers that have been charged for animal cruelty and the Dog Daddy. If we do not have celebrity dog trainers to advocate for animal welfare, we are just standing over here on our soap boxes yelling into the wind. Those with a larger audience should be using their social media influence to challenge these outdated antics. Without this, the media and social media clicks will continue to manifest more Dog Daddy's of the training world. Are you picking up what I'm putting down? Cesar, come tell us that you disown the Dog Daddy as your (grand)son, please. Wouldn't it be glorious to see Cesar Millan vs the Dog Daddy, or is it just me? The final question is: Can prior dominance theory advocates cross-over to kinder methods? The answer is yes! The researcher (Dr. Mech) who studied wolves in captivity later came out to say he had the structure of a wolf pack wrong. Wolf packs were not structured through dominance hierarchy with an alpha male 'fighting' to be the Top Dog. We also know now that a dog is not trying to dominate a human. The relationship between humans and their dogs is through attachment , just as children attach with their parents. Children who grow up with a secure attachment are more likely to maintain healthy relationships when they go through social maturity. Children who received corporal punishment and insecure attachment with their maternal figure were more likely to be aggressive or anxious; notably, maternal 'warmth' was not enough to counteract the punishment. Confidence in our children and dogs is built through secure attachment; the attachment figure is there to support, guide and comfort the youngster as they navigate and learn in their environment. Many certified dog trainers started out training with aversive methods. Many of which have crossed-over from the 'balanced' dog training world to using more antecedent arrangements, setting the dog-human pairs up for success, using positive reinforcement and if the pair is not progressing, instead of adding punishers like shock collars or prong collars, asking themselves, what am I doing or not doing that this dog cannot be successful? Then, if they are still struggling, to set their ego aside, and refer these cases to a certified dog behaviour consultant or veterinary behaviorist . Many human parents have done the same, moving from 'disciplinary' punishment based interactions with their children to a gentler and kinder approach. The positive reinforcement portion of dog training actually entered on the heels of marine mammal trainers and zookeepers who work with no tether to their animal learners. Try asking a tiger to lay down using the Dog Daddy's techniques. In the mid-2000's I started working as a zookeeper. My first behaviour modification subjects were the spider monkeys. I initially got trained on the South American route and the head keeper at the time used intimidation with a water hose to scare the monkeys into their indoor enclosure. One of the monkeys was easy to move because he loved interacting with his keepers, the other monkey didn't. The head keeper's method was negative reinforcement. They would not take away spraying of the hose until the monkeys shifted. Now, this method never worked for me. Both from the perspective of the intensity of the water spraying had to increase, but it was also time consuming to try to intimidate them to shift. Imagine me running around a chain-linked fence with a hose and the monkeys running behind a tree, not getting sprayed, like some sort of cat-mouse game. I quickly gave up and devised a new plan of earning the female monkey's trust. Once I determined an environmental set up that the female monkey was ok with, it was very easy for her to shift using grapes as a reinforcer for shifting. The key component to my success was antecedent arrangement - which is the VERY first step in a behaviour modification plan (see the Humane Hierarchy on IAABC). I locked the male in one compartment of the indoor housing, and then asked the female to shift. She trusted that I would not fully lock her into the indoor housing with the male. With that trust, coercion was unnecessary, and the hose was used for what it was meant for - to clean the floor. I tell this story because people can grow and learn through their experiences. What did we learn from the dog attacking pig incident? The dog was not set up for success (nor were the pigs). The dog learns that I will get punished - if and only if I am close to this human, so be faster. Dogs will learn avoidant behaviours of the humans that are supposed to be their secure attachment figures when these humans use punishment. How many of your dogs jump on the counter - when you are not in the room - but NEVER do it when you are in the room because "they know better"? When you know better, do better. References: Casey, R. A., Naj-Oleari, M., Campbell, S., Mendl, M., & Blackwell, E. J. (2021). Dogs are more pessimistic if their owners use two or more aversive training methods. Scientific Reports , 11 (1), 19023. Link Cobb, M. L., Otto, C. M., & Fine, A. H. (2021). The animal welfare science of working dogs: current perspectives on recent advances and future directions. Frontiers in veterinary science , 1116. Link Crowell, J. A., & Treboux, D. (1995). A review of adult attachment measures: Implications for theory and research. Social development , 4 (3), 294-327. Link de Castro, A. C. V., Fuchs, D., Morello, G. M., Pastur, S., de Sousa, L., & Olsson, I. A. S. (2020). Does training method matter? Evidence for the negative impact of aversive-based methods on companion dog welfare. Plos one , 15 (12), e0225023. Link Fattah, A. F. A., & Abdel-Hamid, S. E. (2020). Influence of gender, neuter status, and training method on police dog narcotics olfaction performance, behavior and welfare. Journal of Advanced Veterinary and Animal Research , 7 (4), 655. Link Gershuny, B. S., & Thayer, J. F. (1999). Relations among psychological trauma, dissociative phenomena, and trauma-related distress: A review and integration. Clinical psychology review , 19 (5), 631-657. Link Lansford, J. E., Sharma, C., Malone, P. S., Woodlief, D., Dodge, K. A., Oburu, P., ... & Di Giunta, L. (2014). Corporal punishment, maternal warmth, and child adjustment: A longitudinal study in eight countries. Journal of Clinical Child & Adolescent Psychology , 43 (4), 670-685. Link Morrill, K., Hekman, J., Li, X., McClure, J., Logan, B., Goodman, L., ... & Karlsson, E. K. (2022). Ancestry-inclusive dog genomics challenges popular breed stereotypes. Science , 376 (6592), eabk0639. Link Sarrafchi, A., David-Steel, M., Pearce, S. D., de Zwaan, N., & Merkies, K. (2022). Effect of human-dog interaction on therapy dog stress during an on-campus student stress buster event. Applied Animal Behaviour Science , 253 , 105659. Link

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How thick should your endometrial lining be for embryo transfer?

How thick should your endometrial lining be for embryo transfer?

It has been a while since I have written a blog post on my fertility journey. But I see that one of my posts has been getting a lot of views, which I can only hope that it is helping people on this journey. At least the bare minimum to say, you're not alone! So, let's chat a bit about endometrial lining. I have done endo-prep several times now. We did a fresh donor cycle last year and did a fresh embryo transfer, which didn't take. Then we did a frozen transfer and it didn't take. So you start to question, is this the right protocol for me? Is my endometrial lining not great? Well, it turned out that after the two failed transfers (lost embabies... may they RIP) my doctor suggested to do the ERA. The ERA or endometrial receptivity analysis involves performing a mock cycle for preparation towards an embryo transfer, but instead of transferring an embryo, the doctor performs an endometrial biopsy. Everything else is supposed to be the same as if you were preparing for a transfer. And guess what?? My ERA was abnormal! So what happens with the endometrium when you start adding progesterone into your protocol? The cells of the uterus start to prepare for maintenance of pregnancy when progesterone is signaled from the follicles lining and the granulosa cells of these follicles as they begin to lutealize (essentially after the LH surge, the follicles ovulate and turn into a corpus luteum). Anyway, gene expression works through turn on or off specific genes that code for proteins in the cells. These proteins could be membrane bound receptors, or some other protein (not muscle protein - don't think about macros here). If you compare fertile women with women who have had repeated implantation failure, the two groups of women differ in the expression of 313 genes ( Ruiz-Alonso et al 2013 )! The ERA tests 238 of those genes. Along with the biopsy for the ERA, the sample was also tested through PCR to look for pathogenic bacteria in the uterine lining (EMMA and ALICE). Which also came back with some pathogens! So part of me said, dang... what a waste of those embabies we transferred and the other part of me said - well, at least there is a reason that they didn't stick! Both from the perspective of having transferred at the wrong time for my uterus to be receptive, but also transferring into a 'hostile' uterus! The tough part of this whole journey is that we started TTC four years ago now and thus far, I have had three miscarriages (natural pregnancy) and spent hundreds of thousands of dollars (Canadian dollars, mind you) on stimulation cycles, a fresh donor cycle and a frozen donor cycle with still no human baby in our arms. This journey is almost as long as my pre-veterinary journey when I applied for 7 cycles before I got accepted. Not to mention the fact that through all of this emotional turmoil, I keep working and there are only a few people in my work that I have even discussed this journey with. So, anyway, back to the endometrial lining preparation! After I received the results from the ERA/EMMA/ALICE, I did a course of Clindamycin for treatment for the pathogenic bacteria that were not supposed to be in there. Since statistics show that the endometrial receptivity gene expression of the majority of women with my set of genes being expressed showed that they were able to get pregnant if given additional time on progesterone prior to the transfer of a day 5 embaby, this is my fertility doctor's plan. Endometrial Thickness Another aspect of embryo transfer is the measurement of the lining. Essentially, estrogen (in the natural cycle it is produced by the growing follicle) signals to the uterus to thicken and create a cozy bed for the embryo to implant. So prior to transferring an embryo, whether fresh or frozen, you are to take estradiol and have serial ultrasounds of your uterus to see how thick the lining is. But my question has always been, how thick should the lining be? Obviously, it needs to be thick enough to allow for implantation, but is a 1 mm difference better or worse?? In science, many statistics fall on a bell curve. Have you every heard of a professor in university curving the grades? The curve they are trying to aim for is that the average, being the middle folks scoring a C, 50% of the population falls above a C and 50% fall below. In statistics with humans they may talk in odds ratio. What are the odds of a positive pregnancy test if an embryo is transfer with X mm thickness of the endometrium? For example, a uterine lining of less than 7.5 mm at the time of trigger (usually talking about a fresh cycle or controlled natural cycle) showed a higher odds of having a pregnancy complication ( Oron et al 2018 ). In a systematic review of the research up to October 2013 (ten years ago!), women whose uterine lining for </= 7 mm had a pregnancy rate of 23.3% compared to > 7 mm of 48.1% ( Kasius et al 2014 ), which is twice as likely to become pregnant if the lining is > 7 mm. Back to my question, does 1 mm really make a difference?? According to Liu et al, 2018 , it does, statistically anyway. For fresh cycles, women with a lining > 8 mm had a 33.7% chance of live birth, while women with 7 to 7.9 mm showed 25.5% live birth rate. That's 1 mm difference. Sadly, we all know that age is a factor, but the thickness of your endometrium is also related to your age. Researchers have looked at whether or not having compaction after starting progesterone supplementation effects live birth rates but have found minimal statistical difference ( Gill et al 2023 ; Ye et al 2020 ), so it appears that the measurement of the lining prior to progesterone supplementation is the important one. So what if you have a thin lining? My current fertility doctor is not against performing some of the less researched protocols. I think when you get on this journey and even if you increase your chances by a small percentage, you are willing to take that risk. At the last frozen transfer, because my lining wasn't ideal (I think her goal was > 7.5 mm) she said we could try platelet rich plasma (PRP) injected intrauterine to see if this could help support the lining prior to implantation. It did help grow my lining at the time (or so we thought) but didn't help with the implantation. I had briefly blogged about PRP as a treatment for ovarian rejuvenation, but I have not tried it, so I cannot say whether it is helpful. For some patients intrauterine PRP helped improve their pregnancy rates ( Kim et al 2019 ). Like I said, statistical improvement may be small, but we're willing to eat pineapple core if it helps! I just wanted to say, I'm still here. I'm still on this journey, even if I haven't blogged about it recently! Think sticky baby thoughts. References: Gill, P., Melamed, N., Barrett, J., & Casper, R. F. (2023). A decrease in endometrial thickness before embryo transfer is not associated with preterm birth and placenta-mediated pregnancy complications. Reproductive BioMedicine Online , 46 (2), 283-288. Kasius, A., Smit, J. G., Torrance, H. L., Eijkemans, M. J., Mol, B. W., Opmeer, B. C., & Broekmans, F. J. (2014). Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Human reproduction update , 20 (4), 530-541. Kim, H., Shin, J. E., Koo, H. S., Kwon, H., Choi, D. H., & Kim, J. H. (2019). Effect of autologous platelet-rich plasma treatment on refractory thin endometrium during the frozen embryo transfer cycle: a pilot study. Frontiers in endocrinology , 10 , 61. Liu, K. E., Hartman, M., Hartman, A., Luo, Z. C., & Mahutte, N. (2018). The impact of a thin endometrial lining on fresh and frozen–thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Human Reproduction , 33 (10), 1883-1888. Oron, G., Hiersch, L., Rona, S., Prag-Rosenberg, R., Sapir, O., Tuttnauer-Hamburger, M., ... & Ben-Haroush, A. (2018). Endometrial thickness of less than 7.5 mm is associated with obstetric complications in fresh IVF cycles: a retrospective cohort study. Reproductive biomedicine online, 37(3), 341-348. Ruiz-Alonso, M., Blesa, D., Díaz-Gimeno, P., Gómez, E., Fernández-Sánchez, M., Carranza, F., ... & Simón, C. (2013). The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure. Fertility and sterility , 100 (3), 818-824. Ye, J., Zhang, J., Gao, H., Zhu, Y., Wang, Y., Cai, R., & Kuang, Y. (2020). Effect of endometrial thickness change in response to progesterone administration on pregnancy outcomes in frozen-thawed embryo transfer: analysis of 4465 cycles. Frontiers in Endocrinology , 11 , 546232.

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What is Positive Reinforcement?

What is Positive Reinforcement?

There have been a few times where people have asked: "How do I do this positive reinforcement thing?" "What is positive reinforcement?" "I've heard of positive reinforcement, but I don't know how to do it." Oftentimes people with an education in psychology or science in general, really struggle with taking that scientific knowledge and boiling it down to something that the general public can understand. Positive Reinforcement is part of the operant learning theory that was developed by B.F. Skinner in the early 1900's. It basically says animals (and people) operate on the environment to gain reinforcement and avoid punishment. If we just focus on positive reinforcement, it is simply, the animal does some behaviour in the environment and gains (adds +) a pleasant sensation that says to the brain, repeat this behaviour in order to gain that pleasant sensation. A very common misconception is thinking that positive means good! Adding something pleasant is good, right? Well, it really isn't anything to do with good or bad. Reinforcement means that it will increase the likelihood of the behaviour occurring in the future. I like to use children as an example, then move on to dogs and cats, and other animals. A simple positive reinforcement task could be: child opens the refrigerator to access cookies. Cookies are consider pleasant in the child's eyes, therefore, the behaviour of opening the refrigerator increases because it gives the child access to cookies. Child cleans up their room and their parent gives them cookies. The cookies reinforce the behaviour of cleaning the room only if the behaviour of cleaning the room increases in the future. Now let's say you grew up in the 80's and 90's when spanking (aka corporal punishment ) was used as the predominant means for disciplining children. Let's say you misbehaved, argued with your sibling, and then your mom said "just wait until your dad gets home". This verbal threat may have been enough momentarily to reduce the behaviour in the moment. But because it likely did not lead to a reduction in the future likelihood of the behaviour, it isn't consider punishment (by the scientific meaning of the word). Later, your dad comes home and spanks you. When your dad spanks you this is supposed to be positive punishment. You did something bad and then you received a spank, which (hopefully) decreases the likelihood of arguing with your sibling. The receipt of a spank is addition, or positive. Notice how positive is not good in this example. The argument is flawed, however, because punishment only works if it has contiguity (the time passed between the bad behaviour and the punishment is very short). I don't know about you, but the spanking was rarely occurring immediately after arguing with the sibling. The reason I bring up this example is, fathers who have to be the bad guy, may feel guilty for spanking their children, and then offer the child a cookie afterwards when everything is settled. You were bad, received a spanking (positive punishment), then a cookie afterwards. Now what is the cookie? The cookie is now deemed less pleasant, or "poisoned" by the order in which the actions occurred. Therefore, it is not the receipt of a cookie that is positive reinforcement. This is a common mistake that we see with uneducated dog trainers . Applying a punishment to an animal (or child) and then following up with a cookie is also not "balanced". Reinforcers are determined by the learner. The learner could be a child, a dog, or you! The reinforcer could be food, praise or attention, touch (a hug or ear scratch), play or engagement with a parent, or access to a highly valuable item like playing with a video game. The level of reinforcement, or value of that reinforcer, is determined by the learner. Let's say for example, our child in question enjoys playing soccer with their dad. Let's say the child was good and didn't argue with its sibling and therefore, the dad was in a good mood when he arrived home and offered to play soccer with the child. If the child places a high value on this activity, then it should increase the future likelihood of being good (not arguing with their sibling) in order to have the chance to earn this reinforcer. This now brings us to reinforcement schedules. Let's say playing soccer is the reinforcer for good behaviour. Every day, dad comes home and the child has been good, then they play soccer. Now, let's say they have built this routine for a few days, but now dad has a deadline with work and is busy. So this one time, dad says he can't. This is a reinforcement schedule that is intermittent. If it is a regular occurrence to play soccer, it will still increase the likelihood of good behaviour, but if the good behaviour has not had repeated reinforcement (aka learning history) then the child may revert back to arguing with its sibling, because there is no reinforcement available. I usually say you need at least 4 repetitions (or sessions) of a behaviour-reinforcement pair before you can move on to any intermittent schedule of reinforcement. This is with cats and dogs anyway. There are fixed-ratio schedules which can be 1 behaviour 1 reinforcer, or 2 behaviours 1 reinforcer, but it is fixed or consistent through sessions/trials. There are variable ratios, usually given as an average (VR - variable ratio of 4 is four repetitions of the behaviour to one reinforcer - on average). Remember, you cannot switch to a variable ratio too quickly, because otherwise the learner is not following. But let's say, we spent a week on a fixed ratio 1 to 1 schedule and now, we want to move to a variable ratio. You may reinforce the first, 2nd, 6th, 7th, 9th,12th, 18th - this works up to be a VR = 2.8; on average the learner earns a reinforcer every 2.8 rounds of behaviour. I know, I probably just confused you. It basically says that on the first day, dad played soccer, and on the 2nd day dad played soccer, then 3rd, 4th and 5th days, dad was busy, but as long as there has been prior history of possible reinforcement, the child gets to play on the 6th day, because it has learned the behaviour of being good earns plays time. The motivation to be good will be higher if the reinforcer is highly valuable to the learn and if the ratio is variable/unpredictable, as well as not too high of an average. Imagine if the child had to be good for 100 days before getting to play soccer with dad. It is unlikely that the child will be good every day. There are fixed-interval schedules - which has to do with time passed, but these tend to not be as strong, so I won't get into them. A note to those of you learning how to implement positive reinforcement. It is easier to provide a reinforcement for each behaviour. I would highly suggest to reinforce all behaviours that are hard for the learner . If not arguing with the sibling is really hard for the child, then you want to reinforce not arguing every time. Ok, now I have used children as an example. Let's talk about dog training. We recently added a puppy to our family (if you follow my TikTok , you would have met her). I'll get to Cola Sweetie in the future! Let's say for example, we are training our puppy to eliminate in the yard (eliminate means to pee and poo). First, we must anticipate her need to go. Take her outside to pee, she pees and they we praise (one reinforcer) and give her a cookie (two reinforcer). The cookie (treat or snack) is the primary reinforcer, and praise is the secondary reinforcer. What that means is primary - something that is innate and needed (food, access to mates, access to safe environment) while a secondary reinforcer is not something that is innate, but something that is learned through pairing with a primary reinforcer. Since praise is learned and food is innate, when you are starting with a new behaviour, ensure that you have treats/food handy right away! I have a treat pouch clipped to my pants every time I am outside with our puppy. Once your puppy goes to squat, you can then say "go pee" or whatever 'cue' you would like to use for the behaviour of peeing. A cue is just a word or phrase that you can add before a behaviour, in order to start having some control over when that behaviour occurs. Dogs do not come with English language imbedded but they can learn words and phrases mean certain things through pairing (pairing in the right order I might add). So, now we have a behaviour chain of go outside, owner cues "go pee" puppy squats and urinates, then we say good girl, here's a cookie. Eventually, you can wean the cookie and only use praise, but NOT when you are first house-training! Later I will talk about more specifics of house-training, because it is a common issue. Now the behaviour of going pee outside is on cue and reinforced through treats and praise. It is the contiguity of the reinforcement of praise and treats following the behaviour of peeing outside that is the important structure of this scenario. This is positive reinforcement. Our addition of treats after the behaviour of peeing outside, increases the future likelihood of peeing outside. Now... let's bring it back to our positive punishment example. You come home from work and find that puppy has peed in the house, so you think that puppy should know better and yell at the puppy and rub its face in its pee. The puppy postures in appeasement (which is not guilt, I may add). The problem is - you are waaaaayyy too late. Remember the rule of contiguity?? The punishment must immediately follow the behaviour in order for the learner to understand what behaviour is receiving the punishment. Just as in the child who gets spanked by their father 5 hours later - no, the child didn't learn that the behaviour he wanted to decrease was arguing with their sibling. All we end up with is a child who has a father that comes home and spanks them. Same goes for this puppy. All the puppy knows is that you come home and yell and do mean things to them. It could have peed 5 hours ago. The puppy definitely doesn't know what you mean. This is where antecedent arrangements come in. Basically, in order for your learner to understand what is needed of them, then need repetition of the wanted behaviour, and biologically appropriate timing for that to occur. Children can learn through positive punishment, if the punishment is given immediately at the time of the unwanted behaviour. BUT this is contingent on you actually being their to give the punishment. So instead of punishing the unwanted behaviour, we can set them up for success by letting them know what is an alternative behaviour they can do to both avoid punishment and earn reinforcement. In our case with a child, it may be called bribing, but I call it a practice of delayed reinforcement, if a parent says, if you play nicely with your sibling, we will play soccer together later. For puppies physiology, the rule of thumb for bladder control is to start when they are 4 months of age. Anything before that is golden. Quickly, after a nap - bring the puppy outside and reinforce the wanted behaviour of peeing outside. After eating/drinking within 15 minutes, outside to potty. After playing! After a walk! After anything exciting! Once they are 16 weeks, then start working on duration. If they are 4 months, they should be able to hold for 4 hours, sometimes plus 1 hour if you are lucky. Later, if you are lucky, you have trained this behaviour on cue, so that at bed time, you can cue them to empty their bladders and go to sleep. To recap, positive reinforcement is a method of increasing behaviour through providing items of value to the learner. The value of the items is determined by the learner. The timing of the reinforcer immediately following the behaviour is important. We can certainly talk in the four quadrants, but just because they exist, doesn't mean that we should use them. We should always be thinking about, what behaviour can I ask the learner to do instead of the unwanted behaviour.

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How to Address Separation Anxiety in Dogs

How to Address Separation Anxiety in Dogs

Separation anxiety is a common issue among pets, particularly dogs, and can lead to various behavioural problems when they're left alone. What is Separation Anxiety? Commonly we use this term to describe obvious behaviours that a dog performs when we leave the house, such as excessive barking, destruction of household items or scratching at the door, elimination inside the house, as well as pacing and panting. This is better described as abandonment anxiety , because anxiety is the thought process that something might happen. Thus far, there has never been a time that you didn't come home. But your dog doesn't know that! This is why with all separation anxiety cases, you should be enlisting a professional to assist you. When we have a pet that performs these behaviours, we also need to determine if this is truly an anxiety related issue and if so, what is the underlying cause of the behaviour? Is this due to confinement, frustration, or boredom? While the treatment of these problems may be similar, the underlying emotions may be different. What Causes Separation Anxiety? Puppies who grew up in a household where they were exposed to time away from their family, that was not excessive, nor led to an event that the puppy found traumatic, tend to have a better outcome. If you understand that during the early socialization period, puppies are curious and resilient, then as they get older (around 12 to 14 weeks) they grow to fear the unknown. If part of that unknown is their pet parents leaving them for the day, this can lead to an excessive attachment. However, if the puppy was left for longer than it could handle on its own, a similar effect of abandonment anxiety may occur. This is very common in puppies who are crated and expected to hold their bladders or bowel movements longer than they are able to. Adult dogs who have noise phobia are more likely to suffer from separation related distress ( Overall et al 2001 ). This may be due to lack of a safe place if suddenly the smoke alarm goes off in your building and you were not there to help them. Any dog that goes through a change in routine that they are unable to cope with can also develop separation related issues. This could be a change in ownership, a change in their environment, or a change in their human's work schedule. We all know that with the COVID-19 pandemic came a plethora of humans working from home - and then not. How do you know if it is Separation Anxiety? The best way to determine if your dog is suffering from separation related distress is to record their actions while you are gone. As mentioned, there may be obvious signs of anxiety, but some dogs will show more subtle signs. For example, a dog that does not eat while their owner is not home may have separation anxiety. A dog that will not or cannot sleep while their owner is gone may also be suffering. Set up your computer camera, or purchase a monitoring system that you can watch while you are gone. If they settle within 15 minutes of you leaving, then great! This is not a separation related issue. If later, they get up because of a noise or they later become destructive, they may have a different behaviour problem. Prevention of Separation Anxiety When you first get your puppy. Play games with your puppy, such as tossing a toy down the hall, or behind a piece of furniture that blocks their view of you. Work on building a safe place for them to stay while you are gone, but start with short durations of time. For example, provide your puppy with a lickimat of wet food, then leave the room. Slowly increase the duration of time you leave the room. When building this safe place, close the door and turn on a white noise machine to block out any noises. You can even try the Adaptil Diffuser that may help puppies adjust to their new homes ( Santos et al 2020 ). My Dog Already has Separation Anxiety, now what? You would not be alone if you adopted a dog that already had a separation related problem. Many dogs who come through rescue organizations are not used to the confines of life within a home. That being said, while some folks think that the reason that their pup demonstrates these behaviours is due to prior abuse, we cannot discount that genetics plays a huge role in how our dogs behave. The genes that are passed on from the sire and dam create a new set within the puppies, then gene expression (whether the genes are turned on or off) will determine the phenotype, or how it is 'seen' in the offspring. Researchers have determined that traits such as fear and anxiety are heritable in several lines within several breeds of dogs ( Overall et al 2006 ). Genetic expression of behaviours is far to complex for a blog like this, so I will leave that up to the researchers, but what I want to reiterate is, you were not the cause of your dog's separation anxiety! Are there scenarios that could have been it worse? Sure... but if the same scenario occurs to a dog who has resilience and does not suffer from an anxiety disorder, then I would not have yourself hold so much power. Now that we have a dog with separation related problems, how are we going to management? The gold standard for separation related cases is to never leave them alone ! But Dr. Serena - this is not realistic!!! ---- I know! So what are we going to do about it? Hire a pet sitter: This will hopefully be a short term idea as you are going to work through the problem in the long term with a professional. But let's say you need to run an errand, can you have a neighbour pop over and watch them? Is there a pet sitter that you can trust? I bet you can find one in your local Facebook community group if you ask nicely. Hire a veterinary behaviorist : This is going to be the biggest bang for your buck. I promise you. If you think that a dog trainer is going to be able to get you far with a separation anxiety case, while you have to go back to work because the COVID-19 pandemic is over, you are sorely mistaken. (see below) Consider whether this dog is the right dog for your lifestyle: We have to think about the quality of life of the animals that we force to be in our homes. Forcing them to bend to our wishes. You got a puppy during the pandemic because you then had time for training the puppy. Now this puppy cannot have you leave their sight for one second! You cannot even go to the bathroom without the clip-clip of their claws on the floor behind you. Ask yourself if you are able to dedicate 2 years of management and training, and the dollars that come with this, to get your pup to have its welfare needs met which include the Freedom from fear and distress . Training for Being Alone This part is when you practice leaving the dog in its safe place. This is not real life! I will get to that. Again, you will practice leaving the dog alone. Rather than doing the "door is a bore" game at the front door, try to do this at their bedroom door. The safe place again, should be a quiet room in the house. This is not the crate in the living room! This is not free in the living room! This is any room that you can close the door, close the blinds and turn down the lighting. It is also a room that your pet will (eventually) choose to take a nap in. This could be a mudroom, this could be a den with a door, this could be in the basement, or it's your own bedroom. When you do the training part, it is similar to when you train a puppy to be on its own. First ensure that all of their needs are met: they have been outside for elimination (urination and defecation), they have had some play/exercise, they have had some attention and affection from you their favourite human, then the only two basic needs that are left are eating and sleeping which they can do in their room. Therefore, get the tastiest, longest lasting treat you can come up with. Think frozen bone broth in a Toppl. Think peanut butter filled Kong. Think frozen wet food in a maze bowl. Time your dog for how long it takes them to get through this. Say it is 4 minutes. Then you are going to leave your dog in their room, door closed, white noise on, dimly lit, and leave them with their busy food puzzle for 3 and a half minutes. When you go to open that door, do not call them out, do not draw attention to the door being open, just walk away. Then repeat this. Eventually, they will be desensitized to staying in their room, on their own, for 3 and a half minutes. Once you notice that they do not come out of their room right away, start slowly increasing duration. Seek Professional Help While you can for sure pay for a dog trainer that specializes in separation anxiety, I can almost guarantee you that you will get to your goal faster if you hire a veterinarian or veterinary behaviourist first. Why? If you have to leave them alone, you will set yourself and them backwards. In which case, you will want to ask your veterinarian, is there a medical option to allow me to leave the home to run some errands (which may or may not be cheaper than hiring a pet sitter). When it comes to medications, as I have mentioned on my TikTok , there are soooo many options, so that advice should come from your veterinarian. BUT! There are two groups of medications: 1) as needed sedatives/anxiolytics/hypnotics/anti-adrenergics, and 2) long term anti-anxiety medications. I will say, in general, most dogs who suffer from separation anxiety benefit from having both, one long term medication that they stay on, and one as needed for while the longer term medication is building, and while you are working with a professional and/or certified dog trainer or dog behaviourist. Which is why I would say, save your money and visit your veterinarian first. If your veterinarian is not experienced with separation anxiety cases, then please ask them for a referral to a veterinary behaviorist.

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Coping with the Loss of a Patient

Coping with the Loss of a Patient

How do you cope with the loss of a patient? I started writing this post in February of 2021, two years later, I am still haunted by a particular case. I know, if you’re out in practice long enough, it is bound to happen. This does not make it easier. We, the veterinary professionals, are perfectionists. We want everything to go perfectly. This is not a realistic view, because sadly, we cannot save them all.
When I lose a patient, I question every step before that. Should I have done this ? If I had done that , would it have changed the outcome? I am not talking about cases where finances were an issue and we had to cut corners to try to do our best with the funds that were available. I am talking about young, apparently healthy animals, that you just do not get enough time for a work-up and treatment to save them. Or you went down one path, while waiting for diagnostic testing results, only to realize your treatment plan was too conservative. Too little, too late.
Debrief This will be dependent on your own personal situation. It will depend on mentorship, and the relationship you have with your colleagues. I am fortunate to have five other general practitioners in my hospital. So, the first thing that I do is mention to my colleagues - I lost a patient. These are the items I have identified that could have gone better. Is there anything else? Some will say, I would have done the same thing. Some will give advice on how things could have gone better. Talking it through with your colleagues is the best way to learn for the future. You have to really try hard to not beat yourself up about it. Cry You may not think that crying is going to be very fruitful. But the stress or emotions that you suppress, or as they say, bottle up, will come out eventually. It is better to talk and cry it out when you can, because if you do not allow yourself to have these feelings, it will go somewhere else. The last thing you want is to take it out on your family or significant other when something small they say ends up being the last straw. Join a Support Group I specifically did not say therapy, because I still believe that they best people to talk to are the ones who work in the same profession. Vets4Vets is a group that was created by the VIN foundation. Whether you are a newly graduated veterinarian or a seasoned practitioner, the group can help you talk through your pains and hopefully allow you to pull through to the other side. Know that you are not alone.

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Compulsion Dog Training vs Positive Reinforcement

Compulsion Dog Training vs Positive Reinforcement

There are many people who call themselves dog trainers, without any credentials, because the title of dog trainer is not a protected title - unlike the title of veterinarian. What makes it difficult for the general public and even for veterinarians is who can we trust with our beloved pets? Key words in a dog trainer's description will be able to tell you what kind of trainer they are. Those who call themselves "balanced" dog trainers will use a combination of all four quadrants of the operant learning paradigm. Those who call themselves "positive reinforcement" dog trainers will use just that - positive reinforcement. But the problem is that the lay person does not know what B.F. Skinner even meant when developing operant learning theory. What "balanced" dog trainers and "positive reinforcement" dog trainers have in common is that they will never recommend a compulsion trainer such as the Dog Daddy as your go-to dog trainer. People online tend to gravitate towards rapidly moving, high action videos. The attention span of individuals in the current day is very small, hence why TikTok itself was only 12 to 30 seconds long - and if you look at your insights on your own posts, they drop significantly within the first 2 to 10 seconds. Flashy accounts get more views, more likes and more subscribers. Unbeknownst to the individual who is looking to hire a dog trainer, the highly qualified individuals are not even active on this platform. One of the criticisms that I have received on my TikTok is: Veterinarians "cherry picking" positive reinforcement dog trainers to be the cream of the crop. The thing is, we do not need more research into how punishment, compulsion, suppression and oppression worsens the quality of life of the pets in our care. Veterinary Behaviorists are the most educated and qualified individuals to speak on dog behaviour - not an unlicensed 'dog trainer'. Positive reinforcement dog training is a training approach that focuses on rewarding desirable behaviours rather than punishing unwanted behaviours. Choosing a positive reinforcement dog trainer can offer several benefits for both you and your dog. Here are five reasons to opt for a positive reinforcement dog trainer: 1. Creates a Positive Learning Environment: Positive reinforcement trainers emphasize creating a positive and enjoyable learning experience for your dog. By using treats, toys, and praise to reward good behaviours, your dog associates training sessions with fun and positivity, leading to a stronger bond between you and your pet. Many of the problem behaviours seen in dogs are made worse by a poor emotional attachment to their humans. 2. Builds Trust and Confidence: Positive reinforcement methods promote trust and build your dog's confidence. When your dog consistently receives rewards for performing desired behaviours, they become more confident in understanding what you expect from them, leading to improved communication and overall behaviour. 3. Reduces Stress and Fear: Positive reinforcement training avoids the use of punishment or aversive techniques that can induce stress, fear, or anxiety in dogs. This approach helps prevent behavioural issues that may arise when using more averse methods that increase the conflict between you and your dog. When we house animals in our care, we owe them the freedom from distress . 4. Encourages Problem-Solving: Positive reinforcement training encourages dogs to think and problem-solve, as they actively seek out behaviours that result in rewards. This mental stimulation can lead to a more engaged and attentive dog, helping to address behavioural challenges and prevent boredom-related issues. 5. Lasting Behaviour Change: Positive reinforcement techniques focus on teaching your dog what to do rather than what not to do. This promotes lasting behaviour change by reinforcing positive habits and reducing the occurrence of undesirable behaviours without resorting to punishment, which may only suppress behaviours temporarily. Overall, choosing a positive reinforcement dog trainer can contribute to a happier, healthier, and better-behaved dog while fostering a strong and positive relationship between you and your furry companion.

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Pibble Mom vs Doodle Mom?

Pibble Mom vs Doodle Mom?

What do Pibble moms and Doodle moms have in common? They are both extreme advocates of their “breed“. I put breed within quotations because “breeds” are just human constructs of selection for phenotypic traits. Phenotype, being the qualities we can see and measure, has a genotype attached to it. That genotype is a set of genes with two alleles. I loved simple Mendelian genetics and drawing Punnett squares when I was younger. If you carry two alleles, you could have one allele be expressed and the other not expressed. Or even more fun is having different expression of each gene in different areas of the body - like those of a calico cat. The truth being is that genetic traits are not so simply expressed or passed on to the next generation. When a "breeder" stands by their "breed" touting that they are protecting the "breed standard" - who determined this breed standard? Humans. The original LabraDoodle was created to serve a purpose, as a 'hypoallergenic' or non-shedding guide dog. One of the three puppies fit the job in the 1980's. Now anyone who is looking for a non-shedding dog is breeding a poodle with anything. On my schedule I have a new pet parent bringing in a Golden Doodle, and in walks a shaggy black dog that isn't a foot high at the shoulders. I don't drive 10 feet in my neighbourhood now without see either a Bernedoodle or AussieDoodle. People will pay over $10k for a trained designer puppy these days. I guess if you have the money to do it, you do you. You know what the Pibbles and the Doodles have in common? Both "breeds" can cause severe bites to young children. Why do you even care? Why would you want to know? Genetics is hard and the phenotype that we as humans has selected for can have dire consequences. You know when the pitbull momma stands there and says, well, the pitbull was not bred to be human aggressive, only dog-aggressive or other animal-aggressive - those people know nothing about modal action patterns within the predation sequence of wild canids that is partially inherited and partially selected for by people. It is that predatory sequence that humans have manipulated in breeds such as the Border Collie - who has an extreme eye->stalk and an inhibited grab-bite/kill-bite. People who chose to have a dog to herd their sheep would cull any dog that would harm the sheep, essentially outbreeding that instinct to kill a prey animal. You know who does not have an inhibited grab-bite/kill-bite? The dogs that were selected for by people for entertainment by pitting one dog against another. Last year a group of researchers published an article on the genetics of dogs, the relationship between breed and the genetics, as well as heritability of certain traits such as the ability of a breed to respond to human direction (aka biddability). You know what that means? To help us determine which dogs are best suited to live a life among human children is not what the breed looks like, but what genetic influence is on how the dog behaves. It is the fool that sits there are tells you that their pitbull is 'friendly' and would never hurt a child. Before you get all uppity, understand that until we know what that genetic releasing mechanism is that says 'chase that erratic moving small mammal' - no dog should be trusted with any erratically moving small child, which if you have children, you know what they look like bouncing around. If you ask yourself, is the life of my child worth it? Only you can answer that. Defenders of the "breed" jump in and say, well, Goldens or Labrador Retrievers are the most reported bites. It does depend on the area in which you live in, and which study you are reading. I said this on a TikTok post , that in order for us to point blame to a particular breed, we need to know what is the popularity of that breed in that geographically area. According to Morrill et al, 2022 , the largest genetic representation was with the pitbull terrier. In other words, if pitbull bites are the largest number of bites to children that end up in the emergency hospitals in Philadelphia, what is the percentage of pitbulls to other dog breeds in the city of Philadelphia? I will say it again... I am not for breed legislation or breed bans, just as I am not for banning of aversive equipment, but those that decide to own these breeds should have respect for the weapon that they bring into their home. Responsible dog ownership is similar to responsible gun ownership: Never leave a weapon around your children, unless you want someone to get hurt.

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Unexplained Pelvic Pain

Unexplained Pelvic Pain

It’s only been in the last year that I have held back with blogging or posting about my personal life. I had two scares - December last year I was in the hospital due to unexplained right lower pelvic pain. I had my hubby call an ambulance because I was in too much pain to consider driving myself and hubby had sold his car, and has not practiced driving manual transmission enough to be able to drive mine. Anyway, we got to the hospital and they gave me some pain medication and ran an IV line. They pulled blood and scheduled an ultrasound to hunt for causes of pain. Hubby was trying to explain to the paramedics and first responders about the previous time I was at the hospital. In August 2021 after a terrible miscarriage, I kept bleeding and then had a vasovagal response when the retained placenta was sticking in my cervix. This time, I had a positive beta HCG, again. So thoughts of an ectopic pregnancy swarmed our minds. Hubby was horrified, now saying that every time I end up in the hospital it’s because I am pregnant. This isn’t really the case. Nor was it the cause of the pain this time. But it is a relevant fear when your loved one is hurting and you cannot do anything about it!
The list of differentials at the time were appendicitis, ectopic pregnancy, or some ruptured ovarian cyst. The ultrasound showed something that could have been a cyst on my right ovary. So, since I wasn’t dying, I got discharged on oral hydromorphone. I obviously had to call in sick that day, and the next. I made a follow up appointment with my family doctor as they recommended further blood work to track my HCG and another ultrasound. When I spoke with my family doctor, she asked if the ER doctor had said anything about my ureter. Turned out my ureter was distended! So then kidney stones went on the list as well. So I had follow up blood work, urinalysis and ultrasound. All was normal, except that my HCG was trending down. Yet another miscarriage, or chemical pregnancy.
I still to this day, four months later, have no idea what the pain was. It hasn’t returned and it went away fairly quickly, within 48 hours. But hubby was scared. To the point where he was talking about any other way that we could build a family. Surrogacy? Adoption? It’s a huge decision to come to, when you know you want to be a mother, but your body hasn’t been working the way you had hoped! Not to mention that Hubby has a son from a previous relationship. So he’s been through having his own genetics being passed on to the next generation. For women, you have to give up on that idea of your genetic child, and look to maybe epigenetic influences if you can carry a child. Many women will question: When do I decide to go with donor egg? Donor Embryo? Adoption? Surrogacy? These are all very personal decisions. For me, surrogacy is not an option. I either carry the child or we look to adoption. Now Hubby has come to terms with saying it’s ok if the child is not genetically related to him, because he just wants to be able to raise a child. He has so much love and teaching to give that it’s hard to not be able to provide that for him. Again, hindsight is 20/20. I knew prior to going to veterinary school, when I was 31, I knew that graduating at the age of 35 would make it challenging for me to have my own child. Prior to being shipped off to Saskatoon, I told my mom... just so you know, it’s likely that I won’t be able to have my own child when I’m done. Was egg freezing a thing that was done in 2012? Sure. Was it readily available and talked about. Absolutely not! If women were not shamed into hiding their problems with fertility, it would have been brought up. But no! Women are shamed to hide when they are having a miscarriage - a loss of a child that needs grieving time. Shamed into continuing to work while having excessive bleeding and essentially giving birth to placental remnants while working. I know it comes from hiding these “problems” from the judgemental men when women were entering the workforce early on through women’s liberation. But I still stand by it. You can have your cake and eat it too. You can build a family while pursuing a career.

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