Dr. Sheila Robertson is board certified in anesthesia and in animal welfare in the USA and Europe and serves as the senior medical director at Lap of Love Pet Hospice. Today, she joins Dr. Andy Roark to discuss a recent research publication on which she is an author: the 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. This is a great episode for anyone interested in getting our feline patients better pain control and generally better experiences in the veterinary clinic.
You can also listen to this episode on Apple Podcasts, Google Podcasts, Soundcloud, YouTube, or wherever you get your podcasts!
LINKS
2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats:
Feline Grimace Scale (Website & App):
https://www.felinegrimacescale.com/
AAFP Feline Friendly Handling Guidelines:
https://catvets.com/guidelines/practice-guidelines/handling-guidelines
Retain Your Team – Speak the Languages of Appreciation in Your Workplace: https://unchartedvet.com/product/appreciation-languages-101/
Creating Content Clients Crave: https://unchartedvet.com/product/creating-content-that-clients-crave/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Sheila Robertson graduated from the University of Glasgow in Scotland in 1980. After some time in mixed animal practice, she spent a year as a surgery intern followed by specialized training in anesthesia and analgesia at Bristol University (United Kingdom). While at Bristol she also completed her PhD investigating the physiologic effects of different anesthetic protocols in horses. She is board certified in anesthesia and in animal welfare in the USA and Europe and holds a certificate in small animal acupuncture. She has been a faculty member at the University of Saskatchewan, Michigan State University, and the University of Florida. Her research interests have focused on the recognition and alleviation of acute pain in cats, horses and even iguanas, topics she has published widely on.
She spent 2 years as an assistant director in the division of Animal Welfare at the American Veterinary Medical Association. In 2014 she completed her graduate certificate in Shelter Medicine at the University of Florida. In 2019 she received her certification as a Traditional Chinese Veterinary Medicine Palliative and End-of-Life practitioner by the Chi Institute of Chinese Medicine. Currently she is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinarians dedicated to end-of-life care and in-home euthanasia throughout the USA. Dr Robertson is also a courtesy Professor in the Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida. She continues to volunteer at community cat clinics and High-Volume High Quality Spay and Neuter Programs.
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andrew Roark.
Dr. Andy Roark:
Guys, I am here today with the one and only Dr. Sheila Robertson. She was on the faculty at the University of Florida when I was there. She is board certified in anesthesia and animal welfare in both the USA and in Europe. She is absolutely brilliant and amazing. And she has got some new research out. She is an author on the 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. And I wanted to talk to her about acute pain and pain management in cats. And man, we get into it.
Dr. Andy Roark:
She’s super excited about the Feline Grimace Scale and the Feline Grimace Scale app, which I was unaware of. And so man, new tool in my toolbox.
Dr. Andy Roark:
Guys, this is a great episode. We really get into it later on talking about, the back half of the podcast, we get a lot into action steps and what we can be doing in the practices. That makes me super happy. Anyway, all-around great conversation. I hope you enjoy it. Let’s get into this episode.
Kelsey Beth Carpenter:
(singing) This is your show, we’re glad you’re here, we want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast Dr. Sheila Robertson. Thanks for being here.
Dr. Shelia Robertson:
Oh, thanks for inviting me. I listen in a lot. Never thought I’d be a guest.
Dr. Andy Roark:
Right. I have known you for some time now. You were on the faculty at the University of Florida when I was there. You were running my anesthesia rotation when I went through. And that was the first time I got to spend time with you. I’ve seen you lecture dozens of times since then all over the world.
Dr. Andy Roark:
You are the senior medical director at Lap of Love Pet Hospice, which is a group that was founded by some of my classmates and dear friends and they’re a great group. And gosh, you’re just everywhere. You work with the global pain council for WSAVA, which is the World Small Animal Veterinary Association. And you publish all over the place. And that’s honestly what I wanted to talk to you about today is a study that you have put out with a group of collaborators, it’s the 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats.
Dr. Andy Roark:
And so this just came out in January. I think you were doing some speaking about it at the VMX Conference in Orlando. And I saw, I think you were on the agenda there talking about it, and I am a huge advocate for better care for cats and I think pain management in cats is something that we have not traditionally done as well as we should as a profession. And so I look at this and I say, “This is something that I would like to understand more.” And I’m always checking myself and trying to make sure that I’m practicing good medicine that I’m up to the current standards and things like that. So that is how I know you and kind of what I wanted to talk to you about today.
Dr. Shelia Robertson:
Yeah. Just so everybody knows what these are consensus guidelines.
Dr. Andy Roark:
Okay.
Dr. Shelia Robertson:
And ISFM stands for the International Society of Feline Medicine. So these are global. We wanted them to be able to be used around the world. Where access to different drugs and different types of therapy can be very different. So we wanted to make them global. And the group that put them together is Paulo Stegall originally from Brazil now working in Hong Kong. Myself, Brad Simon, who’s at Texas A & M, and then we have Leon Warren from Australia, was on them. And then Yael Shilo-Benjamini. She is actually based in Israel, did her training here in the US, and then Sam Taylor, who is a specialist, internal medicine and feline person in the UK.
Dr. Shelia Robertson:
So we got that group together and decided that it was time to really focus on cats and give them an entire paper to themselves, not kind of tagged onto the back of a dog paper. So these are completely feline only acute pain management guidelines.
Dr. Andy Roark:
So, let’s start at a high level. What are the objectives of the guidelines when you set out? So what were you trying to accomplish when you guys went to work on this?
Dr. Shelia Robertson:
Yeah. Well, so it almost like I can tell that you might have read them because one of the opening statements says, “Pain has traditionally been under recognized in cats.” And obviously if you under recognize it, that by default, means it’s undertreated, right? And we also know that pain assessment tools aren’t widely implemented. And so cats are very different from dogs.
Dr. Shelia Robertson:
I mean, cats are so good at hiding everything from people. And they’re not as demonstrative when they’re in trouble and we know that from other diseases. And so we wanted to raise awareness of the fact that they will be as painful as dogs after the same types of procedures or trauma, but there are lots of data to show that they’re not treated as well. People are, “Oh, I’m afraid to give a cat this,” because they have unique metabolism compared to dogs as well.
Dr. Shelia Robertson:
So the object was to really let people know that there are some very easy-to-use pain recognition tools out there that are now apps that you can put on a smartphone. And what does pain look like? And once you know what it looks like, you can actually score it. Because my philosophy is that we have an outcome measure for just about everything we do, right?
Dr. Shelia Robertson:
Say a cat comes in with a fever, like a very high temperature. So you can try and figure out was causing it. You treat it, but your resolution is, the temperature comes down, right.
Dr. Andy Roark:
Right.
Dr. Shelia Robertson:
If they’re diabetic, we follow their blood glucose. If have renal disease, we follow their blood work or SDMA. So what are people using as an outcome measure to say that they treated in pain effectively?
Dr. Andy Roark:
Yeah. It’s very little.
Dr. Shelia Robertson:
Other than I just think the cat looks better?
Dr. Andy Roark:
Right. Or, the cat seems more fractious and anxious next time it comes in and you think, “Oh, well maybe we didn’t do as good a job last time as we could have.”
Dr. Shelia Robertson:
Yeah. Yeah. And so we spent quite a bit of time putting in really nice real life images that each of us had of what feline pain looks like and how to examine a cat and recognize pain. And we did quite a lot on talking about the Feline Grimace Scale.
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
Which I like for a lot of quick assessments because it’s basically, you look at the face and they’re scored from zero to 10. Now that is now an app that can be downloaded on a smartphone. And yeah, it’s at the app store and everybody in the world has a smartphone. So you can download that app and use it cage-side to start scoring. You look at the pictures and you score their facial expression and it can tell you. And then if you instigate treatment, if you chose the right drug and did the right thing and things are better, the score goes down, right?
Dr. Andy Roark:
Yeah. I’ll put links to the app and also to the paper in the show notes so people can grab it.
Dr. Andy Roark:
So how widespread do you think that monitoring of pain in feline patients is in vet practices? Do you see practices that are doing good monitoring sort of patient care? And, I think a lot of us do a good job of recording hydration status, recording temperatures. Coming through and just checking on general wellbeing. Do our patients have food? Do they have water? Things like that.
Dr. Andy Roark:
Do you see a lot of practices that are doing an adequate, I’m just going to set the bar at adequate, do you see practices that are doing an adequate job of pain monitoring?
Dr. Shelia Robertson:
So I would say a lot of people using good protocols, but they’re not actually assessing how effective their protocols are. There was a paper just published very recently from a large number of veterinarians. And it was based in Australia and only 15% actually use a validated pain tool to assess pain in their patient population.
Dr. Andy Roark:
Right.
Dr. Shelia Robertson:
So they’re just doing it based on, well, I know if the cat is okay or not, right? It’s almost like you look at the cat and you guess that it’s temperature’s okay, but you don’t actually take the temperature.
Dr. Andy Roark:
Right? No, that definitely makes sense. Do you see good systems that people put in place? In your mind, when you see this, is this something that is hospital-wide, is this support staff technicians that are going by and sort of checking on this? Is it doctors? How sort of frequent in your mind does a monitoring system like this check-in on the patient? Is this an hourly check postsurgery? Help me dig into the specifics a little bit. I guess what I’m trying to do is really imagine this in my practice and what it could look like?
Dr. Shelia Robertson:
So when I was working in referral practice, so university practices, so we were getting pretty complex cases. And basically, my wing men and women are the anesthesia technicians, right? And I think that we need to empower technicians a lot more than we do, because if you think of yourself every day, Andy, you are probably in the surgery room or your surgeons are in the surgery room, doing surgery. The anesthesia techs admit the cat. It has an exam by a doctor and they often examine it. You check it over, you decide on a protocol, and they get it ready. So they’ve spent more time with the cat than you. So they know its personality, how it reacted to things. And then they take it to recovery. And they are really the advocate for that cat because they know how it was behaving before.
Dr. Shelia Robertson:
And obviously, if it’s now still nice and friendly and wants to play, everything went well. But if it’s not, they could come to you and say, “I don’t think this cat is doing very well.” And you might say, “Well, that’s your opinion. Let me look.” And so if you have a validated pain scoring tool, it’s no longer someone’s opinion, right? It’s well, here’s the temperature and here is its blood glucose level, here’s its pain score. So it gives them a lot more to advocate with and for everyone to focus on trying to get that score down.
Dr. Shelia Robertson:
And I think that is important because it empowers them. And there is a lot of what I know. I have pictures that I sometimes show when I go and visit hospitals, I’ll see notices on the front of a cat cage and it says, “Will bite,” and I’m like, “Why?” Does it bite because it’s painful. And if I ask, they go, “No, it’s just a evil cat.” And I’m like, “Well maybe it’s very anxious. Maybe it’s very afraid. Maybe it’s very painful.” So there is a lot of labeling and bias goes on and then people call it the diva cat, it’ll flinch if you just touch it. But to the cat, that pain is real and it will escalate with each visit if we don’t do the right things. And then we can talk later about the connection between fear and anxiety and pain because that’s more of a connection than we ever thought.
Dr. Andy Roark:
Yeah. So let’s go ahead and start to unpack that a little bit. So I, 100% resonate with what you’re saying about, “Oh, will bite. It’s a bad cat. She’s she’s evil.” Diagnosis, evil.
Dr. Andy Roark:
Why do you think that we don’t commonly make that distinction? Is it a lack of knowledge on our part? Is it a lack of understanding of anxiety, behavior, stress, or things like that? Why don’t we do a better job of understanding sort of why we get the reactions that we do from cats?
Dr. Shelia Robertson:
I mean, I think we’re all we’re moving in the right direction. And of course, there’s been a huge initiative for feeling friendly, cat-friendly practices. Lots of people understand how difficult it is to get a cat and a carrier and then drive it. A lot of them are motion sick and people don’t realize that, yet there are drugs we could give them to make them feel better. They could be dispensed with antiemetics before their next visit. And then a lot of people are using Gabapentin to sedate them. But remember that’s an anti-anxiety drug as well. And I think cats are, they don’t like change, but the biggest thing is they get very, very stressed when they don’t have control over their environment.
Dr. Shelia Robertson:
And they don’t get the same, I think, reassurance from having the owner there. A dog is with its owner and it obeys commands. I know we have difficult dogs to deal with but I think it’s more common in the cat. The cat really does not like a new environment and that new environment is extremely threatening to them when they don’t have control. And the control they have, in most threatening environments, is escape, right? And they don’t have that at your clinic. And then if they don’t live or haven’t been exposed to dogs and there are dogs barking and dogs smell, that’s very distressing to them.
Dr. Shelia Robertson:
So certainly understanding what an anxious, fearful cat looks like and what a painful cat looks like is important. But often they’re both. They can be painful and anxious and fearful and all of that is subversive and unpleasant. So we need to deal with all of it.
Dr. Andy Roark:
Yeah. So it sounds more like a holistic kind of generalized approach as far as low-stress handling. How we’re housing cats, things like that.
Dr. Andy Roark:
All right guys. This is when I jump in here with a couple of quick updates. First of all, the Uncharted Veterinary Vonference was last week in Greenville, South Carolina. It was amazing. We will have a virtual conference in the back half of this year. It’ll be in October. It is our GSD for Get Stuff Done Shorthanded.
Dr. Andy Roark:
That’s right. Get stuff Done shorthanded is going to be a virtual conference, which means you can join it anywhere. It will be in October more details coming soon. Registration is not yet open, but go ahead and get fired up. This is a great way to see what Unchartered is all about. See is it really different from everything else? Like people say it is, yeah. You can come and see just how that works online.
Dr. Andy Roark:
And then, if you love it, we’ll see you in person April next year in Greenville, South Carolina. Or, if you’re a practice owner, we’ll see you in person in December for our Practice Owner Summit.
Dr. Andy Roark:
Gang, if you can’t wait that long, and you know you can’t wait that long. We have a couple of workshops coming up. We have Retain Your Team. Speak the languages of appreciation in your workplace that is with Dr. Tracy Sands. It is on May 21st. It is all about showing your team appreciation. You know, they’re tired, you know they’re overwhelmed. You know that they want to feel appreciated for their work. Are you doing it right? Are you showing them appreciation? There are simple things that you can do that really make a difference. Guys, this is, as I said, May 21st 2:00 PM, Eastern, 11:00 AM Pacific time. It is $99 to the public. It is free for Uncharted members. Jump on, get registered, come and be there. This one is actually already filling up. It’s a month away and the spots are largely taken. So jump in there and grab a spot while you can.
Dr. Andy Roark:
On June the eighth, my friend, Bill Schroeder, founder and CEO of InTouch Veterinary Communications is doing his workshop, Creating Content that Clients Crave. This is all about making information in a way that clients will want to consume it. If you are tired of trying to educate in the exam room, if you want some backup, if you want some help, if you’re like, “I don’t have enough time to communicate everything, I need to communicate,” jump in on this webinar or, it’s a workshop, you’re actually going to work on the thing. That’s the difference in a workshop in a webinar, we do the thing, in Uncharted. June the eighth 7:00 PM, Eastern, 4:00 PM Pacific time. This is $99 to the public. Free for Uncharted members. You can hit the link in the show notes and get registered for that as well.
Dr. Andy Roark:
Guys, that’s enough for me. Let’s get back into this episode.
Dr. Andy Roark:
What do you think are the keys for sort of implementing this in practices? From the things that you see, what are the most important changes that sort of make you try to get practices up to speed? Are there approaches that seem to be particularly successful in getting the team on board and actually making changes?
Dr. Shelia Robertson:
Well, I think the AAFP has some very, very good courses that anyone can take. I mean, from veterinarians, technicians, and nurses, all the way down to anybody that even works in your clinic, and at very reasonable cost, can get certified or take a training course in how to handle cats and recognize, what they’re likely to do.
Dr. Shelia Robertson:
So I think the feline-friendly practice program is phenomenal and it’s coming up on its 10-year anniversary this year. And I think that’s made a huge difference to how we understand cats and allows people to work through learning about those things.
Dr. Shelia Robertson:
I think we all understand the exam room should be a little bit different. Using pheromones to calm animals or cats down. Owners can have a Feliway wipe in the carrier before they even come. And again, doing a cat exam, you can do a little bit, you can’t force it, right. You’ve just got to take your time. And I think the pre-visit Gabapentin, which is what most people use, some use Trazodone, but I think the pre-visit Gabapentin has been very, very successful for a lot of people.
Dr. Andy Roark:
Yeah. That’s a trend I definitely would like to see continue to spread. I’m amazed at how many practices do not have pre-visit Gabapentin or another sedative, anti-anxiety medicine pickup. It’s such an easy trick and pet owners appreciate it and it makes such a difference when people come in.
Dr. Shelia Robertson:
Yeah. And the stress itself can actually make you make a wrong diagnosis, right? They’re hypertensive, but they’re not really, it’s white coat hypertension, their blood glucose through the roof, because they’re so stressed out, and yet that could lead you down the wrong path with a diagnosis.
Dr. Andy Roark:
Yeah. What do you see as the biggest pushback that people run into as they start to improve their feline patient monitoring, things like that? Where, where are the pain points? Say that I wanted to advance this in my own practice as a veterinarian, where do people run into roadblocks?
Dr. Shelia Robertson:
I’ll be honest. I think a lot of people say, “Well, we know what a comfortable cat looks like.” And I thought I did until, I mean years and years ago started creating the Glasgow Acute Pain and validating that scale, which is more than just the face. The face is included, but it’s also palpation and so on. And I think what has been overlooked if a cat is sitting at the back of the cage, quiet and not moving, people have assumed it’s okay. And that’s actually the cat that I would now look at.
Dr. Shelia Robertson:
That would be a red flag because they’re at the back of the cage because they’re trying to hide and they haven’t been given a safe place to hide. Because that’s one of their coping mechanisms, right? They don’t have a box to hide in and they’re not moving because they’re painful and they’re not doing normal behaviors like getting up and having a nice stretch because their incision on their abdomen really hurts or they’re not grooming themselves because they hurt.
Dr. Shelia Robertson:
And then pain can make them nauseous as well and then they don’t want to eat in your clinic. I mean, a lot of them are just very suspicious of everything at the clinic. But use pheromones in their cage. And we do what’s called spot cleaning, which I learned from doing shelter work. Is that if it’s their own cage they will have taken the time to mark it and put their cheek pheromones on it.
Dr. Shelia Robertson:
All you need to do when you tidy up is just take anything that’s soiled, leave everything else because they’ve marked it and they’ve said, “This is my safe place.” So all I ever do now is clean up totally soiled articles in a cat cage and then give them a new towel that has been sprayed and left to air for 15 minutes with Feliway to put it in for security.
Dr. Shelia Robertson:
And again, noise, and partially covering the cage, and having the staff all know how to approach a cat, that not every interaction with the clinic should be for something to be done. I actually advise people when a cat is staying for several days that you should prescribe non-medical treatment. So the cat doesn’t anticipate that every time someone’s at the front of the cage, it’s going to be a pill. It’s going to be they’re going to do something to you. And we have good data, from again, from shelter medicine, showing that if you come up to the cage and just stroke the cat, pet the cat, and just have a safe interaction with it that doesn’t involve anything unpleasant, then everything’s much, much better.
Dr. Shelia Robertson:
It would take five minutes extra each day, or you could have volunteers obviously, that know that they’re going to not get hurt, open up and just speak to the cat and stroke it or get out a brush and brush it to help it because even that in itself releases endorphins and it is a good thing to do. But every single interaction usually is a medical interaction and they anticipate it, right?
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
I would too.
Dr. Andy Roark:
That makes perfect… Oh, absolutely. Sure, every time the door opens something bad happens and I get poked with a needle or grabbed by my neck or whatever, exactly. That doesn’t take long to leave a lasting impression about what’s going to happen.
Dr. Shelia Robertson:
So this not this like positive reinforcement that nothing bad’s going to happen. I’m going to groom you or I’m going to give you just a little bit of really super nutritious food, like a little piece of the tubes of Churu, which all the cats love. And they’re like, “Oh, okay. That was okay.” And then it was a predictable, positive interaction and I think they need, they need more of that. And I know everybody is busy. And then to have the time to do that before a treatment and then immediately after their treatment as well, if they’re getting an injection or something’s being done, would, I think, help lot.
Dr. Andy Roark:
Yeah. That makes a lot of sense. I mean, everybody’s busy at the same time. I mean what are the benefits to patient care? What are the benefits to reducing risk of cat bites and things like that by creating a better experience?
Dr. Shelia Robertson:
Well, yeah, I mean, there is good data to show that feline-friendly, trained practices have lower incidents of bite. Well, fewer people in the practice have a cat bite, and you know that can take someone out for days, right?
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
If they’re a surgeon they’re out for days. All has to be reported to HR and it’s horrible. So we know that cat bites can be reduced when people understand cats. And the other thing is a cat that is being totally defensive. You can’t nurse it, right? So the actual care of the cat is suboptimal. But if they’re very relaxed and feel secure, you can actually nurse them and take care of them.
Dr. Shelia Robertson:
They will want to eat, they won’t have GI stasis because they’re so fearful, which then in itself leads to all sorts of other problems. Hypertension, right? Is it real or is it that they’re terrified of being in their cage? So there’s just so much to understanding normal cat behavior and how to make it a better or experience.
Dr. Andy Roark:
No, that’s actually, that’s really great. That’s actually really useful. I’m going to sit with that. I like this a lot. Prescription snuggles, I think that’s fantastic. That makes me happy.
Dr. Shelia Robertson:
Yeah.
Dr. Andy Roark:
Let’s jump back for one second. So let’s say that I have that cat that’s just sitting at the back of the cage. So, I’ve got a patient, they had a fairly routine surgical procedure we’re going to say. Now they’re just sitting at the back of the cage and I’m hearing your voice in my mind saying, “You know, that cat at the back of the cage, that may be your painful patient.”
Dr. Andy Roark:
Can you walk me through just step-by-step? How would you assess pain in this cat. You talked about patient and things like that, but just run me through kind of what is your thought process as you are looking through the front of the cage and you see this cat looking back at you from the back?
Dr. Shelia Robertson:
Yep. So when we assess pain, we have two parts. We observe them only and we try and do that without them sort of knowing we’re there. So not right in their face, but just kind of have a look at them in the cage. So that’s going to let us see what their spontaneous pain behaviors are.
Dr. Shelia Robertson:
Now a spontaneous pain behavior in a cat is sitting still doing nothing but hunched up. That’s a pain behavior, but because it’s not throwing themselves around and wailing like a dog. It’s often ignored as an actual pain behavior.
Dr. Shelia Robertson:
And then we have what we call evoked pain behavior. So that’s when we have done the observation and then we actually interact and touch the wound. Sometimes that’s possible. Sometimes it’s not.
Dr. Shelia Robertson:
So for the cat, that’s sitting at the back of the cage, I would be, if I’ve downloaded, which probably everyone hopefully will do after this podcast, download the Feline Grimace Scale onto my iPhone. I’m going to pull it up. And I’m going to look at the cat’s face and start scoring it.
Dr. Shelia Robertson:
So we look at their ears, we look at their eye position, we look at their whiskers, we look at their muzzle, because it’s called the Grimace Scale for a reason, right?
Dr. Shelia Robertson:
When you’re painful, you kind of go, eh, and when you are a cat that makes your whiskers move, right? And your whole jaw and muzzle changes.
Dr. Shelia Robertson:
And then the other thing, which isn’t actually the face, but it’s the position of the head in relation to the cat shoulders.
Dr. Shelia Robertson:
So cats that are painful will just kind of drop their head down like this. But when they’re happy, their head is up, above their shoulders.
Dr. Shelia Robertson:
So those are the five things that you look at, and each is scored zero, one, or two. So you can have zero for the happiest, I’m doing great cat, and 10, yikes. Something’s really wrong. And round about four or five, we would say this cat needs rescue or needs to be looked at. What’s wrong?
Dr. Shelia Robertson:
Now the ear positions for pain and stress and fear are similar, right? So a cat that’s very fearful. Their ears go kind of flat. And so does a cat in pain. So we need to kind of figure out, and that’s why your nurses and technicians know when they come in for an elective procedure, they’re very unlikely to be painful, right?
Dr. Shelia Robertson:
So you do a baseline score. Now a baseline cat could score two for flat ears because is afraid. So what we’re looking at is differences in that score after the only thing you did before and after is do the surgery, right? So you’re looking for the pain scale or their score not to go up. You’re looking for it to the same. Maybe the flat ears. I’m still a little anxious, but not to go up.
Dr. Shelia Robertson:
And if you take care of anxiety, it’ll go down, right. It’ll be even better.
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
Right. If you take care of that. So that would be the first thing is look at their face. And then we look at posture. But I think people are finding the Feline Grimace Scale does correlate well with the Glasgow Acute Scale, which takes a little longer to do because then you interact with the cat. You touch it and stroke. Does it do the usual greet you? Does it not want to let you near it? Because that’s a bad sign. Do you hold their head, you should be able to touch around and palpate a wound gently if your pain management is adequate or good.
Dr. Andy Roark:
Okay.
Dr. Shelia Robertson:
Without them trying to turn around and nail you, they may flinch a little bit. And it also helps you look and see if your protocols are working most of the time and what I can do, even at feral cat clinics. I can go into one of those clinics, do the facial scale and show that their protocol works for most cats, like 96%. But there’ll always be a few that fall between the cracks, even with the same protocol. And that’s genetics, every cat’s different. It may have had previous pain. So it may already have come in with chronic pain that we don’t know about and we’ve added acute pain because we neutered it. But if I went into clinic and we’re rescuing, 50% of the time your protocol needs to be reworked, right?
Dr. Andy Roark:
Yeah. No, that totally makes sense. All that makes sense. I love the idea of a baseline score and it’s so simple it makes a ton of sense and it simply didn’t occur to me to do a baseline pain score on a cat. You go, “Well, you just came from home, the baseline score’s going to be 0. Well, no, we need to start looking at signs of stress.
Dr. Shelia Robertson:
And, the great thing about if you want to talk about continuing continuity of care when they go home before the owner leaves, they can download the Feline Grimace Scale app onto their phone, right? Or you can give them as part of their, like here. They could even do it at home before they leave to come in. Score their cat and then they can be monitoring the cat at home after a surgical procedure. And you know, you can say, “Well, if you score them with this app and their score goes back up to seven, you need to call us.” And it could be that the cat is getting more painful. Often it’s like, “Well you gave me those meds, but I can’t get her to take them,” right? And that’s why she’s painful. So it helps with the continuation of care at home.
Dr. Andy Roark:
Yeah. And so the app is approachable for vet owners.
Dr. Shelia Robertson:
Yeah. It’s free. It’s one of the number one medical download apps at the moment and it’s for Apple and for the other.
Dr. Andy Roark:
For Android, yeah.
Dr. Shelia Robertson:
It’s IOS and Android and Android. Yep. And it’s free. Yep.
Dr. Andy Roark:
Perfect.
Dr. Andy Roark:
Well, that’s awesome. I’m going to put a link down in the show notes. I’m going to link to the study so that people can download and have that as well. I’ll put a link to the AAFP courses for feline handling.
Dr. Shelia Robertson:
Yep.
Dr. Andy Roark:
Are there any other resources that you would recommend for my cat warriors who want to make sure they’re doing good pain control and learning what they can to be the best advocate for our feline patients?
Dr. Shelia Robertson:
Yeah. Well the good thing about the Feline Grimace Score, other than the app, they have their own website. And it’s now, the actual tool is in multiple different languages. So it’s in Spanish, it’s in lots of different languages because a lot of us have clients or people in our practice that English isn’t their first language. So that’s very positive.
Dr. Shelia Robertson:
And then the other thing, in there, they’re upgrading it more and more. So the really good thing about the Feline Grimace Scale, or tool, is that there is the app, but there’s their own website. And if you go to their website, it’s felinegrimacescale.com. You can get it in multiple different languages, the scale. It’s in Spanish, it’s in Portuguese, it’s in French, and so on. And on that website, they’re updating it all the time. What you can do, or your staff can do, is you can go in and score a cat and see how you compare to an expert that has scored that.
Dr. Andy Roark:
That’s cool.
Dr. Shelia Robertson:
So they’re doing it as a training center, right? You can go in, test yourself. Can I actually score a cat? And the answer is after a few minutes of training, owners can score a cat’s facial expression, whether it’s painful or not.
Dr. Andy Roark:
That’s awesome. That sounds like such a fun thing to do with the team. To say, “We’re going to do this together and everybody gets to do their scores and then we’re going to see what the experts come back at.” That’s really cool.
Dr. Shelia Robertson:
Yep. And then what I would remind people is, if you have a clipboard or you have an electronic, whatever you do for your postop monitoring, you’re probably going to put how much fluid they’ve had or are still having. If they ate. What their temperature is. What their pulse respiration is. Just add a line and put Feline Grimace Score. What was it?
Dr. Andy Roark:
Yeah, that’s awesome. I really appreciate it. That this has been wonderful. Thanks so much for… Thanks for all that you do for our patients. Thanks for taking time to be with us. Thanks for all the research resources. Like I said, I’ll link those down the show notes. I really appreciate you. Thank you for doing this.
Dr. Shelia Robertson:
Well, and I’m going to thank you for getting it out to the masses because that’s what we need. It’s the getting it out there and getting people just to say, “Yeah, wow, this is kind of cool.” And like I always have said, empowering our technicians and nurses that work with us, our support staff, because they’re with the patient more than we are usually.
Dr. Andy Roark:
Yeah. I completely agree. Awesome. Well thank you so much guys. Take care everybody.
Dr. Shelia Robertson:
Thank you.
Dr. Andy Roark:
And that is our episode guys. That’s what I got for you. I hope you did enjoy it. I hope you got something out of it. If you did, the kindest thing you can do for me is go in, leave an honest review wherever you get your podcast. If you didn’t enjoy it, then the kindest thing you can do is just not leave a review until next week when we have a whole new episode that you might like, and then if you do like it, then you can go leave an honest review. And that would be great as well.
Dr. Andy Roark:
So guys, that’s all I got take care of yourselves. Be well, I’ll talk to you soon.
