I RECENTLY attended the joint BVBA/APBC symposium, “One Health: People and Pets’ Behaviour”. The meeting was excellent and certainly made for an interesting discussion.
The most alarming fact that I took home was the general thought that it is a “normal” part of a veterinary surgeon and veterinary nurse’s day to get bitten by our patients. These bites may range from a nip to a serious bite requiring surgery.
The reason I found this so alarming is that I have been in practice for 25 years and have only ever been bitten by a dog once. This wasn’t a dog I was handling but one I was standing next to in the waiting room.
Over the years I have had many discussions with fellow nurses and vets about dog bites in practice and still find it alarming that so many of us get bitten and mostly just shrug it off as another day at work.
Where are we going wrong?
The highest frequency of bites occurs during the initial clinical examination. We seem to have lost the ability to “read” dogs’ signals. Does the problem start at university? Are our veterinary students getting the correct handling techniques shown to them?
After all, if they can’t perform a clinical examination safely, how are they going to diagnose the problem? How many of us are aware of the “ladder of aggression” produced by Kendal Shepherd? Is it due to the high-pressure of short consultation times?
How many of us actually look at the dog as it enters the room and take a second to stand back and observe before we lift the dog onto the examination table and start prodding and poking?
So where do we start?
The most logical place is at the beginning when they are puppies. At first vaccination we need to spend time getting to know the puppy’s character.
“We don’t have time!” I hear you all scream. Well this is where you should be using your nurses. We run a 10-minute appointment system for the vet to do the initial health check and vaccination, then a nurse takes over discussing flea, worms, diet and training.
We use a “puppy socialisation chart” and “puppy behaviour progress chart”. The nurse will go through lots of things the puppy should meet and be able to cope with, especially handling, picking up paws, checking ears, lifting tails up, checking teeth, lying on their back for a tummy rub which also doubles as an abdominal examination.
The nurse will see the puppy two to four times before it is six-months-old so we have already identified the nervous or boisterous puppies and have advised correctly. All accompanied by lots of tasty treats of course.
Now you might be thinking that is a lot of time all at no charge! How will this benefit my practice?
- Happy patients that will tolerate a clinical examination throughout their life.
- Clients bonded to the practice.
- Safe staff, and less time wasted with difficult patients.
At the end of the day this patient will be visiting you for approximately the next 12 years, so make friends now!
What can we do?
Let’s look at the three main areas where veterinary staff are getting bitten:
- The clinical examination.
- Kennel cough vaccine.
- Sedating or anaesthetising the dog.
What do we know about the dog? Watch the dog as it enters the room: is it confident or is it shy? Let the dog approach you. Would it be happier to be examined on the floor? Does it need separating from an over-bearing owner? Would it prefer to be handled by a nurse?
Don’t be scared to ask to put a muzzle on the dog before it tries to bite you. The muzzle often distracts them if they are not used to muzzles, as it gives them something new to think about. Give the dog time to relax and ask for the clinical history first.
Think about the dog: is it better to pre-medicate it while the owner is present or when the owner has gone? Do you need to arrange for it to come in just before pre-medication is due or is it better to settle in the kennels first? Would it be better to come in the night before?
What kennel suits the dog best? If it is cowering at the back of the kennel, can you reach it to slip a lead over its head? Would it be better to leave the lead on? Does it have a nurse it trusts? Does it need some sedation before coming in to the surgery?
If it’s not on nil by mouth, offer a treat, but make it tasty! Drop the treat on the floor first as the dog is more likely to take it. Note: dogs and cats love “dreamies” treats!
If you experience a difficult dog, take time to ask why. How could it have been approached with a better outcome? Did the dog wait too long in the waiting room? Is it phobic about white coats?
Does it prefer to be examined in the waiting room so could it come in between clinics? Does it prefer male vets to females or vice versa? Does it need to be de-sensitised to the surgery or to having the kennel cough vaccine?
These are all questions we should be asking every day. There is no need to be wrestling with dogs or taking risks. I have seen some nasty bites over the years and some that have ended a surgeon’s career.
Is taking that extra five minutes to assess the behaviour of the dog really too much to ask?
- Next month we will consider how we can help prevent dog bites in the wider public.
References
- Ladder of Aggression: Kendall Shepherd, BSAVA client handout and behaviour manual.
- Puppy socialisation and Behaviour progress charts: Hill’s Pet Nutrition.
