1 00:00:05,150 --> 00:00:07,800 Welcome to this special episode of Chattering with 2 00:00:08,010 --> 00:00:09,810 iCatCare sponsored by Orion. 3 00:00:10,559 --> 00:00:14,919 I'm Yaiza Gomes Mejias, iCatCares Veterinary Community Coordinator and I'm 4 00:00:14,920 --> 00:00:19,410 hosting this episode today with Laura Watson, our Cat Welfare Coordinator. 5 00:00:20,010 --> 00:00:23,650 Today we are joined by one of the leading voices in veterinary 6 00:00:23,650 --> 00:00:28,620 behavioural medicines, Dr Sarah Heath, with decades of clinical experience, 7 00:00:28,930 --> 00:00:33,070 Sarah has redefined how we understand the emotional lives of our cats. 8 00:00:33,630 --> 00:00:39,000 We will explore how behavioural medicine is no longer a niche interest, but a 9 00:00:39,000 --> 00:00:45,819 vital integrative discipline that touches every corner of any veterinary practice. 10 00:00:47,710 --> 00:00:49,820 So would you like to start with the questions, Laura? 11 00:00:49,929 --> 00:00:50,680 I can indeed. 12 00:00:50,830 --> 00:00:54,630 So the Heath Model redefines how we think about emotional health in animals. 13 00:00:54,820 --> 00:00:57,350 Can you explain its core principles and how they translate 14 00:00:57,360 --> 00:00:59,059 into clinical decision making? 15 00:00:59,070 --> 00:01:02,519 So the Heath Model, it's really about comprehensive veterinary healthcare. 16 00:01:02,519 --> 00:01:07,149 So the idea that healthcare has got these three elements to it, one element 17 00:01:07,150 --> 00:01:11,570 to that is emotional health, which I guess the Heath Model started with the 18 00:01:11,570 --> 00:01:16,910 sink analogy, thinking about how to explain emotional health to caregivers. 19 00:01:17,559 --> 00:01:21,070 The first part of your question was about what are the core principles of 20 00:01:21,080 --> 00:01:23,260 the emotional part of the Heath Model? 21 00:01:23,670 --> 00:01:27,709 And certainly I think the thing that differentiates it from other ways 22 00:01:27,710 --> 00:01:32,740 of understanding is that it really talks about that integration between 23 00:01:32,750 --> 00:01:38,560 emotional capacity, emotional input, and emotional drainage leading to arousal. 24 00:01:38,560 --> 00:01:42,140 So not just thinking about emotions as valence or whether they're 25 00:01:42,789 --> 00:01:48,940 engaging positive or protective, but also about that state of arousal. 26 00:01:48,950 --> 00:01:52,870 How much emotional of whatever type is this animal dealing with 27 00:01:52,870 --> 00:01:57,059 at the time, and how is that influencing behavioural output? 28 00:01:57,620 --> 00:02:01,029 The core of the emotional part of the Heath Model is the sink 29 00:02:01,030 --> 00:02:04,800 analogy and the idea of this interplay between those factors. 30 00:02:05,049 --> 00:02:09,230 So knowing some history to know a bit about their potential sink 31 00:02:09,230 --> 00:02:13,940 size, their capacity for emotion, thinking about their bias emotionally. 32 00:02:13,960 --> 00:02:16,609 So are they more engaging or more protective? 33 00:02:16,980 --> 00:02:20,589 And thinking about their drainage ability, how well do they cope? 34 00:02:21,080 --> 00:02:25,820 How resilient are they from an emotional health point of view, which results 35 00:02:25,820 --> 00:02:30,060 in the residue in the sink as we talk about it in the sink analogy, 36 00:02:30,060 --> 00:02:32,100 but basically that state of arousal. 37 00:02:32,110 --> 00:02:36,430 So that's really the concept of emotional health, but the Heath Model 38 00:02:36,750 --> 00:02:39,250 in its entirety is far more than that. 39 00:02:39,610 --> 00:02:42,839 So it's all also about comprehensive veterinary healthcare. 40 00:02:43,240 --> 00:02:45,920 The physical, emotional, and cognitive together. 41 00:02:45,950 --> 00:02:49,760 Cognitive health can be looked at as the way we think, learn, and remember. 42 00:02:50,570 --> 00:02:53,480 All the time when you're having experiences, there is an 43 00:02:53,480 --> 00:02:57,140 element of cognition, there's an element of memory formation. 44 00:02:57,540 --> 00:03:04,360 There's also an element of learning to use a different, more applicable, 45 00:03:04,370 --> 00:03:06,600 more successful behavioural response. 46 00:03:06,970 --> 00:03:10,089 behaviour is just an output, not a diagnosis. 47 00:03:10,130 --> 00:03:15,369 These elements create a behaviour, which is what we see the animal doing, but 48 00:03:15,370 --> 00:03:18,290 that response also becomes learned. 49 00:03:18,340 --> 00:03:21,150 How do they think about what they're doing? 50 00:03:21,230 --> 00:03:23,923 How do they remember what they're doing? 51 00:03:23,923 --> 00:03:27,310 How do they decide a good response in the future? 52 00:03:27,349 --> 00:03:31,959 There's a term emotional intelligence where cognition meets emotion and where 53 00:03:32,410 --> 00:03:38,250 you make decisions about how you respond to those emotional responses, and 54 00:03:38,250 --> 00:03:42,920 that's really important when we think about a cat in a clinic because they 55 00:03:42,920 --> 00:03:45,340 will have certain emotional responses. 56 00:03:45,639 --> 00:03:51,580 What they do about those has quite an impact on their welfare, but also 57 00:03:51,620 --> 00:03:54,890 on the welfare of the veterinary staff, the perception of the 58 00:03:54,890 --> 00:03:58,680 caregiver of how that visit has gone, and therefore the potential to 59 00:03:58,680 --> 00:04:00,600 have subsequent visits, et cetera. 60 00:04:00,600 --> 00:04:04,239 So we are affecting the cognition of the human animals involved as well. 61 00:04:04,580 --> 00:04:09,960 But that cat will be learning something and if we can teach them that they 62 00:04:09,960 --> 00:04:16,070 can succeed in dealing with these protective emotions by using things 63 00:04:16,070 --> 00:04:20,279 like avoidance, by staying in their carrier, being partially hidden by 64 00:04:20,279 --> 00:04:26,519 a towel, and feeling that they are successful in using avoidance, we lower 65 00:04:26,790 --> 00:04:32,030 the potential for them to use repulsion because repulsion is not needed. 66 00:04:32,080 --> 00:04:37,740 But it doesn't mean if an animal's using repulsion, it is more or less unhappy or 67 00:04:37,740 --> 00:04:43,529 threatened that an animal using avoidance or is inhibited and doing nothing. 68 00:04:43,759 --> 00:04:48,139 They're just alternative strategies to deal with emotion 69 00:04:48,750 --> 00:04:49,770 and influence through cognition. 70 00:04:51,040 --> 00:04:54,190 If they are successful, they're more likely then to be put into 71 00:04:54,190 --> 00:04:57,030 that behavioural repertoire for that individual for the future 72 00:04:57,240 --> 00:04:58,979 through cognitive processes. 73 00:05:00,039 --> 00:05:00,409 Brilliant. 74 00:05:00,409 --> 00:05:00,780 Fantastic. 75 00:05:01,250 --> 00:05:04,640 I remember the first time I heard you talking about the sink. 76 00:05:04,690 --> 00:05:07,590 That was the moment where I really understood emotional resilience. 77 00:05:07,690 --> 00:05:11,240 In your experience, what are some of the most overlooked behavioural 78 00:05:11,250 --> 00:05:14,945 signs that actually point to underlying physical health issues? 79 00:05:15,200 --> 00:05:19,710 So we talk about flare up in cats in relation to things like cystitis or things 80 00:05:19,730 --> 00:05:26,990 like skin disease or the flu signs where we have a pattern of a disease process 81 00:05:26,990 --> 00:05:32,969 in a physical sense that sometimes is quiescent, sometimes may appear to be 82 00:05:33,099 --> 00:05:35,669 treated, but then raises its head again. 83 00:05:36,309 --> 00:05:41,220 And that to me is a big sign that says, let's consider what are 84 00:05:41,220 --> 00:05:42,730 the other components of health? 85 00:05:42,850 --> 00:05:44,080 Is emotion involved? 86 00:05:44,100 --> 00:05:45,300 Is cognition involved? 87 00:05:45,340 --> 00:05:49,280 They will always be involved, but to what extent is it involved? 88 00:05:49,760 --> 00:05:53,450 To what extent do we have to address that in order to get a full 89 00:05:53,719 --> 00:05:55,920 resolution of the physical signs? 90 00:05:56,550 --> 00:06:00,070 I don't think it's one particular disease process, but more the 91 00:06:00,070 --> 00:06:06,180 pattern of how it presents in terms of this quiescent flare up history. 92 00:06:06,300 --> 00:06:08,619 That would be a big red flag for me. 93 00:06:09,210 --> 00:06:15,299 The other is when your experienced veterinary surgeon finds a case baffling. 94 00:06:16,219 --> 00:06:20,180 I think that's another signal for me that you need to also consider the other 95 00:06:20,180 --> 00:06:25,230 dimensions of the health triad, because that can be a complicating factor. 96 00:06:25,580 --> 00:06:28,949 So you've got your physical health condition, but if there's emotional 97 00:06:28,969 --> 00:06:33,640 compromise involved, cognitive compromise involved as well to a significant 98 00:06:33,640 --> 00:06:37,640 level that may actually make that physical disease much more difficult 99 00:06:37,660 --> 00:06:39,150 to really pinpoint and get to the 100 00:06:41,750 --> 00:06:41,820 bottom of. 101 00:06:41,960 --> 00:06:43,369 So I would always see that as a red flag. 102 00:06:43,400 --> 00:06:45,449 The third thing would be response to treatment. 103 00:06:46,040 --> 00:06:49,250 If I've made a good diagnosis as a general practitioner, and I know 104 00:06:49,250 --> 00:06:52,519 that this is a case I deal with a lot and I know this condition 105 00:06:52,520 --> 00:06:54,399 well, and I know how to treat it. 106 00:06:55,100 --> 00:07:01,240 And yet I'm not getting the resolution I expect or not in the speed of efficacy 107 00:07:01,260 --> 00:07:04,989 or the retention of that efficacy, which brings us back to flareups. 108 00:07:05,330 --> 00:07:09,283 If something doesn't fit your normal pattern, I would then go, have we looked 109 00:07:09,283 --> 00:07:11,240 at the other parts of health enough? 110 00:07:11,309 --> 00:07:13,770 Are they contributing more than we thought? 111 00:07:14,200 --> 00:07:15,540 Should we revisit that? 112 00:07:15,540 --> 00:07:17,800 So those would be my flags. 113 00:07:17,800 --> 00:07:21,080 Rather than looking at specific conditions, a general practitioner 114 00:07:21,080 --> 00:07:26,719 might think, hang on, maybe we need to think comprehensive healthcare 115 00:07:27,130 --> 00:07:31,609 approach here and look at the relative contributions from all three domains. 116 00:07:32,770 --> 00:07:36,940 How can general practitioners begin incorporating behavioural assessments 117 00:07:36,940 --> 00:07:41,590 into routine exams, considering our limitations in time and training? 118 00:07:42,240 --> 00:07:47,909 So this is where I hope the sink analogy does help and also the tree analogy, 119 00:07:47,910 --> 00:07:51,640 that's also part the Heath Model, because what I'm hoping is that general 120 00:07:51,640 --> 00:07:56,030 practitioners will realise that what they can do in that very short time is 121 00:07:56,030 --> 00:07:59,650 a very first point emotional assessment. 122 00:07:59,660 --> 00:08:04,789 A bit like in your 10 minutes of a consult, you don't investigate 123 00:08:04,789 --> 00:08:06,339 physical health entirely. 124 00:08:06,990 --> 00:08:11,115 You gather some basic information about its physical health in that 125 00:08:11,280 --> 00:08:14,160 10 minutes, and if you need more, you're gonna have that animal in 126 00:08:14,160 --> 00:08:18,530 and do other tests, but you don't do a full write down to everything 127 00:08:18,550 --> 00:08:21,559 clinical examination from a physical health point of view in 10 minutes. 128 00:08:21,570 --> 00:08:22,440 It's impossible. 129 00:08:22,709 --> 00:08:25,730 We wouldn't expect you to do that from an emotional point of view either. 130 00:08:25,990 --> 00:08:30,140 So what is the equivalent of taking a temperature and having a look in 131 00:08:30,140 --> 00:08:32,120 its mouth and auscultating its heart? 132 00:08:32,750 --> 00:08:40,420 Basically it's to look for signs of two things, emotional bias and arousal level. 133 00:08:41,070 --> 00:08:44,770 So arousal level talked about as being synonymous in the sink with 134 00:08:44,770 --> 00:08:46,490 the amount of water in the sink. 135 00:08:46,800 --> 00:08:50,060 Look for signs of displacement behaviours. 136 00:08:50,420 --> 00:08:53,530 Those displacement behaviours, this sink is very full, this 137 00:08:53,540 --> 00:08:55,190 animal's got a lot of emotion. 138 00:08:55,590 --> 00:08:57,260 So are they yawning? 139 00:08:57,460 --> 00:09:00,510 Cats also do yawn, not as extensively as dogs do. 140 00:09:00,510 --> 00:09:04,500 For cats, more thrashing tails, they do lick their lips. 141 00:09:04,740 --> 00:09:08,390 So those behaviours that are grooming without intent. 142 00:09:08,450 --> 00:09:12,479 So that's spontaneous, quick grooming type behaviour that's 143 00:09:12,480 --> 00:09:14,060 often displacement related. 144 00:09:14,370 --> 00:09:17,059 So we are looking for those signs that the sink is very full. 145 00:09:17,770 --> 00:09:22,660 Now for cats, that could be because they often get a lot of input 146 00:09:22,970 --> 00:09:26,060 from coming in the car, being in a carrier, being in a strange place. 147 00:09:26,070 --> 00:09:30,929 Arousal may be contextual rather than as inherent, but it's a guide that 148 00:09:30,929 --> 00:09:35,204 this animal does have quite a lot of emotion to deal with at the moment. 149 00:09:35,389 --> 00:09:39,329 That means that it's unlikely to make very rational decisions. 150 00:09:39,570 --> 00:09:42,530 Think about yourself when you're full of emotion and how bad 151 00:09:42,530 --> 00:09:43,979 your decision making can be. 152 00:09:44,429 --> 00:09:48,840 This animal is probably on the back foot in terms of making good decisions, 153 00:09:49,259 --> 00:09:52,469 and that's therefore a bit of a warning sign that we're gonna have to be careful 154 00:09:52,469 --> 00:09:57,969 handling this individual because it hasn't got much capacity to deal with the next 155 00:09:57,970 --> 00:10:00,250 input and do something sensible with it. 156 00:10:00,970 --> 00:10:06,000 So that's a really useful thing to have ascertained in your 30 seconds as it 157 00:10:06,000 --> 00:10:10,120 walks through the door, or you see it come out of the carrier, or you lift the 158 00:10:10,120 --> 00:10:13,939 carrier lid and leave it in its carrier, and you are looking for those signs. 159 00:10:14,780 --> 00:10:20,620 The bias that's about is this animal more pessimistic or optimistic? 160 00:10:20,670 --> 00:10:25,389 We talk about the inflow from those different emotions, so the engaging 161 00:10:25,389 --> 00:10:30,489 emotion represented in the Heath Model sink analogy by the cold tap 162 00:10:30,540 --> 00:10:35,190 and then the hot tap representing the protective emotions and what we are 163 00:10:35,190 --> 00:10:39,990 looking for is which is predominant because they are not in isolation. 164 00:10:40,389 --> 00:10:42,869 Engaging in protective emotions are not an either or. 165 00:10:43,460 --> 00:10:45,660 It's like the health triad. 166 00:10:45,889 --> 00:10:47,259 It's not, which is it? 167 00:10:47,259 --> 00:10:49,456 It's what's the relative contribution from each. 168 00:10:49,650 --> 00:10:53,700 It's the same with emotion, which is the predominant input 169 00:10:53,850 --> 00:10:55,550 in this cat at the moment? 170 00:10:55,980 --> 00:11:00,590 If engaging emotion is predominant, the animal will show engaging 171 00:11:00,599 --> 00:11:05,389 behavioural responses, they'll want to interact, to explore or be interested. 172 00:11:05,900 --> 00:11:08,430 Those behaviours will be the predominant signs. 173 00:11:08,450 --> 00:11:12,420 You know, you've got an animal getting input from its engaging emotions. 174 00:11:13,080 --> 00:11:16,010 As long as that's coupled with low arousal, you've probably 175 00:11:16,010 --> 00:11:17,649 got a good consult on your hands. 176 00:11:18,599 --> 00:11:22,110 But remember, you could have engagement, but a high level of 177 00:11:22,129 --> 00:11:24,170 arousal and still have a problem. 178 00:11:24,799 --> 00:11:29,000 Whenever you put into a full sink, you still get a flood, so doesn't matter. 179 00:11:29,000 --> 00:11:30,460 So look at the two together. 180 00:11:30,650 --> 00:11:32,630 That's why arousal's so important. 181 00:11:33,490 --> 00:11:38,180 The protective side, do I think this animal's more protective in its responses? 182 00:11:38,550 --> 00:11:42,740 Thinking about the four elements of the tree analogy, the four 183 00:11:42,740 --> 00:11:47,949 different responses from protection, is this animal trying to repel me, 184 00:11:48,200 --> 00:11:50,870 trying to avoid inhibiting itself? 185 00:11:51,000 --> 00:11:54,410 The cat's appeasement behaviour plays a role, and one of the 186 00:11:54,410 --> 00:11:58,650 difficulties with cats is differentiating between appeasement 187 00:11:58,969 --> 00:12:01,750 interaction and engaging interaction. 188 00:12:01,990 --> 00:12:06,230 But once you've looked at those responses, you've got an idea of pessimistic 189 00:12:06,230 --> 00:12:08,420 cat with a high state of arousal. 190 00:12:09,340 --> 00:12:12,070 Now I want to know, is that purely contextual? 191 00:12:12,520 --> 00:12:14,320 Does that only happen here? 192 00:12:14,950 --> 00:12:18,250 Or is that something caregivers see in other contexts as well? 193 00:12:19,100 --> 00:12:22,449 So I would have just maybe three different contexts that you ask about. 194 00:12:23,680 --> 00:12:26,610 Let's see, what, how does your cat respond when visitors come to the house? 195 00:12:26,840 --> 00:12:30,430 How does your cat respond when you show it affection? 196 00:12:30,849 --> 00:12:33,150 You've got a familiar and an unfamiliar person. 197 00:12:33,639 --> 00:12:38,160 And then other than coming to the vet practice, do you ever take your cat 198 00:12:38,170 --> 00:12:40,510 anywhere else, cattery, et cetera? 199 00:12:40,960 --> 00:12:43,189 How do they react to that, for example? 200 00:12:43,200 --> 00:12:48,409 So you just get some scenarios, though you can test out that bias and that 201 00:12:48,489 --> 00:12:53,530 arousal in another context and see, does that sound like it's actually something 202 00:12:53,530 --> 00:12:55,300 that's seen in other contexts as well? 203 00:12:55,470 --> 00:12:58,370 Because if that's the case, I've got a pessimistic, high arousal 204 00:12:58,400 --> 00:13:02,929 cat who shows that in a lot of various contexts, I've got more 205 00:13:02,929 --> 00:13:06,209 likelihood it could be a significant factor in this animal's health. 206 00:13:06,620 --> 00:13:07,594 You've now queued it up. 207 00:13:07,889 --> 00:13:09,289 You haven't got a diagnosis. 208 00:13:09,650 --> 00:13:13,920 You don't know if there is emotional illness or just emotional compromise, 209 00:13:14,160 --> 00:13:15,820 and those two things are very different. 210 00:13:16,300 --> 00:13:20,349 But you'd have some idea of, am I gonna think about emotional 211 00:13:20,370 --> 00:13:25,150 contribution for this individual, or am I concentrating on physical health. 212 00:13:25,490 --> 00:13:28,090 At the moment, I've done a quick emotional assessment. 213 00:13:28,590 --> 00:13:31,750 I'm reckoning this animal is actually engagingly biased, 214 00:13:32,160 --> 00:13:33,469 pretty low level of arousal. 215 00:13:33,779 --> 00:13:37,820 I'm not seeing signs that emotional compromise are likely to be a 216 00:13:37,840 --> 00:13:39,539 big factor in this cat's life. 217 00:13:40,150 --> 00:13:42,840 I'll concentrate on my physical health diagnosis. 218 00:13:44,020 --> 00:13:48,650 Or am I going, no, I think this could be a major factor in this condition. 219 00:13:48,680 --> 00:13:52,170 I'll treat the physical health and then decide whether I ask a 220 00:13:52,170 --> 00:13:53,440 veterinary nurse to take that further. 221 00:13:53,580 --> 00:13:57,510 That might be the first step, not referral, but get another member of the 222 00:13:57,510 --> 00:14:02,810 team to spend a little bit longer asking more questions and then make a decision. 223 00:14:03,240 --> 00:14:07,930 Am I going to need to refer out for that behavioural medicine approach, the 224 00:14:08,500 --> 00:14:13,580 emotional and cognitive health input or am I gonna be able to do that in-house? 225 00:14:15,090 --> 00:14:16,860 That's fascinating and it's so important. 226 00:14:16,910 --> 00:14:21,300 We usually tend to make notes about the barriers we find to approach the 227 00:14:21,300 --> 00:14:26,390 animal, but we don't add many words that refer to the actual animal's 228 00:14:26,390 --> 00:14:28,439 perspective of the situation. 229 00:14:28,640 --> 00:14:30,370 So I think words there are very useful. 230 00:14:30,370 --> 00:14:31,099 Thank you for that. 231 00:14:31,670 --> 00:14:31,990 Yeah. 232 00:14:32,059 --> 00:14:32,520 Love a word. 233 00:14:32,520 --> 00:14:36,920 I loved something that I heard you say in one of your lectures, Sarah, once a 234 00:14:37,490 --> 00:14:38,239 few years back, listen with your eyes. 235 00:14:38,239 --> 00:14:38,849 It was profound. 236 00:14:38,849 --> 00:14:42,869 You don't have to do much with the actual cat, just watch the cat in front of you 237 00:14:42,869 --> 00:14:46,350 and it really shaped my nurse consults going forward because I was like, 238 00:14:46,350 --> 00:14:47,600 actually, I don't need to touch the cat. 239 00:14:47,630 --> 00:14:48,470 I don't need to do anything. 240 00:14:48,470 --> 00:14:51,810 Just have a little conversation with the owner, watch the cat, does it come 241 00:14:51,810 --> 00:14:55,100 out of its carrier and yeah, I'm ready, I love this environment and allorubbing 242 00:14:55,110 --> 00:14:58,650 on everything, or are they hiding in their carrier underneath the blanket? 243 00:14:58,650 --> 00:15:02,520 Because it just instantly gives you that idea of what emotional bias, 244 00:15:02,520 --> 00:15:05,550 like you say, that cat is sitting at, which can then help shape your 245 00:15:05,570 --> 00:15:10,160 consult because what's priority to actually get done in that consult? 246 00:15:10,160 --> 00:15:11,173 Interesting what you just said, Laura. 247 00:15:11,173 --> 00:15:13,359 We'll just pick up on something you just said then. 248 00:15:14,419 --> 00:15:19,040 So that is, absolutely, that this emotional assessment in its barest 249 00:15:19,040 --> 00:15:22,120 sense, if you like, in getting it right back down to the minimal, 250 00:15:22,410 --> 00:15:23,949 can actually be done in seconds. 251 00:15:23,950 --> 00:15:27,780 The more you do them, the more easier and the quicker you will do those, the quicker 252 00:15:27,780 --> 00:15:32,293 you'll get a feeling for that emotional bias and that arousal level in that 253 00:15:32,410 --> 00:15:34,500 individual as they come into the practice. 254 00:15:35,029 --> 00:15:37,979 With cats, I mentioned earlier about appeasement and said that 255 00:15:38,560 --> 00:15:41,240 one of the difficulties with cats and appeasement I think is our 256 00:15:41,240 --> 00:15:43,140 understanding isn't quite there yet. 257 00:15:43,160 --> 00:15:48,479 We are still grappling with this concept of how it works in cats, but I personally 258 00:15:48,480 --> 00:15:52,600 believe, this is a personal belief and not saying I've done any studies yet 259 00:15:52,609 --> 00:15:54,769 to really determine where this fits. 260 00:15:54,770 --> 00:15:59,300 But I see that allogrooming and allorubbing, yes, there's affiliative 261 00:15:59,980 --> 00:16:04,110 behaviours in a feline sense, but because I believe them to be appeasement 262 00:16:04,110 --> 00:16:08,150 to behaviours, I think they actually come from a point of uncertainty. 263 00:16:08,620 --> 00:16:13,300 The difference being appeasement is gathering information through 264 00:16:13,510 --> 00:16:17,090 engagement, finding out about it and telling it about you. 265 00:16:17,510 --> 00:16:21,660 And the reason, therefore, I believe we see that in cats who are considering 266 00:16:21,660 --> 00:16:25,779 themselves to be part of a social group, the only individual they exchange 267 00:16:25,780 --> 00:16:29,919 information with, rather than just take it from, would be an individual that 268 00:16:29,959 --> 00:16:33,990 they trusted to some extent because otherwise it's too dangerous as a prey 269 00:16:33,990 --> 00:16:38,150 animal and as a solitary survivor, you put yourself in too much danger. 270 00:16:38,490 --> 00:16:41,959 Whereas if you're a dog, horse or a person, it makes perfect sense because 271 00:16:41,960 --> 00:16:46,460 you're socially obligate, that the value of social contact is always going to be 272 00:16:46,970 --> 00:16:51,590 there and therefore it might be better to engage with this thing I'm worried about. 273 00:16:52,000 --> 00:16:56,520 It shows more input from engagement, but the protective emotion is still there. 274 00:16:56,770 --> 00:16:58,890 Appeasement comes from protection. 275 00:16:59,300 --> 00:17:02,079 Engagement comes from engaging emotions. 276 00:17:02,340 --> 00:17:08,226 When cats go up to another cat or a person and rub and and do that, my belief on that 277 00:17:08,369 --> 00:17:13,480 is that it tells me that I've got both engaging and protective emotion present. 278 00:17:13,829 --> 00:17:18,599 Not that they are 100% engaging, is that protective emotion of a worrying 279 00:17:18,700 --> 00:17:23,529 degree is a different question because appeasement inhibition repulsion 280 00:17:23,549 --> 00:17:29,879 avoidance are absolutely normal when justified, absolutely normal. 281 00:17:29,980 --> 00:17:36,510 Nothing abnormal about using any of those responses if justified by the 282 00:17:36,510 --> 00:17:38,330 emotion and the context that you are in. 283 00:17:39,150 --> 00:17:45,870 So that animal who shows engagement is a cat, isn't a cat who lives in this context 284 00:17:46,230 --> 00:17:48,810 and then shows some appeasing behaviour. 285 00:17:49,120 --> 00:17:53,169 Yes, I would believe there is an element there of protective emotion, 286 00:17:53,380 --> 00:17:58,420 but probably within normality and not something to worry about, but there is 287 00:17:58,420 --> 00:18:03,860 a bit of a, or there has been a little bit of a tendency to create this image 288 00:18:03,910 --> 00:18:07,670 of some emotions as being negative and bad, and we should get rid of them. 289 00:18:07,710 --> 00:18:11,710 That worries me because these are very important emotions. 290 00:18:11,710 --> 00:18:16,800 The fear anxiety system is hugely important and in our animals in a 291 00:18:16,879 --> 00:18:22,470 consulting room should be present because it is not a normal place to be. 292 00:18:23,030 --> 00:18:27,930 If we see that animal showing that sort of behaviour that I would say is 293 00:18:28,000 --> 00:18:32,649 okay, yes, that animal has got levels of fear, anxiety, but they are normal. 294 00:18:32,670 --> 00:18:37,430 They are things that are protecting it from making a mistake and doing 295 00:18:37,430 --> 00:18:41,723 something stupid and letting itself be too open because it's a cat and 296 00:18:41,723 --> 00:18:46,350 it has to protect itself, but it's actually got enough engagement 297 00:18:46,660 --> 00:18:50,540 that it is going to use appeasement rather than inhibition or avoidance. 298 00:18:50,759 --> 00:18:54,030 It's going to want to find out more proactively from you. 299 00:18:55,430 --> 00:18:55,810 Amazing. 300 00:18:55,810 --> 00:18:56,795 And it helps us learn, doesn't it? 301 00:18:56,795 --> 00:18:59,880 Because it helps us gauge what's normal for that individual 302 00:18:59,880 --> 00:19:00,610 in front of us, isn't it? 303 00:19:00,610 --> 00:19:02,060 And react accordingly. 304 00:19:02,060 --> 00:19:04,560 If it didn't have that fear and anxiety there, then we wouldn't 305 00:19:04,570 --> 00:19:06,760 know when not to go too far. 306 00:19:06,799 --> 00:19:09,859 It's their way of communicating with us, 'No, I've had enough, this needs to 307 00:19:09,860 --> 00:19:12,259 stop here', so it's really interesting. 308 00:19:12,709 --> 00:19:13,449 Fantastic. 309 00:19:13,690 --> 00:19:17,900 So many of the cat caregivers views on behaviour can be seen as 310 00:19:18,000 --> 00:19:22,619 training issues rather than medical concerns or normal species typical 311 00:19:22,620 --> 00:19:24,080 behaviours as problem behaviours. 312 00:19:24,550 --> 00:19:27,090 How can veterinary teams reshape that narrative? 313 00:19:27,849 --> 00:19:27,869 Yeah. 314 00:19:27,869 --> 00:19:32,089 So we're back to this differentiation between behaviour 315 00:19:32,119 --> 00:19:33,159 and behavioural medicine. 316 00:19:33,690 --> 00:19:38,770 And so you are absolutely right that many of the behaviour outputs that 317 00:19:39,099 --> 00:19:43,170 caregivers find difficult are things that are incompatible with living as a human. 318 00:19:43,690 --> 00:19:47,730 That's a problem when you take any species into a domestic environment, 319 00:19:48,029 --> 00:19:49,870 these animals are not humans. 320 00:19:50,620 --> 00:19:56,390 This ideal existence that we perceive from a human perspective is not necessarily 321 00:19:56,390 --> 00:20:00,680 going to be the ideal perceived existence for them, and that is automatically 322 00:20:00,860 --> 00:20:03,019 going to cause some miscommunication. 323 00:20:03,710 --> 00:20:05,329 And it's all about education. 324 00:20:05,330 --> 00:20:09,360 It's all about understanding what the species is that you take on. 325 00:20:10,180 --> 00:20:15,320 I share concerns with many people about the horrors of images on 326 00:20:15,460 --> 00:20:20,340 YouTube and TikTok skewing perception of what these animals are. 327 00:20:21,049 --> 00:20:25,830 And then we have inappropriate breeding, which is leading to morphologies, 328 00:20:25,840 --> 00:20:30,720 which are not compatible with being a cat in the normal sense of the word, a 329 00:20:30,800 --> 00:20:34,120 species specific normal, if you like. 330 00:20:34,750 --> 00:20:38,719 Dan O'Neill at the RVC, he talks about innate health and talks about health 331 00:20:38,790 --> 00:20:43,719 being something that is needed to allow you to be what you are meant to be. 332 00:20:43,950 --> 00:20:45,770 Whether you're a cow, cat, or a human. 333 00:20:46,340 --> 00:20:47,450 We need innate health. 334 00:20:47,450 --> 00:20:50,560 We need a health that allows us to be what we are supposed to be. 335 00:20:51,030 --> 00:20:53,789 One of the problems with any domestic animal, and then we could 336 00:20:53,790 --> 00:20:57,639 get into a ethical debate on pet caregiving, but we won't but that's 337 00:20:57,639 --> 00:20:59,119 another topic for another day. 338 00:20:59,619 --> 00:21:04,320 But we need to remember that as human animals, we are making a decision to 339 00:21:04,380 --> 00:21:07,940 take another species, whatever that species is, we are talking about cats, 340 00:21:07,940 --> 00:21:13,530 but whatever species into an environment which is not their chosen environment. 341 00:21:14,360 --> 00:21:18,010 If we're gonna do that, we have to be willing to compromise. 342 00:21:18,289 --> 00:21:22,230 We have to be willing to understand what is absolutely 343 00:21:22,230 --> 00:21:26,629 essential for that individual to be a cat and what is optional. 344 00:21:26,710 --> 00:21:29,450 The essential stuff must be provided. 345 00:21:30,309 --> 00:21:32,720 In the Heath Model we talk about environmental 346 00:21:32,780 --> 00:21:35,040 optimisation, not enrichment. 347 00:21:35,629 --> 00:21:37,500 Environmental enrichment is different. 348 00:21:37,530 --> 00:21:41,000 It is a thing, but it's the addition of things that are not 349 00:21:41,010 --> 00:21:42,790 necessary, but nice to have. 350 00:21:43,370 --> 00:21:50,550 The five pillars from iCatCare and from the guidelines are fundamental needs. 351 00:21:50,550 --> 00:21:52,280 They are not enrichment. 352 00:21:52,430 --> 00:21:56,350 When we were doing those guidelines a long time ago now, we sat and had 353 00:21:56,490 --> 00:22:00,199 that debate about what they would be called, and they are called 354 00:22:00,200 --> 00:22:05,050 environmental needs for a reason that they are a need, they're not an option. 355 00:22:06,120 --> 00:22:11,399 So I think getting that across, that if you want to live with another species, 356 00:22:11,400 --> 00:22:14,689 I think this is an education piece across the board for the veterinary 357 00:22:14,690 --> 00:22:19,120 profession, not just in the cat world, but if you want to live with another 358 00:22:19,120 --> 00:22:23,669 species, and I would highly advocate that we do, we benefit enormously from it. 359 00:22:24,309 --> 00:22:27,010 But we can only do that if they benefit too. 360 00:22:27,210 --> 00:22:31,260 If it's only for our benefit, then I don't believe we should be doing it. 361 00:22:31,580 --> 00:22:34,910 It has to be beneficial and I feel that about assistance animals and 362 00:22:35,190 --> 00:22:39,500 animals doing anything to further and increase the quality of life 363 00:22:39,510 --> 00:22:41,280 of human animals, I'm all for it. 364 00:22:41,330 --> 00:22:45,395 As long as the individual involved is also benefiting. 365 00:22:45,630 --> 00:22:49,429 If it's at the detriment of their health and welfare, then 366 00:22:49,769 --> 00:22:51,240 I don't think it's acceptable. 367 00:22:52,410 --> 00:22:53,490 No, I completely agree. 368 00:22:53,500 --> 00:22:55,010 A veterinary team could do so much to help. 369 00:22:55,020 --> 00:22:59,000 The big part of my job in practice as well was supporting cat caregivers, 370 00:22:59,000 --> 00:23:02,739 and how many times did I email those environmental needs to caregivers and 371 00:23:02,740 --> 00:23:06,399 discuss them with them and put them in the kitten packs and put them on social media 372 00:23:06,400 --> 00:23:08,590 and little nuggets of information used. 373 00:23:08,860 --> 00:23:12,139 Like you said, social media can be used for such a negative, so let's, 374 00:23:12,150 --> 00:23:15,789 in practice use it as a positive tool that we can actually educate with our 375 00:23:15,789 --> 00:23:18,137 caregivers so that they know what they need to provide their cats with as well. 376 00:23:18,137 --> 00:23:20,560 And be very careful about the images we use on veterinary 377 00:23:20,560 --> 00:23:22,169 practice social media sites. 378 00:23:22,170 --> 00:23:28,770 I see terrible imagery used and used on cat social media platforms by 379 00:23:28,780 --> 00:23:32,940 individuals who are very experienced in physical health treatment for feline 380 00:23:32,940 --> 00:23:38,300 patients, but the imagery that's shown and used on their platforms is really 381 00:23:38,320 --> 00:23:43,459 detrimental because it's showing protective emotional bias without 382 00:23:43,610 --> 00:23:47,020 that being talked about, recognised, even spoken about, and even sometimes 383 00:23:47,020 --> 00:23:48,170 talked about in the opposite way. 384 00:23:48,170 --> 00:23:52,049 Look at how lovely and happy this cat is, when actually the signs that we're seeing 385 00:23:52,050 --> 00:23:57,139 on that is of a cat that's clearly in protective emotional bias and struggling. 386 00:23:57,440 --> 00:24:00,439 We have to be really careful as a profession about imagery. 387 00:24:00,640 --> 00:24:05,040 Yes, inappropriate breeding and morphologies, but also emotionally. 388 00:24:05,360 --> 00:24:10,100 It is really important that we get that message out there, that they show these 389 00:24:10,100 --> 00:24:11,530 behaviours because they're unhappy. 390 00:24:11,840 --> 00:24:15,020 How do you envision veterinary nurses contributing more actively to behavioural 391 00:24:15,020 --> 00:24:16,259 medicine in everyday practice? 392 00:24:16,260 --> 00:24:19,139 What makes them particularly well suited to supporting the emotional 393 00:24:19,139 --> 00:24:20,649 health of their feline patients? 394 00:24:21,490 --> 00:24:24,279 Love veterinary nurses, advocate the use of the word the veterinary 395 00:24:24,460 --> 00:24:25,889 team, veterinary professionals. 396 00:24:25,940 --> 00:24:26,630 We are a team. 397 00:24:26,650 --> 00:24:31,080 One can't operate without the other and as far as caregivers are concerned, 398 00:24:31,210 --> 00:24:35,279 nurses are traditionally thought of as potentially more approachable 399 00:24:35,320 --> 00:24:36,830 people that they can talk to. 400 00:24:37,380 --> 00:24:42,050 I think nurses sadly do not have any more time than vets have, but they do 401 00:24:42,060 --> 00:24:47,169 have some communication skill differences with, compared with a lot of veterinary 402 00:24:47,170 --> 00:24:51,330 surgeons, although they are now better, much better trained vets in communication 403 00:24:51,330 --> 00:24:52,819 skills at undergraduate levels. 404 00:24:52,850 --> 00:24:58,040 But caregivers often perceive that the vet doesn't have time to talk about it. 405 00:24:58,040 --> 00:25:03,250 As I say the vet nurse is just as time pressured, but their perception is very 406 00:25:03,250 --> 00:25:04,980 different from the caregivers themselves. 407 00:25:05,360 --> 00:25:09,739 So I think there's a window there of opportunity and that also, I think this 408 00:25:09,740 --> 00:25:14,669 is an area where we can really, as a profession, give this message to the 409 00:25:14,670 --> 00:25:17,010 world that it is a veterinary team. 410 00:25:17,650 --> 00:25:21,620 That a vet nurse and a vet have equal contribution to make to a veterinary 411 00:25:21,620 --> 00:25:27,939 practice by doing dual consults, having a nurse in the room with you, but having 412 00:25:27,940 --> 00:25:31,830 the nurse in there at the beginning because they may actually be using their 413 00:25:31,830 --> 00:25:33,399 eyes to do that emotional assessment. 414 00:25:33,960 --> 00:25:38,450 And then the vet saying, I'm going to leave you now with my colleagues capable 415 00:25:38,450 --> 00:25:41,529 hands, who will just take some of those little things we've talked about a 416 00:25:41,559 --> 00:25:45,750 little bit further and decide whether or not to arrange another appointment. 417 00:25:45,940 --> 00:25:49,410 And then they go into another consulting room and start another consultation. 418 00:25:49,760 --> 00:25:54,360 But the nurse has been introduced as a co-professional, as someone 419 00:25:54,360 --> 00:25:59,659 who's on a equally important for this cat's welfare, and therefore 420 00:26:00,030 --> 00:26:01,789 the caregiver sees it as a team. 421 00:26:02,730 --> 00:26:06,459 So it's important the vet is talking about behavioural medicine, emotions, 422 00:26:06,469 --> 00:26:10,720 et cetera, but it may be the vet nurse who then takes that step further and 423 00:26:10,730 --> 00:26:12,560 does more than that initial assessment. 424 00:26:12,610 --> 00:26:16,970 But I'm also a massive advocate of vet consults, but I know that time 425 00:26:16,970 --> 00:26:20,039 pressures and other pressures have meant that isn't always the case. 426 00:26:20,070 --> 00:26:24,800 But I do believe that is how we should be seen by the client that we're a team. 427 00:26:25,090 --> 00:26:26,620 There's two people involved in this. 428 00:26:26,830 --> 00:26:30,649 There's the vet and nurse contributing different but equally important things. 429 00:26:31,690 --> 00:26:33,589 We did that in our practice and it worked really well. 430 00:26:33,590 --> 00:26:36,140 So just as an example, like with our diabetic patients, the vet would 431 00:26:36,140 --> 00:26:39,379 do the spiel on the, this is what you medically need to treat the cat 432 00:26:39,380 --> 00:26:40,470 with, but then they'd do the same. 433 00:26:40,470 --> 00:26:42,329 We're gonna leave you with Laura, for example. 434 00:26:42,330 --> 00:26:45,760 She's gonna go through everything else, how to teach the owner to actually inject 435 00:26:45,770 --> 00:26:47,340 the cat and that's just as stressful. 436 00:26:47,340 --> 00:26:50,170 And then how they might need to adapt the home environment as well. 437 00:26:50,220 --> 00:26:51,900 It's such a big change for them, isn't it? 438 00:26:51,900 --> 00:26:53,219 And what to spot for. 439 00:26:53,219 --> 00:26:54,170 And I used to really love that. 440 00:26:54,170 --> 00:26:56,549 And like you say, it comes a lot when that veterinary professional, 441 00:26:56,759 --> 00:27:01,270 when that vet does speak highly of you and they do see you because 442 00:27:01,270 --> 00:27:02,780 then the owner sees you as an equal. 443 00:27:02,780 --> 00:27:04,960 There's not that kind of hierarchy there. 444 00:27:04,960 --> 00:27:08,230 It's then you are seen as just as valuable to that cat's journey. 445 00:27:08,800 --> 00:27:12,490 So one of the things that Ilona Rodan, who many of you will know, very dear friend 446 00:27:12,500 --> 00:27:16,430 and colleague, and I remember talking to her about cat friendly practice, right 447 00:27:16,510 --> 00:27:18,659 way back over a decade ago now, isn't it? 448 00:27:18,910 --> 00:27:20,840 When we started talking about these things. 449 00:27:21,560 --> 00:27:24,170 Her saying that one of the things she'd found in her cat only practice 450 00:27:24,170 --> 00:27:27,945 in the States was that not moving the cats from one place to another 451 00:27:28,070 --> 00:27:29,550 is hugely beneficial for them. 452 00:27:29,550 --> 00:27:34,180 So she got her nurses to come into the consult room to take bloods and 453 00:27:34,180 --> 00:27:35,680 do that with the caregiver present. 454 00:27:36,059 --> 00:27:39,240 And that not only was that very beneficial for the cat because the cat 455 00:27:39,250 --> 00:27:43,130 didn't transition, and that's, we know that to be very important for them. 456 00:27:43,330 --> 00:27:50,050 But also she said the value caregivers placed on nurses shot up and their respect 457 00:27:50,059 --> 00:27:54,890 for them as professionals changed because they saw vet nurses taking blood samples. 458 00:27:54,890 --> 00:27:58,350 They saw vet nurses doing what vet nurses do all the time, 459 00:27:58,550 --> 00:27:59,860 but often behind closed doors. 460 00:27:59,920 --> 00:28:04,229 The caregiver only sees the vet in the consult room, they never meet the 461 00:28:04,230 --> 00:28:07,780 vet nurse apart from one discharge maybe where they're just handing them 462 00:28:07,780 --> 00:28:09,930 over, they don't see those skills. 463 00:28:10,299 --> 00:28:13,740 Bringing the nurse into the room, taking samples and doing blood pressure 464 00:28:13,740 --> 00:28:16,939 measurements, doing things like without moving the cat, beneficial for 465 00:28:16,940 --> 00:28:22,629 the cat, but also hugely beneficial for increasing the recognition of 466 00:28:25,059 --> 00:28:25,199 veterinary nurses. 467 00:28:25,199 --> 00:28:28,149 So I think that's also an important part of cat friendly approaches. 468 00:28:28,680 --> 00:28:31,810 Do you have a standout case where you remember a nurse's positive 469 00:28:31,810 --> 00:28:35,439 impact in the clinical outcome or communication with a caregiver? 470 00:28:35,940 --> 00:28:39,810 I think that's probably difficult for me at specialist level because that, it's 471 00:28:39,820 --> 00:28:45,000 not the same scenario, but I do know from teaching veterinary nurses a lot about 472 00:28:45,009 --> 00:28:49,950 the fact that they often have input, particularly in observational skills, 473 00:28:50,310 --> 00:28:54,843 and pick up on things that through no fault their own the vets are, have got 474 00:28:55,080 --> 00:28:56,759 their head thinking about something else. 475 00:28:57,090 --> 00:29:02,120 Maybe they're doing an otoscope examination and don't notice the cat 476 00:29:02,340 --> 00:29:07,570 shows a behavioural change or is finding it hard to maintain a sit posture to get 477 00:29:07,590 --> 00:29:12,639 that look down the ear, and therefore the vet nurse brings in that extra bit 478 00:29:12,710 --> 00:29:16,530 listening with their eyes and giving that information and feeding it back. 479 00:29:16,530 --> 00:29:20,659 So I think there are countless examples of where that has been the case, where 480 00:29:21,020 --> 00:29:25,850 vet nurses notice something, maybe heard something a caregiver said, that 481 00:29:25,860 --> 00:29:31,260 has led that individual to actually have their behaviour investigated 482 00:29:31,480 --> 00:29:34,769 because the caregiver hasn't actually come out and said it outright. 483 00:29:35,040 --> 00:29:39,340 It's just something that has come in a much more subtle way through a comment 484 00:29:39,340 --> 00:29:43,419 or through a, an action, comment from the caregiver or an action of the pet. 485 00:29:44,680 --> 00:29:47,390 For clinics looking to utilise their registered veterinary nurse, what 486 00:29:47,430 --> 00:29:50,440 first steps would you recommend for building behavioural responsibilities 487 00:29:50,460 --> 00:29:51,799 into their daily routines? 488 00:29:52,240 --> 00:29:55,169 I think we have this idea that emotional assessment is something 489 00:29:55,170 --> 00:29:56,629 we should be doing on a daily basis. 490 00:29:56,630 --> 00:29:58,520 We are getting better, aren't we, at pain scoring. 491 00:29:58,529 --> 00:29:59,369 That's really good. 492 00:29:59,719 --> 00:30:04,060 But we are still not very good emotional scoring or emotional assessment of 493 00:30:04,150 --> 00:30:06,229 an animal in the veterinary context. 494 00:30:06,690 --> 00:30:11,120 Vet nurses can be really good at doing, so again, in a consult room if the 495 00:30:11,120 --> 00:30:15,640 vets are not feeling overly confident about doing emotional assessments try 496 00:30:15,650 --> 00:30:19,490 having your vet nurse in with you for a while, into a series of consults, and 497 00:30:19,490 --> 00:30:25,530 see what did they pick up using those emotional values of arousal and bias 498 00:30:25,820 --> 00:30:28,090 and what have they seen in that consult. 499 00:30:28,330 --> 00:30:32,419 See how much additional information you get from nurses standing, 500 00:30:32,420 --> 00:30:34,299 watching, and taking in information. 501 00:30:34,690 --> 00:30:40,260 Progress that into emotional assessment of our hospitalised patients and also 502 00:30:40,450 --> 00:30:44,250 thinking about that recurrence, I talked about the flags at the beginning of 503 00:30:44,540 --> 00:30:48,679 what about a physical health case makes me think that the contribution from 504 00:30:48,679 --> 00:30:51,530 emotional dimensions may be significant. 505 00:30:52,139 --> 00:30:55,440 If that happens, and as a vet, you go, 'God, this is the third time 506 00:30:55,440 --> 00:30:57,209 I've seen this cat with cystitis. 507 00:30:57,650 --> 00:31:01,090 I'm gonna make an appointment for you to see the nurse because that is 508 00:31:01,250 --> 00:31:05,320 a red flag that tells us that other domains of health may be involved. 509 00:31:05,780 --> 00:31:10,239 I want to investigate that further.' I hope we talk about it in those terms. 510 00:31:10,240 --> 00:31:13,949 We don't say it could be stress because caregivers become 511 00:31:13,949 --> 00:31:16,439 defensive, upset, worried. 512 00:31:17,230 --> 00:31:21,100 Talking about it in a way that could be perceived as being negative because of 513 00:31:21,100 --> 00:31:24,599 some of the misunderstandings about what stress actually is, which we probably 514 00:31:24,599 --> 00:31:26,350 haven't got time to go into today. 515 00:31:26,750 --> 00:31:32,633 But if we talk in terms of health domains and the vet says, 'I've noticed this 516 00:31:32,633 --> 00:31:37,340 is the third time we've seen fluffy for cystitis, a little concerned because 517 00:31:37,340 --> 00:31:38,940 there are other dimensions to health. 518 00:31:38,940 --> 00:31:41,030 I've talked to you about what's happening with the bladder. 519 00:31:41,420 --> 00:31:45,350 Sometimes there can be an interplay with emotions and with the way the animal 520 00:31:45,360 --> 00:31:49,320 thinks or what their memories they've got, and those things can impact as well 521 00:31:49,320 --> 00:31:52,640 and it's all about their health and so really the best person for me to pass 522 00:31:52,640 --> 00:31:56,500 you to now is the vet nurse because I want her to expand on our clinical 523 00:31:56,720 --> 00:31:59,630 examination as a clinical assessment.' 524 00:31:59,630 --> 00:32:00,870 It's a clinical exam. 525 00:32:00,900 --> 00:32:01,510 It's health. 526 00:32:01,530 --> 00:32:05,170 That's what you are looking at, rather than talking about it as a behaviour 527 00:32:05,170 --> 00:32:11,300 problem or stress, that word is so difficult because it's rarely defined. 528 00:32:11,860 --> 00:32:13,389 It has two aspects to it. 529 00:32:13,400 --> 00:32:16,870 There's physiological and psychological stress, and we very rarely define 530 00:32:16,870 --> 00:32:17,930 which one we're talking about. 531 00:32:18,330 --> 00:32:21,259 We talk about it as if it's an emotion, which it isn't. 532 00:32:21,589 --> 00:32:24,080 It gets lumped in with fear and anxiety, which it's not. 533 00:32:24,549 --> 00:32:26,840 It's given bad press, which it's not. 534 00:32:27,090 --> 00:32:30,620 So stress, none of us would be alive if there wasn't such a thing as 535 00:32:30,640 --> 00:32:32,290 psychological and physiological stress. 536 00:32:32,290 --> 00:32:33,120 It keeps you alive. 537 00:32:33,429 --> 00:32:37,811 There's a lot of misperception and caregiver defence around that word, 538 00:32:37,811 --> 00:32:40,950 they're worried about that word because it makes them feel like 539 00:32:40,980 --> 00:32:42,559 they must have done something wrong. 540 00:32:43,170 --> 00:32:45,250 If their cat is stressed, 'oh my God, that must be my fault. 541 00:32:45,310 --> 00:32:48,949 That must be something wrong with, I must have done something' instead of thinking 542 00:32:48,950 --> 00:32:52,670 about it as having some compromise in its emotional health systems. 543 00:32:53,059 --> 00:32:55,909 Which is, could be an illness as well. 544 00:32:55,909 --> 00:33:01,079 It isn't always, often it's not, often it's a reactive emotional compromise 545 00:33:01,139 --> 00:33:05,350 that's, that is related to environments and needs, but it can be an illness. 546 00:33:06,130 --> 00:33:10,019 I see nurses as helping to keep it as behavioural medicine. 547 00:33:10,809 --> 00:33:16,070 And yes, if it's just a behavioural change which is purely cognitive, 548 00:33:16,500 --> 00:33:18,680 then what you need then is training. 549 00:33:18,760 --> 00:33:22,899 We think more of that in the dog world because with cats we have a 550 00:33:22,900 --> 00:33:24,860 different perception of training. 551 00:33:25,280 --> 00:33:29,590 In the behavioural world, we prefer the word education to training because 552 00:33:29,820 --> 00:33:34,419 training is literally about a response being put into a particular context and 553 00:33:34,419 --> 00:33:39,100 that can be important and is important for dogs in a challenging domestic world. 554 00:33:39,160 --> 00:33:43,286 Education is relevant to any species to live in a world that's not their own. 555 00:33:43,500 --> 00:33:48,139 So they need to learn and be educated to be able to do that. 556 00:33:48,499 --> 00:33:53,689 But getting that differentiation between education and behavioural medicine, I 557 00:33:53,690 --> 00:33:55,490 think nurses are fundamental to that. 558 00:33:56,580 --> 00:34:00,520 And talking about education, if you had to choose a few changes in veterinary 559 00:34:00,520 --> 00:34:04,689 education and practice to better integrate behavioural medicine into mainstream 560 00:34:04,690 --> 00:34:06,860 care, which ones would you choose? 561 00:34:07,150 --> 00:34:10,530 I really want to see behavioural medicine as a day one skill. 562 00:34:10,889 --> 00:34:15,510 That's been my sort of professional life ambition, to get to the point where it's 563 00:34:15,510 --> 00:34:19,410 recognised that it's not a, an added extra, and that behavioural medicine 564 00:34:19,410 --> 00:34:23,000 is a veterinary discipline, different from behaviour counselling, behavioural 565 00:34:23,010 --> 00:34:26,150 medicine is something different, and it's a veterinary discipline. 566 00:34:26,150 --> 00:34:31,140 So it should be fundamentally central to veterinary undergraduate education, 567 00:34:31,140 --> 00:34:32,600 veterinary nursing education. 568 00:34:32,840 --> 00:34:36,159 Not an optional extra, not something that's added on, but something that's 569 00:34:36,199 --> 00:34:40,959 absolutely fundamental from first year, when we teach them in first year as 570 00:34:41,119 --> 00:34:46,779 veterinary students about husbandry and about ethology, that we actually talk 571 00:34:46,789 --> 00:34:51,850 about it in terms of behavioural medicine, not just in terms of pure ethology or 572 00:34:52,179 --> 00:34:56,750 et cetera, but actually talking about it as part of what creates health. 573 00:34:57,250 --> 00:35:02,209 And that's actually, go back to the oath, that issue of the health and 574 00:35:02,210 --> 00:35:05,459 welfare of the animals committed to my care shall be my prime concern. 575 00:35:05,719 --> 00:35:10,154 I didn't say the physical health, I said the health and that to me is absolutely 576 00:35:10,410 --> 00:35:13,940 fundamental to what we need to change in the veterinary profession, that health 577 00:35:13,940 --> 00:35:18,189 is seen as a comprehensive thing, which is why in the Heath Model we talk about 578 00:35:18,210 --> 00:35:19,829 comprehensive veterinary healthcare. 579 00:35:21,420 --> 00:35:24,819 Thank you for your valuable insight on the behavioural medicine in, in modern 580 00:35:24,820 --> 00:35:29,029 veterinary care and for reminding us that health isn't just physical, 581 00:35:29,040 --> 00:35:31,470 but has a lot of other components.