S2 Week 13: Behavior Week, Ice Breaker Triathlon, and Recover CPR!
Our week of behavior has come to an end, and we are gearing up for the last block of the year which focuses on the gastrointestinal system and metabolism!
Monday started off with some lectures that covered the biological basis and functional basis of learning. This was a great foundation to build off of for the rest of the week’s activities! During lunch we had a wonderful lunch talk from Dr. Jankowski who is the Access to Care Chief of Service at the UC Davis veterinary hospital. Dr. Jankowski began her talk by defining some of the terminology that is typically associated with “access to care”.
Here are some of the key definitions you should be aware of:
Access to Veterinary Care (AVC): any work that makes vet care more universal and accessible. This includes considering the economic, physical, social mental and emotional resources necessary for people to obtain care for their pets.
Spectrum of Care: Providing a continuum of acceptable care that is considered available. *Spectrum of care falls well within the standard of care, it is just a range of options that may better suit the needs of the client.
Social determinants of health: Economic stability, education access and quality, health care access and quality, neighborhood and built environment, social and community context. For a deeper explanation and example refer to A Tale of Two Zip Codes.
During the presentation we learned that roughly 70% of households own a pet and 61% of Americans live paycheck to paycheck. It was also noted that 37% of Americans lack enough money to cover a $400 emergency expense and one in four families cannot afford veterinary care. With these statistics, it makes sense that ethical dilemmas surrounding the ability to provide vet care are at the top of the list of mental stressors for care providers and economic limitations of clients are a key cause of professional career dissatisfaction and burnout for veterinarians.
It may seem like providing adequate access to care to every pet owner would be a fairly uncomplicated task, however, there are a plethora of challenges surrounding this topic. Many veterinarians choose not to go into a career with this focus because they are unaware of the financial sustainability associated with providing services at a lower cost or expanding the spectrum of care that they offer. This theory was seen to be false, and overall practice revenue was still increasing after practices began to provide a spectrum of care.
Veterinarians may also feel judged by their peers if they are not practicing the “gold standard” which is what everyone is taught in veterinary school. We are all privileged to learn in an “Ivory Tower” where most people can afford to do everything that is recommended, but in the real world, that is not the case and veterinarians have to learn how to be creative and work within the means of their clients. A few other challenges regarding AVC include a lack of resources for the veterinary team, technicians, and receptionists as well as an increased focus on specialization. Increased specialization has resulted in less options available for intermediate level care and instead of trying a new procedure or method for treating a condition, many general practitioners feel as though they should refer the animal to a specialist. The client may not be able to afford the referral, but they could have still had a good outcome with their regular veterinarian’s treatment plan.
I am super grateful that Dr. Jankowski gave this talk because it is a topic that I am extremely passionate about. I think it is crucial that we as veterinary professionals, educate ourselves about cultural humility and standard of care in a real-world setting. Not every client will be able to do all of the things that you recommend but most of them will be able to do something that you recommend. Presenting treatment options in a guilt-free manner and understanding that there is never just “one way” to address a situation is crucial. The client came to the clinic for a reason and obviously love their animal regardless of the condition it is in or what they can afford. Leaving any judgement at the door and being willing to work within their means to help their pet will help everyone involved!
Monday afternoon included a team-based learning activity focused on behavioral assessments of different animals. It was interesting to learn about some of the less common species such as primates and dolphins and see what we can learn from studying their behavior. That evening finished up with another shadowing session with the undergraduate Knight’s Landing One Health Clinic course.
Tuesday started with a few lectures discussing genetics and socialization as well as an exploration of the social behavior of animals. It was super interesting to learn more about the things that influence an animal’s behavior and how we can take that information and use it to our advantage in training sessions. That afternoon we had a fabulous lunch talk from Dr. Koh, one of our fantastic integrative medicine veterinarians. Dr. Koh dove into Traditional Chinese Medicine dietary therapy and walked through some examples of how food can be used to treat different conditions according to Traditional Chinese Medicine principles. If you are interested in learning more, here is a TCVM Food Therapy chart.
The rest of the afternoon was spent in lab learning about classical and operant conditioning and then applying our skills and teaching some of our colony dogs a new trick. Classical conditioning was coined by a scientist named Ivan Pavlov. Pavlov’s experiment showed that dogs could be conditioned to associate a neutral stimulus (such as a bell) with a reflex (like salivation) by repeatedly pairing the two stimuli together. In the beginning the bell had no meaning to the dog but over time once the sound of the bell was paired with food the dog began to associate the sound of the bell with food. By the end of the experiment just hearing the sound of the bell made the dogs start to salivate even if food was not present.
On the other hand, operant conditioning is a method of learning that employs rewards and punishments for behavior. An association is made between a behavior and a consequence (positive or negative) for that behavior. This type of conditioning was first described by B.F. Skinner, a behaviorist that studied mice in a box with a lever that would release food. The mice learned that if they pressed the lever, they would get food. As mentioned earlier, operant conditioning utilizes positive and negative consequences to increase or decrease the change of a behavior happening. Here is a quick breakdown of the differences between positive/negative reinforcement and punishment:
*Think of this as simple math, positive means you add something and negative means you take away something (it does not indicate good or bad). Reinforcement is something that strengthens a behavior and punishment is something that decreases a behavior.
Positive Reinforcement: The addition of a desirable event or outcome that strengthens the behavior. Ex: Giving a dog a treat for sitting. The treat is the positive reinforcer for the performance of the trick (sit) and since the dog was rewarded for sitting, that behavior was strengthened.
Negative Reinforcement: The removal of an unfavorable event or outcome to strengthen a behavior. Ex: The tension on the dog’s neck is removed when they are walking by the owner’s side instead of pulling. The tension on the dog’s neck is something that the dog likely finds undesirable and when they are walking nicely by the owner’s side, they relieve the tension on their neck. This reinforces the behavior of walking calmly next to the owner.
Positive Punishment: The addition of adding something undesirable to decrease the likelihood of an event happening in the future. Ex: Spraying a cat with water when it jumps up on the counter. The addition of water was an undesirable stimulus used to decrease the cat’s behavior of jumping up on the counter. It is important to note that positive punishment is NOT recommended and has been seen to severely hinder the relationship between the owner and animal. It has also been seen to be less effective in creating behavioral changes when compared to less aversive techniques such as positive reinforcement or negative reinforcement.
Negative Punishment: The removal of something desirable to decrease the likelihood of a certain behavior. Ex: Walking away from your dog when he starts to jump up on you. You are removing yourself and your attention (which is desirable to your dog) in order to decrease the jumping behavior.
Wednesday morning started off with an awesome hot yoga session followed by some lectures on sexual behavior in animals. That lecture was followed by one on normal and abnormal feeding behaviors and then we transitioned into a group welfare discussion. This discussion was a fun way to tie in all of the topics that we had been covering in class and gave us the opportunity to tie in our own ethical opinions think about things that we would want to implement as veterinarians. The final activity of the morning was a comparison of two animal hospitals and by the end of the session we had to choose which one supported animal welfare to a higher degree and support our decision with evidence.
The rest of the afternoon was spent working on a group project focused on animal welfare and behavior. Our topic was based on a horse that had been cribbing and it was now our responsibility to formulate a way to address the situation. Cribbing is a stereotypy behavior exhibited by some horses. Stereotypies are repeated behaviors that appear to lack an apparent foal or function and are often induced by boredom, stress, frustration, or illness. Our overall recommendations involved that addition of enrichment to the horse’s environment as well as a thorough health evaluation to see if there are any underlying medical issues. More information on cribbing can be found here.
Thursday was our final “mini-rotation” of the year and I was on the Equine Surgery rotation! The day started off by visiting the newborn foal as well as checking on some yearling Thoroughbreds that were being observed after their arthroscopic surgeries. We then used an endoscope to assess the airway of a beautiful Friesian stallion who had been making some interesting sounds while breathing. Once we got the scope in the horse’s airway we were able to visualize the arytenoids and saw that the horse had grade 4/5 left laryngeal hemiplegia. This is likely the reason that the horse was exhibiting greater respiratory effort and producing the sound that the owners had described. That horse was admitted to the hospital and was scheduled for a “tie back” surgery the following day to help improve airflow. We then had the ability to observe a “tie forward” surgery which is a procedure done to treat a dorsal displacement of the soft palate. The procedure aims to bring the larynx into a more rostral and dorsal location to keep the airway clear. The rest of the day was spent looking at a horse with a sizable mass on its right stifle. We performed radiographs and did an ultrasound to assess the mass and discovered that it appeared to infiltrate the patellar ligament. This means that it would potentially be more detrimental to the horse if we removed it surgically. This was a super interesting rotation to be on and I had a blast expanding my knowledge of equine medicine!
Friday started off with a hot yoga session followed by an exam on the past week’s information. After the exam was over, we had two awesome lectures by Dr. Lynette Hart. Dr. Hart is a professor of veterinary population health and reproduction and has also heavily researched the effects of the human-animal bond. Her lectures focused on dealing with animal deaths in homes, farms, labs, and zoos and the impact that these deaths have on humans. The following lecture focused on how the United States is an inclusive society for human-dog support. This lecture was interesting because it went over the standards for service dogs, or lack thereof and how the US policies vary compared to other places in the world.
That afternoon, Dr. Bain gave a lunch talk on how to choose a dog trainer. Dr. Bain is one of our lovely veterinary behaviorists. This means that after getting her veterinary degree, she pursued additional training and a residency in animal behavior. This talk was a great way to finish up the week of behavior lectures and give us some practical ways to take this back to a clinical setting and help our future clients. One of the super interesting things I learned from this lunch talk was the fact that a “dog trainer” is literally anyone that trains a dog. Before you roll your eye and think “duh”, let me explain this a bit further. Dog trainers DO NOT have a license of any kind. There are NO licensing programs in the United States that will license a dog trainer meaning that there is ultimately NO consumer protection. They may have complete courses and received a certificate, but they DO NOT have a license, DO NOT have to complete any continuing education courses, and DO NOT have to be humane. This means that BY LAW, when a veterinarian recommends a certain dog trainer, they are backing that trainer and if something goes wrong, they can be held responsible. As a side note, it is important to recognize that this goes further than just dog trainers. As licensed professionals, veterinarians are held responsible when referring animals to ANY unlicensed professionals such as human chiropractors (that practice on animals), dentists, or groomers. When we (veterinarians) mess up as a licensed professional, we can lose our license, since dog trainers are not licensed, if they mess up there are no consequences that would prevent them from training other animals in the future.
Now that all of that is out of the way, here are some things that you should look out for when selecting a dog trainer. If you see any of the following words in a trainer’s advertisement, you may want to look elsewhere because these are buzzwords used to cover up some degree of forceful training methods:
Balanced: usually involved positive punishment to shape behavior
Dominance/Alpha/Pack: typically includes techniques to create a submissive/fearful dog
No treats bribery: typically uses methods of force to shape behavior instead of positive reinforcement
Boot Camp / Board and Train: there is no legal requirement to disclose their training methods and many inhumane techniques occur without the owner’s knowledge (neck burns from shock collars etc.)
Schutzhund Ring
Negative Reinforcement
Remote/ Leash-free / E-collar: Dogs are shocked until they perform the desired behavior
Guarantee
Guard / Protection
A common thread that appears through these words is the use of force or a shock collar. These collars have been a popular way to correct or shape a dog’s behavior but if you take a step back and think about it, using this method on any other creature would seem ridiculous. Could you imagine putting a shock collar on a cat and zapping it when it jumped on the counter. Or take a dolphin for example, no one in their right mind would stick electrodes into the tank and shock the dolphin for not performing a trick. When you use a shock collar for things like reactivity you are punishing the animal’s behavior but are not changing it’s emotional state which is the root cause of the reactivity. The dog is likely scared or triggered by whatever they are reacting to and instead of trying to understand the emotional component, it is just being punished which is ineffective in changing the behavior in the long-term. It is important to note that these collars are often recommended by trainers and owners are not aware of the psychological damage that this can inflict on their dog and the damage that it can do to their relationship with their pet. I am by no means blaming anyone for using these collars, especially since many people do not have access to the research or understand the detrimental effects of these devices. I am just telling you this information so you can make informed decisions and possibly rethink the way that you train your dog. As Dr. Bain mentioned multiple times during this week, “just because we can, doesn’t mean we should”. As more evidence emerges regarding dog behavior and training, we have the ability to adapt our methods to better support animals and their owners. You can’t change the past, but you can adapt and do better in the future.
Now that you know what to avoid, here are some resources that will help you assess different trainers. Dr. Bain and a team of veterinary behaviorists have reviewed different dog trainer certification programs (remember a certification is different than a license) and has ranked them based upon their use of appropriate techniques and training. That list and other resources can be found here.
The rest of the afternoon included the group presentation on the cribbing horse and the rest of the evening was spent hanging out with Churro.
Saturday started off with the Ice Breaker Sprint Triathlon. This was my first time racing since starting vet school and it was SO much fun competing again! The race definitely lived up to its name and was unlike any other triathlon that I have done in the past! To start it off, it was raining the whole time which did not affect the swim but added a little spice to the bike and run portion. The weather turned the bike course into a white-knuckle adventure as we all traversed the sharp turns and winding hills, and the run was fairly comparable to a slip and slide. Roughly 75% of the run was on a slim trail that was fairly washed-out, and everyone played the fun game of judging what mud was safe enough to go fast through, and when slowing down would be necessary to preserve an upright posture. There was also a nice half-mile barefoot run from the swim to the transition area. Luckily, all of our feet were numb enough to ignore the sharp gravel and uneven terrain. While none of that may sound appealing to you, this race was honestly so much fun! Racing in suboptimal conditions is such a great way to develop mental toughness and while racing it was awesome to look around and realize how similar (and crazy) we all are. Everyone was in a good mood and cheering for each other along the course. There were also some creative techniques that I observed on the course. One racer wore his wet suit on the swim AND bike. I had never seen this before, but it must have saved him a lot of time in the transition area as well as provided some extra warmth and protection from the rain on the bike course. I personally will not be trying this technique and did not even wear a wetsuit in the swim (even though it was a warm 58°) but I appreciate the creativity.
The rest of the afternoon was spent hanging out with Churro and the evening was filled with Recover BSL CPR training hosted by Companion Animal Health. This training was complementary to a series of online modules that taught the basics of CPR in animals. Unsurprisingly, CPR in animals is a little more complicated than in humans. Depending on the dog breed and body conformation, hand positioning and the overall chest-compression technique will vary. During the in-person session we practiced doing chest compressions on dogs for 2-minute intervals as well as initiating single and double-person CPR. We finished up the night with a written and practical assessment and then received the official certification! Prior to this training I knew close to nothing on animal CPR and was honestly clueless on how to run a code. Thanks to Companion Animal Health who provided all of the materials, training, and certification at zero cost, I am way more comfortable around this topic and know the steps to take during an emergency where CPR would be necessary.
Sunday started off with a little 3 mile run with Churro followed by getting some things done around the house. The rest of the afternoon was spent relaxing and preparing for the final block of the year!
*As a side note all of the neurology resources have been updated and there is also a video on pelvic and thoracic limb reflexes that can be found here!
Quote of the week: “I will make you another $500 bet, you will never be bitten by a rectum.” -Dr. Bain
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