Being the one who remembers: humane housing in shelters

A cat who is clearly not in a shelter.

Last night I wrote the first draft of a document on appropriate housing for shelter animals for IAABC’s new shelter division. Before getting into the nitty gritty details, I wrote as part of the general overview:

Housing for any shelter animal should be clean and safe: easy to sanitize; no sharp edges that could injure the animal; no gaps or broken latches that could allow the animal to escape. Animals should not be housed in temporary enclosures like airplane crates for more than a few hours while longer term housing is located.

I wondered: Is this too basic to even cover? Will readers stop reading the document at this point, thinking it’s worthless?

But then I remembered the story of a cat I encountered at a shelter during my internship. I was working in the kitten house, a small house dedicated to raising kittens during The Season. The cages were mostly roomy enough for moms with their litters; smaller cages were reserved for litters of orphan kittens. But one small cage had an elderly adult cat in it.

This cage was just too small for this cat. Now, some shelters keep all their cats in cages like this. But the thing was, this was a really excellent shelter. They did a great job of providing their cats with roomy housing. And their vet knew the importance of good housing and advocated for it, and moreover had enough authority to make it happen (sadly, a bit of a rarity in many shelters). So what was going on here?

I asked. Turns out, the cat had been adopted by a staff member but had proven to have behavoral issues that made it difficult for her to live in a home. So she had come back to the shelter. She also had a disease or two which made her expensive to keep and difficult to adopt. But the shelter wasn’t willing to euthanize her, so they put her in a spare cage in the kitten house and planned to figure out the situation later. And hadn’t figured it out yet, because in a shelter, there’s always some more pressing problem that has to be figured out today.

What it took for this cat to get good housing was for someone to notice and make her a priority. We moved her into the bathroom for a few days so she could have more legroom, and she hung out with me in the guest bedroom at night. I found a roomy wire crate intended for litters of kittens and we set that up for her for her evenings long term, and during the days she got to hang out on the desk of the kitten house manager.

And that is often the job of the person at a shelter who works on animal behavior and welfare. Not training. Not making plans for Kong programs. Not fighting to change whole banks of cat cages out for something better. But noticing one single animal who got forgotten in an airline crate in a corner. Being the advocate for the little things. Being the one who remembers.

Testing behavioral assessment

My Bark article, Testing the Tests, is now available on the web for free. I did a lot of background reading for this story and I learned a lot of interesting stuff about shelter behavioral assessments: how they're designed, how to evaluate whether they work, and new work that's going into improving them. Check it out!

The spectrum of hoarding

There was almost no furniture in the entire house. This was unusual for hoarder houses, which are usually packed full of stuff or just of trash. But she was a somewhat unusual hoarder, with only 26 cats and one dog. We stood in the living room and talked to her about her animals. We could see into the kitchen, which was swarming with cats, on the counters, poking out of empty cabinets, sleeping in the sink. The woman we were talking to told us how she loved them but how her son had called us in because he was concerned about them and about her.

While we talked, her dog urinated in the middle of the empty floor in front of us. She didn't notice. The room contained a couch and an entertainment center and absolutely nothing else: the entertainment center had a few knicknacks but was mostly empty. On it sat the box of flea preventative that our team had given her months ago. It was unopened.

And everywhere was the smell of urine. I could barely stand to be in the room, but I could do so without a mask, which made it one of the cleaner hoarder homes. All I could think of was getting outside and getting a breath of air that was not thick with ammonia, so thick that my eyes watered and I could not fill my lungs. But this woman lived here. She could no longer smell it. She no longer noticed or cared when her dog urinated in the middle of the floor. And I remembered another time I had smelled this smell: at a cat shelter in another part of the country.

That was in rural New England. The two women running the place called it a shelter, but I knew it was really a hoarding house. They did not know how many cats they had. They would find cats unexpectedly dead, because no one had noticed for days or weeks when they were sick. And everywhere the smell. Not as bad as in the hoarder house in the big city, but bad enough to scare away adopters. Yes, they opened their doors to adopters. They advertised their cats for adoption. But adopters who brought these cats home risked bringing a sick animal into their lives, or contracting ringworm from their new pet, a story I heard unfold at least once from this shelter. The women running the shelter grilled every potential adopter and turned many away for not being good enough for their cats. And they continued taking in more cats — if they turned them away, they said, what would happen to them? But could another fate have been worse than dying trapped in that place, where adopters did not want to come, and were turned away when they did? Was this place a shelter or a hoarding house or some weird combination of the two?

But the combination isn’t weird. It happens all the time. I saw it again at a shelter in the deep South. This shelter proclaimed that they would kill no animals, and they did not, even the dogs who had been there for seven or eight years, that had gone insane and were unadoptable. These dogs were loving with the shelter staff, but when I came within a dozen yards of their enclosures they would erupt in terrifying, violent barking. I had no doubt that if I entered their enclosures I would be badly bitten. One dog was not aggressive, but hardly seemed to see the rest of the world any longer: he spun in circles around his enclosure, up on the roof of his dog house, down on the ground again, paws hitting exactly the same point every time. Over and over and over.

And the dogs who were not yet insane were not moving out fast enough. I could see their fates. This shelter was so overwhelmed with the number of dogs they were managing that they did not have the energy to keep these dogs mentally healthy, or to do the extra legwork it takes to adopt out a large dog in an area like the South which is so overpopulated with them. These dogs needed transfers to different shelters, they needed adoption events, they needed foster care to get a break from the shelter. They got none of those things. And as soon as a cage opened, it was filled with a new dog. This shelter actually transferred dogs in from outside their community. If they had not done so, they told us, what would have happened to those dogs? Where else could they have gone?

When I started to look, I started to see it everywhere. How many shelters provided enough space for their cats? Even the shelters that have big condo-style cages for cats in their adoption areas, with enough space to move around and a separate area for the litter box, even these shelters still have cats in tiny three by three foot cages in the back, in the sick rooms, in the intake and holding rooms: not enough room for a cat to stretch out, not enough room to get away from the litter box to eat. Even these shelters tell me of course they can’t use that antibiotic, because it must be given twice a day, and they don’t have time to visit so many sick animals twice a day, so they must use the one that doesn’t work as well but can be given less often. Even these shelters say, Of course we would love to have dog play groups, but we don’t have enough trained staff to manage them.

So what is sheltering and what is hoarding? A good shelter provides a needed service: a brief place for an animal to stop on its road to a new home, some medical care, some help finding that home. Keeping that stay brief is the hard part. It is, in fact, a very hard part, balancing keeping the animal healthy (it’s hard and potentially unethical to adopt out a sick pet), finding the right adopter (for that pit bull type dog that looks like row upon row of others in your shelter, for that orange cat that doesn’t come to the front of his cage to meet adopters), keeping them mentally healthy while you’re at it (play groups, training, just plain time out of the cage and time with humans).

And keeping large animals like dogs takes space. In fact, keeping a small animal like a cat takes space, much more space than we as a sheltering community realized until recently. Sheltering can so easily start to slip down the spectrum. It is a spectrum! Many shelters, real shelters, shelters that have legal non-profit status with the government, shelters that don’t smell like urine and have lots of volunteers and get grants and have spay-neuter services, yes these shelters too can fail to provide minimally acceptable care for their animals. Simply because they have too many.

What’s the answer? In one sense, it is simple. Call in someone from the outside, who can see your facility with unbiased eyes. Someone who doesn’t have to answer all the calls for pets that need homes. Someone who can look at the pets that you have and tell you how you are keeping them. This person must know how to assess humane capacity, so it can’t be just any animal lover. They should be able to look at your facility, know how much space is appropriate for animals of different sizes, and calculate how much space you have for each animal. Then they must look at your staffing, and calculate how much staff time you have for each animal. Not just to feed and clean them, but to spend time with them. To notice when they are sick: to look at them every day, carefully, and think about what they need and how to get it to them. To not be running ragged putting out fires, but to be able to plan adoption events, and to notice that dog that’s been here for months and needs special work to get out.

When this person tells you how many animals you can care for humanely, not just how many you can fit in your facility, you will be shocked. You will deny it. You will say that’s half what you can handle. You will point to your records: you’ve had many more than that for years! But they will insist: yes, you’ve had more. But you haven’t had them humanely. You have had a toe on the road to the hoarder end of the spectrum.

So in another sense, it is not at all simple. Because embracing humane capacity means accepting that you have not done as well in the past for your animals as you could. It means not beating yourself up over this, not feeling guilty, not indulging in denial. It means moving forward: it means promising yourself and the animals in your care that you will do better in the future.

And even harder, it means saying no. No to the animals that need a place. No to the people who just can’t find a home for their pit bull type dog but have to move, and the new place does not take animals. No to the mom whose dog bit her child but is such a loving dog with adults. No to the stray cat who is so sweet. Surely you can find homes for these animals? If you don’t, who will?

But that is the central point: you can’t do it humanely, but you try anyway, you will add to the problem. Sheltering is where it is because shelters try to do too much, and if a shelter’s doors are open, animals will pass through them. Shelters which have put waiting lists into place have found that many people do manage to find homes for their animals, if they have to keep trying. Some don’t, and they wait until a place opens. Will these people abandon their animals on the street? Will they take them to a quiet spot and shoot them between the eyes? Very, very rarely does this happen: when it does, it is big news. But you know what? Doing that is illegal. And that is where we need to prevent it: with laws, and enforcement of them. Not by saying, Okay, I will take over your responsibility for you.

That is what we as a society must embrace: responsibility. Not taking in animals that we can’t care for appropriately. And not accepting someone else’s responsibility. Being strong, and doing only what we can, and no more. Because by doing more, we actually do less.

The thing about shelter consulting

I’ve been doing a lot of thinking about shelter consulting over the last few weeks. The thing is, shelters need help. There is a massive amount of work to do to make things better for the animals who are unlucky enough to end up in the American shelter system. Some shelters do things pretty well, some not so much, but they can all do better, and they can all benefit from the work being done by shelter medicine specialists. We have learned so much in the past decade about how to get animals out of shelters faster and how to keep them healthy while they are in there, and that information is percolating into the shelter system at an upsettingly low rate.

But how can the specialists work with the shelters to get these changes implemented? I have seen specialists offer to help shelters for free, because they are paid by animal welfare organizations and by universities to offer free consulting and extension work. The shelters accept in theory, but when the time comes for the director or the board to commit to real change, they push back. No, we’ve always done it this way. No, what you’re saying doesn't make sense to us. No, we don't think this is the right thing to do.

And why shouldn’t they? The consultants have years of expertise, but it’s hard to believe that someone who’s giving you advice really knows what they’re talking about unless you’ve seen them in action. And the staff at these shelters don’t get to see the consultants successfully helping other shelters. They just see the consultants coming in from the outside, not having worked at their shelter, not understanding their specific history, with no close personal ties to shelter staff. (Some of the shelters where these stories have played out are in small communities where everyone knows everyone and always has.) They often don’t even understand the consultants’ credentials. This one is a “doctor” but apparently not a veterinarian — what does someone with a PhD know about shelters? This one is just a "consultant" and not a veterinarian — what’s her actual experience? This one is a veterinarian, but veterinarians aren’t shelter staff, and in the staff's past experience, most veterinarians don’t know much about how shelters operate. She says she has advanced training in shelter medicine, but what does that really mean? How is it relevant to this shelter?

The consultants almost inevitably get impatient. It is hard to take the time to get to know a shelter, build ties with the staff, and introduce change at the rate at which staff can accept it. It’s hard to do that with one shelter when there are dozens more that need your help too, and you just want this one fixed so you can move on to the next one. It’s hard to take the time and accept the slow rate of change when you see animals being neglected and even abused in a shelter, with the staff not understanding that the level of animal care is unacceptable. When you truly feel that the situation in a shelter is an emergency, how can you take the time to do things right? How can you stop yourself from barging in and just getting it done? But if you do those things, you will lose the trust of the shelter staff. When is that worth losing?

Sometimes shelters actually go out of their way to invite big consultations with multiple specialists. I have seen this in universities. A shelter sends a request, and often pays for the service. A dozen or so veterinary shelter medicine specialists spend a week crawling all over the shelter. They often antagonize the staff, simply by watching and photographing them at work. The staff feel that they are being graded and judged — and they are; there's really not a way around it with this "learn everything about the shelter in one week" approach. At the end, the consultants give their findings. I have seen staff cry at the final presentation. I have seen consultants deliver massive documents, hundreds of pages long, with recommendations. No one should be surprised that these recommendations are not followed. The experience isn’t pleasant. But is there a better way?

Shelter consultants are actively seeking better ways, and while I was at a shelter medicine program, I saw the consultation procedure evolve rapidly. But I think the essential dilemma remains: how can consultants give a single shelter the time that it needs to digest change, when their job is to help many shelters? Is the process simply too labor-intensive?

One shelter director told me recently that she didn’t feel the need to work with consultants because there is so much information available directly to her now, online at Maddie's Fund and ASPCAPro and at shelter conferences like Expo. Why should she let outsiders tell her what to do when she can learn herself? There is a lot to be said for this approach. I am absolutely a fan of education, and of providing new findings to everyone who’s interested. I think that if shelter staff really own their own education, they will accept new procedures much more quickly. Personally, I’d always rather make my own decisions after understanding the problem space, rather than being told what to do by someone else. (Flashbacks to being a teenager!)

But I think that if all these available resources lead shelter staff to feel that they can do it all themselves without consultants, they are missing a valuable resource. Consultants are experts. They are immersed in this stuff. And, perhaps even more importantly, they can take a step outside of the experience of one shelter, and draw on experiences from multiple shelters, something that can be extremely difficult for staff to do. They can focus staff on their primary problem -- something staff may not even be able to recognize, due to having lived with it for so long. I visited one shelter with dogs who had been on site for years. The shelter was full of behavioral emergencies, dogs who were engaged in full blown stereotypical behavior, dogs who were terrified constantly, dogs who were aggressive to all strangers. The shelter staff couldn’t see it. The dogs were great with them.

So, does it ever work? I am going to close this pessimistic post with a video about one time when it did work. Here, the two leaders of the Maddie's Shelter Medicine Program at the University of Florida accept recognition from the city council of a nearby community for their help with that community's municipal shelter. Watching this video made my heart warm. The councillor presenting the award listed accomplishments I never would have expected a politician to recognize as important. Maybe it is all possible. May we all find a way to work with shelters, not against them. And may shelters find a way to work with us.

Pets as gifts: should we trust adopters?

A few days ago I tweeted a link to a blog post by the ASPCA’s Dr. Emily Weiss questioning the shelter dogma that animals should not be given as gifts. In this and an earlier post, Weiss describes her research which suggests that animals given as gifts are no more likely to be given up than animals not given as gifts. That article is open access, so you can read it and judge for yourself. It is a retrospective survey, so there is room for more rigorous science about this topic, but the paper definitely opens up interesting space for discussion and further investigation.

My bosom buddy Julie Hecht posted her thoughtful response on her Dog Spies blog and then ruminated more in a letter to her blogging pen pal Mia. Julie and I got into a conversation about it on Twitter, which unfortunately led to me ranting a bit (not in a hostile way, just in a “I thought about this all so much during my shelter medicine internship and I must let you all know everything I learned!” way). I’ve been thinking since then that 140 character spurts is not the best way to get across what I was trying to say.

Here is the story we tell ourselves about animal sheltering: there are irresponsible people out there. Lots of them. And they have animals, which they don’t value as animals deserve to be valued. They bring the animals to shelters, where people who care more and know more do their best to find the animals good homes. It is the job of the shelters to place these animals in the best homes possible, and to that end they should be very careful about every placement, because animals who have been abandoned once deserve never to be abandoned again.

There is a lot that is true in this story, mainly that animals do get the short end of the stick way too often and that, once abandoned, they absolutely deserve for the rest of their lives to be catnip and sunny couches or steaks and tennis balls. What I question is whether the shelter system that we are able to provide today is equipped to manage them well for long enough to find those homes, and whether shelter workers have the information necessary to predict what kind of home a particular adopter is actually able to provide.

Many, in fact most, shelters in this country are overwhelmed and are still euthanizing adoptable animals to provide space for more animals to come in. There are shelters for which this is not true, more and more of them every year. But they are the exception, and they tend to cluster in particular parts of the country. My friends in New England were shocked when I told them that during my internship I saw shelters where euthanizing healthy kittens for space was common. So given this situation, is it better to hold on to animals until you can find them the home that you think is perfect? Or is it better to take a chance and hope that you can get that animal out of a shelter which may have a 50% kill rate?

That leads us to the question of these lovely shelters which are able to place every medically and behaviorally healthy animal, and often even some not so healthy ones. These days there are plenty of those out there too. What should they think about animals as gifts?

I think that Dr. Weiss’s article makes the point that we aren’t really sure that we have all the information necessary to judge a particular adopter. I don’t think that this particular study makes an open and shut case. But I do think it provides evidence that this is a question worth asking. What do we really know about the home any adopter is going to provide? Is it worth denying an animal a potentially loving home because you don’t trust the word of the adopter?

In her post, Julie argued that there are some cases in which animals as gifts are particularly bad ideas, giving the example of bringing a puppy home to your grandmother who does not have the energy to deal with it. I agree. My suggestion is that shelters should consider moving to more case by case evaluations of particular adoptions, rather than operating on policies alone. If an adopter makes a good case, consider the adoption, even if they are planning to do something like give the animal as a gift. Keep an open mind about what constitutes a good home. But in the case where the adoption is patently a bad idea, then yes, talk the adopter through making a better decision, and refuse the adoption if need be.

In academic shelter medicine, where we like to think about changing everything about shelters because we don’t have to actually operate shelters, there has been a lot of discussion about this kind of change. Outdoor cats? No home visit prior to adoption? No adoption fee at all? Maybe those things are all good ideas. Maybe we really don’t know much about what makes a good adoption or a good home. We guessed, for years, and that was all we could do. But there is more and more research in the shelter community these days. We are starting to apply science (SCIENCE!) to these questions. I hope we can all both keep our minds open and evaluate the incoming research rigorously. It is a fascinating time for shelter medicine and shelter research; as one academic shelter veterinary specialist said to me, when I expressed shock at the overturning of some old principle or other, “Everything is on the table.”

Happy holidays to you and your animals from me and mine!

Laws and consequences: Texas legal changes in excruciating detail

On the face of it, the recent changes to Texas state law appear to be a good idea, aimed at preventing non-veterinarians from practicing veterinary medicine. But as is often the case with legislation, digging in to the situation a little deeper uncovers a load of unintended consequences, in this case in animal shelters. The whole story makes a great teaching case for how population medicine differs from individual medicine. There's a lot to cover, so let's get going.

The body of law in question is the Veterinary Practice Act. This Act covers, you guessed it, the practice of veterinary medicine. Among the basic rules that the Act lays out is the rule that in order for veterinary medicine to be legally practiced on an animal, there must exist a valid veterinary-client-patient relationship. That statement takes quite a lot of unpacking, so here you go:

• Veterinary medicine: in this case, giving a vaccination
• Valid veterinary-client-patient relationship: the relationship between the veterinarian, the client, and the patient. The veterinarian must have actually met both the client and the patient. Usually this must be renewed yearly -- so if you call your veterinarian and ask for a refill on your pet's medication, but you haven't had your pet in to the clinic for more than a year, the veterinarian must ask you to bring your pet back in for a checkup, or the veterinarian is at risk of losing their license. (Seriously. That's why they won't refill over the phone after a particular period of time.)
• But there is an exception made for herd health. If the veterinarian is treating a herd of animals (commonly livestock such as cows) then the relationship is with the herd, not the individual animal. So the vet can prescribe treatments over the phone for a herd member that they haven't ever seen, if they have recent experience with that herd as a whole.

In the case of an animal shelter, some states treat animals in a single shelter as a herd. This is entirely appropriate. In a shelter, medicine should be practiced with the good of the population at heart, not the individual animal. I promise that this is not as heartless as it sounds, and ends up actually being better for the individual in the end. If you let parvovirus get a hold in your shelter, it is the herd that is sick, but it is individuals that die. It is best for individuals to be in a healthy herd.

Until recently, the situation in Texas was that it was legal for a non-veterinarian shelter employee to give vaccines to animals in the shelter because they were members of a herd, so the veterinarian could write general herd health protocols ("give the core vaccines to all animals at intake") without having to see each individual animal. Now that's changed.

The problem is with stray animals. Shelters don't own stray animals for the first few days that they are in the shelter. This is called the animal's "stray hold," and is intended to give the owner a chance to reclaim their animal before it is put up for adoption. The number of reclaimed stray animals is typically low, especially for cats; often only 2% of stray cats are ever reclaimed. The majority of stray animals go on to be owned by the shelter.

Texas has changed the wording of their Animal Practice Act to specify that dogs and cats cannot be considered herd animals. Yes, it has really taken me this much explanation to get to the actual change in wording, but here it is: in the middle of a definition of the veterinary-patient-client relationship, the Act states (newly added text in italics):

A veterinarian possesses sufficient knowledge of the animal for purposes of Subsection (a)(2) [having a valid veterinary-patient-client relationship] if the veterinarian has recently seen, or is personally acquainted with, the keeping and care of the animal by:
(1) examining the animal; or
(2) making medically appropriate and timely visits to the premises on which the animal is kept. (NOTE: Per TAC 573.20(b) and 573.80(14), this section only applies to herd animals not including cats and dogs.)

On the one hand, it does seem silly to think of a "herd" of dogs and cats. But if you forget about the fact that the word "herd" has other meanings in other contexts, the real question that this change in wording is addressing is: Should shelters be allowed to practice population medicine on their animals?

In this particular instance, the fallout goes like this:

• By default, shelter animals in Texas cannot be treated as "herd" animals.
• Animals which are owned by the shelter are exempt from the Veterinary Practice Act, and therefore may still be treated as a herd.
• Stray animals which are still in their stray holding period, however, are not yet owned by the shelter and therefore are not part of the shelter's herd.
• Therefore, stray animals in their stray hold period must be examined by a veterinarian before receiving any treatment, including initial vaccines.

Not a big deal. Surely all shelter animals are examined by a veterinarian, right?

Actually, in quite a few shelters, veterinarians are only called in to treat sick animals, and the healthy animals are managed by technicians. Even in shelters which have a veterinarian, it is common for the veterinarian to only see sick animals. Of course, it is in the best interest of the animals for a veterinarian to see all of them as they come in the door, to establish a baseline of health status and to identify any problems that a technician might miss. But even in shelters with this policy, an animal may not be seen by a veterinarian for several days. Shelters are chronically understaffed and the vets are often behind on performing physical exams, as they have to prioritize treating sick animals more highly than checking on healthy ones.

Even in shelters which are fully staffed, it may be the next day before an animal is seen. If an animal comes in at the end of the day, the veterinarian may be in surgery the next morning and not get to physical exams until the following afternoon, so that the animal isn't seen for about 24 hours.

So the animal isn't seen by a vet for a day or three. If it's healthy, that shouldn't be a problem.

In the case of a shelter animal, one thing must happen the minute it comes in the door to the shelter: it must receive its vaccines. Prompt vaccination, right at the time of intake, is crucial in keeping animals healthy in shelters. Vaccination takes several weeks to bring the immune system up to its full efficiency in dealing with a pathogen, but there does seem to be an effect much earlier than that. Just a few hours one way or the other can actually make a difference, most critically in the very young and susceptible animals (did I mention in any previous posts how crazy kitten season can be in some areas?) and in the very dangerous diseases (such as parvovirus, which often simply manifests as dead animals with no warning). But don't take my word for it. The bible of shelter medicine, the Guidelines for Standards of Care in Animal Shelters, has this to say about prompt vaccination:

Because risk of disease exposure is often high in shelters, animals must be vaccinated at or prior to intake with core vaccines... Shelters that do not vaccinate with core vaccines immediately on entry, or do not vaccinate all animals, are much more likely to experience deadly outbreaks of vaccine preventable disease (Larson 2009).

This is how it works: the animal comes in to the shelter, either as a stray or surrendered by an owner. It gets processed, minimally receiving an identifying number, and is placed in a cage or run. Whoever performs this processing can either stick the animal with vaccines (and give it dewormers) at that time, or call a technician to do it. Giving vaccines isn't hard and you can train just about anyone to do it: it's technically easy (though it's nice to have someone else around to hold the animal still), and no decisions are really necessary. If the animal is too sick to receive its core vaccines against the most dangerous shelter diseases, it is too sick to be in the shelter and should get transferred to a hospital or other off-site care. Period. They all need their vaccines.

I'm saying this as someone who vaccinates her own animals much less often than conventional veterinary wisdom would have me do it. Shelters are full of disease and stress, and decisions about when and how to vaccinate there are going to be very different from decisions about animals in a home environment. I can't say it too often: without prompt vaccination, animals in shelters will die. The first question a shelter medicine specialist asks upon being confronted with an outbreak of parvovirus or distemper is "Are your animals vaccinated on intake?"

So, finally, on to this recent legal change in Texas. What shelter specialists see coming like an impending train wreck is lots of stray animals in Texas not getting seen by a veterinarian as soon as they are brought in to the shelter (it is not reasonable to expect that the vet could see them immediately); therefore, those animals not getting prompt vaccination; therefore, sick animals in shelters. Lots of them.

There is legal recourse at the city or county level: each city or county with a municipal shelter can change its ordinances to appoint the shelter the "designated caretaker" of stray animals during their hold periods. This allows the shelter to once again consider stray animals as part of the shelter herd, so that the veterinarian may ask someone else to give the vaccines before a physical exam has been performed. I have no real idea how likely it is that cities and counties will pass such ordinances, but I am guessing that the rate of adoption won't be anywhere near complete, and that the speed of adoption won't be blinding.

What's the moral of this story? I'm not really sure, but I think it has something to do with how complicated the consequences of legal wording can be, and how important it is to take the advice of specialists into account. I send my sympathies to Texas shelter veterinarians, who now will be faced with the scramble to still vaccinate stray animals on intake despite the change in laws.

Is the flood of animals receding?

I got a great question from Christopher of Border Wars on my last post. He wrote: “From the data I’ve seen, shelter intakes are dropping in real numbers and have been for decades despite constant growth in both population and animal ownership. So aren't the flood waters already going out?” I answered there, but have been feeling that there’s more to say on the topic.

As I wrote back to Christopher, the numbers of animals surrendered to shelters and the numbers of stray animals are definitely dropping in most (but not all) communities. Does this mean our work is done? Below you will find rampant over-generalization! Enjoy.

Location, location, location
Things are pretty good in the northeastern United States. When I started this blog, I lived in New England. Shelters there certainly had their problems, but they weren’t nearly as overwhelmed as the shelters that I have seen this year in the South. Northeastern shelters often import dogs (particularly puppies) from Southern shelters. So when you’re looking at intake numbers, think about what part of the country you’re in. The problems in the South are still intense, as I can attest from first-hand experience this year.

Dogs vs cats
When I was in New England, I observed that many shelters were managing their dog populations very well. Dogs in most shelters had a very high adoption rate there; healthy, behaviorally stable dogs in New England shelters had little to fear. Cats were an entirely different story. Plenty of shelters were euthanizing cats for space, and the others were stuck holding cats for months before finding homes for them.

Ironically, the tide is turning with the new programs in which cats who have been successfully following a healthy free-roaming lifestyle are simply sterilized, vaccinated, and returned to the neighborhood in which they were living. This has dropped cat euthanasia rates dramatically in participating communities. (See my previous post on leaving outdoor cats where they are.) You can’t really do this with dogs, so suddenly some shelters are finding themselves euthanizing more dogs than cats!

A dog problem or a pit bull problem?
I have been told that New England doesn’t have an unwanted dog problem, but it does have an unwanted pit bull problem. By that, of course, I mean pit bull type dogs, as the “pit bull” designation does not refer to a specific breed and is often used loosely to describe mixed-breed dogs who have a certain look.

For sure, in almost any shelter you go to, you’ll see many more pit bull types than dogs of any other breed. (The exception is shelters in communities with breed specific bans, in which those types of dogs may not be allowed in the shelters, or are immediately shipped out or euthanized.) This type of dog is harder to adopt out of shelters, as many adopters are looking for a different type of pet. They also do poorly in shelters, because they are highly social, smart, and energetic. Many shelters are specifically struggling with how to stem the flood of pit bull type dogs; the various programs that have been tried are a topic for a different post.

Some improvement is not enough

And finally, as I said to Christopher in my answer to his comment, we may have seen some improvement, but it is nowhere near enough. Appalling numbers of animals were euthanized in shelters in the past. Somewhat less appalling animals are euthanized now. The Humane Society of the United States estimates that the numbers have dropped from 12-20 million shelter euthanasias per year in the 1970s to 2.7 million shelter euthanasias today. It’s all guesswork, because there is no centralized reporting for animal shelters; we don’t even know how many shelters are in the U.S., let alone how many animals they process and how many animals survive. Remember, though, that those numbers don’t include animals trapped in inhumane conditions in long-term facilities, sometimes for years (again, this is from personal experience). It does not account for overcrowding at shelters causing welfare problems, even short-term, for the animals who stay there. Nor does it account for animals dying of disease in shelters which do not have the resources to manage their populations. And it probably accounts for spectacular changes in some shelters, but much less change in others.

The trend is in a good direction, but we’re not done, and the trend won’t continue in this direction without more work. So get your animals spayed or neutered, don’t buy animals from pet stores or flea markets or online, take your dog to a training class to prevent behavior problems, exercise your dog for the same reason, and volunteer at your local shelter.

Stemming the flood of animals

This past week I was at one of the largest shelters in the United States. At one point, I was standing by a door chatting with some of my co-workers for ten minutes, and during those ten minutes we saw three sets of people coming in to surrender their dogs. This shelter takes in about 100 animals a day, 30,000 animals a year.

My co-workers and I realized that the biggest problem this shelter faced was its massive intake. Nothing else they could do to solve their problems would be more effective than reducing that. In fact, it has been shown again and again that euthanasia in shelters mirrors intake: more intake means more euthanasia, and less intake means less euthanasia. But how do you reduce intake?

When I was catching up on my life this morning with my husband, I told him about managed intake: the shelter only accepts owner-surrendered animals that they have room for. If they don’t have space, they don’t accept the animal. The animal may be put on a waiting list, and ideally the shelter offers support during the wait (food if the owner can’t afford to feed the animal, behavioral advice, help finding animal-friendly housing).

In the case of animals that the shelter knows that they will have great difficulty placing (old, sick, etc.), they will let the owner know that they will immediately euthanize the animal. This sounds cold, but the alternative that many shelters practice is to take the animal in and euthanize it without warning the owner that this is inevitable. (No one likes conflict, least of all institutions run by local government.) This approach shifts the responsibility onto the owner. Although many people who surrender animals to shelters know that the animal may be killed, it is much easier to convince yourself that that could never happen to your animal (which you know is so wonderful) if there is some chance that the animal will survive. This puts the choice of euthanasia onto the shelter, and the blame onto the shelter. But moving the decision back to the owner means that the owner has to deal with the decision, and hopefully find another solution, or at least take the experience into account the next time they acquire an animal or have difficulties with a pet. (Is the experience of surrendering a pet to an unknown fate more difficult than the experience of having a healthy pet euthanized? I have my own guess, and you can make yours.)

My husband (kindly playing the foil in the Socratic dialogues of this blog) asked me about the unintended consequences of such a policy. The shelter is mandated by the county to accept stray dogs. Will the policy result in more people untruthfully representing their surrendered pets as strays? Will it even result in more animals being abandoned on the street?

We don’t know; the research hasn’t been done. Some shelters have experimented with managed intake, and their experience has been that this policy does not actually cause very many people to do reprehensible things. Mostly, people will put their animals on the waiting list (perhaps with some yelling at the shelter employees first), and then some of them will surrender the animal when room is available, and some will find other options (like a friend who wants a dog), and some will decide to keep the animal after all. And some will be lost to follow up, so perhaps those people do put the animal on the street.

But here is what I think about it: abandoning an animal on the street is illegal. So if a shelter institutes managed intake, and as a result some people break the law, whose fault is that? Is it the shelter’s fault? In my book, the shelter is behaving very responsibly by refusing to accept animals that they cannot care for, and by being honest that a new animal which is accepted must be euthanized. Some support for owners who need it is essential, and should be considered a part of managed intake. If an owner responds to this policy by breaking the law, I feel that the blame is with them. Perhaps increased enforcement of animal cruelty laws (which include neglect) is the proper answer to this problem.

More and more shelters are considering managed intake. I think there will be anger in some communities at first, but I am very hopeful that if enough shelters institute this policy, there will eventually be a sea change in our culture’s approach to unwanted animals. Whose problem is an unwanted animal? The owner's.

Making replacement nipples

Kittens like to nurse on things. It is best to nurse on mom, but orphaned kittens will nurse on other things. A favorite option for many orphans is the belly and genitals of their siblings. This can be physically traumatic for the recipient. One solution to the problem is to separate the kittens, but a lonely kitten is a stressed and pathetic creature (and stress leaves them more susceptible to disease). Another solution is to offer something better to nurse on!

Today I got mad when a newly arrived kitten was nursing on his littermate, and as I had a little free time, I decided to make an offering for him. Materials: nipples for kitten bottles; some soft fleece; needle and thread; rice; a plastic bag; a binder clip. I sewed the nipples into the fleece, sewed the edges of the fleece together to make a fleece bag, warmed up the plastic bag full of rice in the microwave, and put the warm rice into the fleece bag. I secured it closed with the binder clip.

I predict the kitten will hate it, because cats always hate things that you put a lot of work into.

The fake mom, in production

The fake mom, in place, being ignored by kittens

Keeping score of kittens

Last week I worked in a kitten nursery — a small building off of a larger shelter, full of underage kittens (mostly orphans, some with moms). Although this shelter has literally hundreds of kittens out in foster care, kitten season in the South is so intense that they have this separate building just as a nursery, with its own staff and volunteers (and for these two weeks, its own vet! With consultations from the main shelter vet, of course).

Cats seem to take the approach to reproduction that you should make as many babies as possible, and if not all of them make it, that’s life. Outdoor, unowned kittens have about a 75% mortality rate. Cats are mostly very good moms, but kittens are just so little and fragile. After a few days of kitten deaths I became almost manic. I would not lose more kittens! I started keeping score, me versus kitten death.

• Feral mom is too scared to take care of her neonatal kittens. I give her a place to hide and some time to figure it out. I give her too long, and her three kittens die. Three points to kitten death.
• A cat is brought in while in labor. It becomes clear that things are not proceeding, so we take her to surgery. Three kittens survive. I sit with them for two hours trying to get them to nurse. They do, a little bit, but their mom doesn’t recognize them as hers since she wasn’t awake when they came out. One dies. I foster the other two onto a receptive mom with her own four kittens and spend another hour making sure they learn to nurse on her and can defend their nipples from their week-older foster siblings. So far, they are still alive. Two points to the Dog Zombie, one point to kitten death.
• Six kittens in a little cage feel funky for several days, just sitting around and not playing like normal little fiends. I give them fluids for several days but they don’t perk up. We start them on antibiotics that are good for GI disease, because they have diarrhea and deworming hasn’t helped. When a new cage opens up, I move three of them into it, so everyone will have more space. I coddle them with fluids and medication to make them not feel sick to their stomach. At the end of the week, two of them are playing and three of them are eating. Three points to the Dog Zombie. (The other three are holding steady. We’ll see.)
• One kitten is a little lethargic and dehydrated one evening. I give her fluids, but I am not worried about her. The next morning she is found dead. I do a necropsy and find that she had pneumonia. This is weird, because she didn’t have an upper respiratory infection, so where did it come from? But her lungs were definitely funky. I panic and give her cagemate antibiotics that are good for pneumonia, since whatever happened to her, it happened so fast that I want to prevent it rather than wait and see. One point to the Dog Zombie?
• One kitten fades fast and dies. (One point to kitten death.) His cage mate starts to fade the next day, lethargic and dehydrated. I necropsy her brother and find a bad infection in his GI tract. I start the living kitten on antibiotics that are good for GI infections and leave orders for lots of warming pads and fluids. She does not survive the night. A second point to kitten death.

Those are only some of the stories. I have learned all about antibiotics for head colds and stomach bugs, I tell you what. And I have learned that a roomful of kittens becomes much less cute after the first hour of dealing with it. But they will still make you manic trying desperately to save them all. You can’t save them all. But you also can’t stop trying.

...or you could zeuter the dog, instead

The dog was on his back, sedated on a table. I was not wearing a surgical cap or a sterile gown. I held the first testicle between two fingers, pushed the needle in, and injected a little less than a milliliter of a mixture of zinc gluconate and L-arginine. Then the second testicle. And now the dog was non-surgically castrated. In a few weeks, once he was rid of the sperm he had already made, he would be sterile for the rest of his life.

This product, Zeuterin, is newly released in the US market, just starting to make its way into veterinary clinics. I was part of a one-day training at a low cost spay/neuter clinic which has partnered with the company as an early adopter. On the one hand: if we can avoid doing surgery on dogs, why wouldn't we? Isn't an injection better than cutting? On the other hand: if you have to sedate the dog for the procedure anyways, and surgical castration is so very quick and simple, what's the benefit of zeutering rather than surgically neutering them? And is the benefit to the dog (healthier) or to the human (faster and/or cheaper)?

I'm considering a few different populations of dogs: owned dogs being brought to a clinic, shelter dogs being altered on site, and owned dogs being altered on an outpatient basis. The answers to the above questions will differ for each population.

• Sedation versus anesthesia: Surgical castration of a dog requires full anesthesia. Zeutering requires only sedation, and in some calm dogs can be done without even that. A dog will recover more quickly from sedation than from anesthesia, so he'll be able to go home earlier in the day. (Important in a clinic and for outpatients; not important for most shelters.)
  
• Time: You'd think that an injection would be faster than surgery, but it isn't clear that this is so. A trained high volume surgeon will perform a castration (a very simple surgery) in just a minute or two. The injection has to be given slowly and the needle has to be positioned precisely. The time difference may not be significant.
  
• Cost: Zeuterin is expensive! It costs $10-25 to neuter a dog with this product, depending on the size of the dog. I don't think anyone really knows how this compares to surgical castration, which doesn't have clear costs per animal. How much is your surgical suite costing you, and how valuable is it to keep a dog out of it? How much does it cost to sterilize a pack of surgical instruments? For shelters where every penny is counted, the cost of the product will matter more than in a veterinary clinic where an owner may not mind a difference of $10 one way or the other.
  
• Using technicians: Technicians can't perform surgery. That requires a veterinarian. But a technician can give an injection. The spay/neuter clinic where I learned to zeuter are currently only allowing vets to zeuter, but they expect to start using technicians in this role as they become more comfortable with the procedure. Saving the veterinarian's time is a big bonus. Vets are expensive!
  
• Testosterone reduction: Surgically neutering a male dog reduces his testosterone level by 100%. Zeutering him reduces it by 50%. Which is better? Hard to say! We don't really know yet whether zeutering will reduce unwanted behaviors (roaming, peeing on things) the way neutering sometimes does. (But we tell people that really training is better for that sort of thing anyway.) And is it healthier for a dog to have all of its testosterone, or only half? Testosterone is a steroid which affects metabolism and various physiologic process in many ways. I'm guessing that it does some good things for dogs and some bad things, and only time and a lot of research will tell whether it's better to have 50% or 0% of normal levels.
  
• Aesthetics: Zeutered dogs still have their testicles, although atrophied and therefore somewhat smaller in size. Good or bad? Opinions will differ on that one.
  
• Complications: Surgical complications can include anesthetic death and bleeding, but complication rates for this simple surgery in healthy dogs are very low. Complications with zeutering include the development of ulcerations or even necrosis of the scrotum. These complications are also expected to be low when the procedure is done correctly, but again, it's too soon to know exactly how that will shake out.

So is there a place for zeutering in veterinary medicine? I think there is, but it's not clear yet exactly what it will be. I'm not convinced that that place is in a shelter (though some shelter vets disagree with me). I'm also not convinced it's in a general practice veterinary clinic for the average owner, although I think some owners will prefer Zeuterin both for avoiding general anesthesia and for maintaining a higher testosterone level, and of course for keeping the dog's balls. The place I really see this product is for performing neutering outside of the veterinary clinic, for example, in low income areas of the US where the population has difficulty getting their animals to a veterinary clinic, either for lack of transportation or for lack of enough committment to follow through with an appointment for surgery. In other countries, trap-neuter-release programs may also find a great benefit to being able to do this procedure in the field.

(Posted by a bleary DZ at the fabulous but overwhelming ScienceOnline 2013 unconference.)

Diary of a shelter medicine veterinary intern: late fall

I seem to have spent two months with no time to blog. What in the world was I doing?

The last you heard from me, dear readers, I was in the first week of our month-long shelter consult. The first week we digested a lot (a LOT) of data from the shelter. The second week we wrote up what we thought about that data. How many dogs did this shelter take in over the last few years? Cats? Are there changes in intake? How many of each species were euthanized? Why? What is the average length of stay for each species? Are pit bull type dogs treated differently? Etc.

The week after that, we were on site, crawling all over that poor shelter. That was a very busy week; in the evenings we were scrambling to write up everything we had seen and photographed during the day. On the last night of the consult, we generated our exit report, which was an overview of our findings. What did we think were this shelter’s greatest strengths? Its greatest challenges? What did we think they should address first? How? What was our five year plan for them?

The week after that, we were back on campus, writing, writing, writing. The complete consult report is traditionally quite a long document; in previous years it has been hundreds of pages long. The shelter medicine residents (the veterinarians who are specializing in shelter medicine) worked on the report for another week after that, but we interns were released after just one writing week.

After that, I spent two weeks at a truly lovely limited admission, adoption guarantee shelter about an hour and a half from home. I shadowed the shelter vet some of the time, and worked on my own some of the time. I did a lot of physical exams and surgeries! I also helped one day to select animals from the local municipal shelter (lots more animals, lots more euthanasias) for transfer to the adoption guarantee shelter. Our truck was almost full of animals when shelter staff pointed out an ancient, arthritic collie mix and asked if we might consider taking her. I argued against it, saying she was too old and decrepit to be adoptable. But in the end we felt sorry for her and took her (another dog had to ride on my lap on the way home to make room). Then I felt too bad for her to put her in the shelter kennels — her arthritis was so bad and she seemed so depressed. So I took her back to my room for the night. And the next night. And home over the weekend. And hung on to her my second week in the shelter. I officially adopted her on the last day. Her name is Rosie.

In mid November, I spent two weeks on campus, working with veterinary students as they learned how to spay and neuter animals. I am getting more and more confident in my own spay/neuter skills, but teaching still feels scary. Will I be able to tell ahead of time before someone does something wrong? I also got to amputate a badly broken leg off of a kitten. My first amputation! Terrifying. There are big arteries in there.

After Thanksgiving, I was on campus again for our shelter behavior course. This was a blast. A lot of reading about behavior (one of my favorite things to do), and a surprising amount of hands on work. We learned about different temperament tests for dogs and tried them out, both on shelter dogs and on our own dogs. We visited some different shelters in the area and talked about how they handled their dogs, and at the end of the two weeks we spent two days at one shelter, getting hands-on helping some of their dogs: setting up play groups, putting up cage barriers for those dogs who were over-stimulated by their surroundings, hanging treat buckets, etc.

Now I am in the hospital on the dermatology service. Skin problems are really, really common in shelter animals, particularly in the South. Flea allergies! Pollen allergies! Allergies allergies allergies! Also mites.

And that brings me to today. I finish up my dermatology rotation next week and head on to another week in the emergency room. And that is what I have been up to. I have been quiet, but I have not forgotten you guys.

When the patient is a shelter: week one

The next question I get after “what do you do?” is always “what’s shelter medicine?” I have been playing around with different ways to sum up a complicated veterinary specialty in a few sentences, suitable for cocktail party conversation. (No, I do not actually go to cocktail parties.) Recently I found an answer I liked: shelter medicine is where the patient is an animal shelter, not an animal.

For the next four weeks, my shelter medicine program will be working on a consultation with a particular animal shelter. This week, we are analyzing data from the shelter, which is a large municipal animal care and control facility in the South. As such, it will be open admission (take in almost any animal offered to it) and therefore likely to perform euthanasia of potentially healthy animals to free up space for more animals, rather than solely for behavioral or medical purposes.

Step one: analyze what this shelter takes in. I have received spreadsheets of data from the last five years. I will be building data tables to tell us how many animals of each species it accepted (we’re only looking at cats and dogs); how many animals of each age category it accepted (kitten/puppy, adult, and the always dreaded “unknown,” of which there are more than you would expect at most shelters even though it isn’t hard to tell if an animal is an adult or not); why the animals came to it (surrendered by owner, stray, confiscation, returned by an adopter, return from foster care, other). This will help us understand where most animals in the shelter have come from, which will be key data in making recommendations to the shelter about how to work to reduce their intake numbers.

One of the residents in my program is simultaneously looking at what happens to the animals who are in the shelter, by age and species: euthanized? Died in the shelter? Adopted out or transferred to a rescue (“live release”)? This will help us make recommendations about how to increase live release. For example, which kinds of animals are most at risk of euthanasia: feral cats? (Does the shelter have a trap-neuter-return program?) Adoptable puppies? (Do they have a program to transfer to other groups which might have more resources to put towards finding homes?) Adoptable kittens? (There are always too many kittens!) Sick animals? (It may be acceptable to euthanize sick animals, but why did the animal become sick? Does the shelter have a problem with communicable disease?) And, of course, we will look at how many animals died in the shelter. (That is the worst outcome. That should rarely happen. If it happens too often, it is a huge red flag.)

So wish me luck with all my spreadsheets. Luckily, I used to be a computer programmer. I may call on some old skills to help me out this week.

Ten's company for cats in shelters

Austin Bouck at Animal Science Review recently posted about the benefits of group housing for cats in shelters. (Well, sort of recently. I meant to write about this two weeks ago!) Apparently adopters prefer group-housed cats as adoption prospects. Decreasing the length of an animal’s stay in a shelter is a very important tool in decreasing shelter overcrowding, so this is good information for shelters. Austin adds, “Arguments against housing cats in groups are primarily based on disease management,” citing upper respiratory infection (URI) as the most common disease seen in sheltered cats. (Too true.) So is group housing a good idea for cats in shelters, then? What should shelters be considering if they are designing a plan for cat group housing? I turned to my new bible, the Association of Shelter Veterinarians’ Guidelines for Standards of Care in Animal Shelters, to see what it had to say about group housing. It has an entire section on this topic.

Risks and benefits of group housing
Absolutely, group housed animals can pass infectious disease back and forth. A quick Dog Zombie sidenote about infectious diseases of cats in shelters, not covered by the Guidelines in this particular section: about half of shelter cats will get a URI within two weeks of their introduction to the shelter, and they may well pass that URI to other cats with whom they come in contact. However, the main cause of URI in shelters is stress, which causes viruses which the cats have been carrying without trouble for years to reactivate. So if the group housing is lower stress than individual housing, I am less concerned about URI. I would be concerned about ringworm (highly contagious!), as well as FIV (feline AIDS) and FeLV (feline leukemia). These last two are less infectious, but very serious (life shortening) if acquired. All animals should be tested for FIV/FeLV and inspected for ringworm lesions before they are put in with other cats. The Guidelines do cover these diseases, but not in the group housing section.

Aside from risk of infectious diseases, what else should we be concerned about? “Stress, fear, and anxiety.” Some cats like group housing. Some don’t. Make sure you don’t put a timid cat in with bullies. It can be easy to miss these kinds of social interactions in a busy shelter, but if you are group housing animals, you have to take the time to make sure everyone gets along.

Speaking of which, it can be difficult to keep an eye on everyone in a group housing situation. A cat in a cage is easy to check up on. But if you have 10 cats in one room, it is easy to miss the little one who hides in her hide box all day. It is even harder to tell who is not eating, or who had that stinky diarrhea in the litter box. So group housing can be a lot of work to manage. But the consequences are serious if some cats become sick and early signs are missed.

There are benefits, though, even aside from increased attractiveness to adopters. Many cats very much enjoy the company of other cats. They like the opportunity to sleep together, groom each other, and play together. Shelters can be very sterile environments, and there’s little that is as enriching to a social animal as a well-matched member of your own species.

Facilities
One danger of group housing is that an overcrowded shelter might see it as a way to save space. Well designed group housing won’t actually save any space, although it may redistribute space (enabling more vertical space, which cats enjoy so much). The Guidelines recommend at least 18 square feet per cat. That’s a lot, but it provides cats with room to get away from each other when they need to. Of course, you also need enough feeding stations, litter boxes, hide boxes, and elevated perches. I have been told that it’s a good idea to have more elevated perches than cats so no one is fighting over the best one! If you look at cats in group housing, it is often true that most of them are off the ground at any one time.

Selection
We already talked about some selection criteria for cats being put into group housing: do they like other cats? Are they sick? Cats should be grouped by age (no energetic kittens in with old codgers). Obviously, intact males should not be put in with intact females (you’d be surprised, but some facilities don’t take these simplest of precautions against breeding).

Since we’re worrying about disease, it’s worth mentioning that a lot of population turnover (a new cat put in to an enclosure whenever an old one is removed) is a prime cause of disease. Remember, a cat is liable to come down with URI soon after it arrives at the shelter. Do you want to put it in with a population of healthy cats? (I said that the cats came down with URI because they were stressed, but that doesn’t mean that the virus that reactivates isn’t infectious to other cats, not to mention bacteria that take advantage and colonize a sick animal.) It is an excellent idea to have stable populations per group room, let the group size diminish as animals are adopted out, and then start an entirely new group periodically. Animals who stay in the shelter for a very short period of time may never make it in to a group housing situation, which is fine. This “all in, all out” method of group management is also used in farm animal husbandry, by the way.

Group size? With cats, 10-12 is a good group size. More than that can be really unmanageable. The shelters I have seen that do cat group housing well have multiple rooms with groups about this size. It can be tempting to have one large room with all your cats in it. I have seen this done as well. It was a disaster, with rampant disease and fighting.

Is group housing a good thing?
I definitely think group housing is a good thing for cats in shelters when done well. But it does have to be done thoughtfully and with planning. It is good for the cats, but it is not a way to save time or money.

I haven’t seen group housing for dogs in a shelter yet. Word on the street is that there is a shelter a few hours from me that does this, and I really want to check it out. I will report back if I do!

Diary of a shelter medicine intern: the first few weeks

At my last report I had finished about two days of my internship and was still giddy with joy. During the rest of that week, I got to work on site at a major cat hoarding case. Hundreds of cats at a cat sanctuary gone bad had been seized by a large rescue organization, and were being managed in a previously abandoned animal control facility which had been patched up to manage all these cats. My team swooped in to help with spay/neuter. We surgerized about 200 cats over two days. We also got to see how the facility, originally designed for dogs, had been fixed up to house so many cats. Quite a bit of creativity had gone into making dog runs inviting to feline inhabitants. I was impressed.

The following week, I was oriented to my new job (even though I had already been working for several days). There were lots of lectures about things I now have no recollection of, and lots of tours of the hospital.

Then I started two weeks of Primary Care service, which represents the first of six or so rotations in the main hospital, so that I can be exposed to other kinds of medicine besides shelter medicine. Primary Care is different this far south than it was in New England. I learned so much about flea control. I was completely unprepared to deal with animals who were on flea preventatives and still crawling with bugs. Fleas down here have become resistant to preventatives; who knew? I also had my first interactions with veterinary students since I stopped being one. They would not call me by my first name no matter how much I asked. Being called “Dr. Dog Zombie” still feels odd and stilted to me. They were also all mildly afraid that I would give them a bad grade whenever I asked them a question.

The week after that was a hodge podge of stuff. All the interns (3) and new residents (2) dove in to studying the Guidelines for Care in Animal Shelters: we watched webinars, read consulting reports from when our department had visited shelters and given recommendations for improvement, discussed, and of course read the actual guidelines. We also had an ophthalmology lab, in which we practiced common eye surgeries which we might have to do in shelters, using cadavers. And, fortuitously for us but not for the shelter, we consulted on a small outbreak of panleukopenia in a nearby shelter. I really want to blog more about all of those things, but may not find the time, as they are working us hard. If there are any particular things you guys want to know more about, please ask! Getting feedback on what interests you will definitely influence what I choose to spend blogging time on.

Which brings us to this week. This week, I’m at a course on campus about managing feral cat colonies. Am I a student? Sort of, because I have to attend all the lectures and take the tests. Am I an instructor? Sort of, because I run a station during the clinical section of the course and teach the course participants how to prep anesthetized cats for surgery. Perhaps I have gotten the worst of both worlds!

Tonight, I am off to learn how to trap feral cats. Despite never having done this before, I will be a team leader. But how hard can it be?

[ETA: So far we have trapped three cats, out of a reported ten. Go Team Dog Zombie!]

Animal shelter surgery: autoligation

When I watched my first video on how to spay a dog, lo these many (two) years ago, I kept saying “what’s a pedicle?” Apparently it was very important to tie the suture around the pedicle very tightly. And from context it was clear that the pedicle was the bit of tissue connecting the ovary to the body wall. But what was it?

I finally figured it out. The pedicle is the bit of tissue connecting the ovary to the body wall. It isn’t really anything in particular, it isn’t any actual anatomical structure, it just holds the ovary in place. But blood vessels run through it, so when you cut it in order to remove the ovary from the animal, lots of bleeding can happen. Bleeding is bad, particularly if it continues after the animal is closed up. So one of the hardest and most important parts of spaying a dog or cat is to make sure that you wrap some suture really, really tightly around the pedicle and tie it in a really, really secure knot so that no blood can get out.

Or not.

In shelter spays, the goal is speed. Most importantly, the less time spent under anesthesia, the better. This is particularly true in the case of feral cat spays, in which the cat can’t receive optimal post-op care because she can’t be handled. Also, of course, shorter spays means you can move more animals through in a day, sometimes dozens of animals per surgeon. We are not keeping up with the cat population with surgical sterilization as it is, so the high volume spay/neuter operations really try to keep as many animals as possible moving through.

One way that shelter vets try to make surgery time shorter is with autoligation. Instead of tying suture around the pedicle before cutting it, the pedicle is actually tied to itself. It’s a lot faster once you learn to do it. There is no futzing with getting the suture around the little cat pedicle with all the big clamps around it (oops! I looped the suture around a clamp! Time to start over). Tie the pedicle to itself, cut, inspect, let it sink back into the abdomen and move on. This is a pedicle tie, also known as autoligation (in other words, ligating the pedicle with itself).

Why don’t all vets do this? I suspect some private practice vets do. However, the technique takes a little learning, so if you’re not doing at least a few spays a week, it’s not really worth the investment. One vet recently told me that his private practice only performed about one spay a month. The rest were done in shelters, and that was fine by them.

And that’s one of the ways in which shelter surgery is different from general surgery.

This post written in celebration of my first unsupervised pedicle tie.

Day Two

I didn’t really feel like a vet until the second day of my veterinary internship in shelter medicine. I spent the first day being driven from department to department in the blazing heat to get my email address working (it still doesn’t), turn in medical records (not yet successful), and get my ID (the photo isn’t great, but a lot better than what I had managed on my first day of vet school).

The second day was different.

My alarm went off at 4:45 am. In New England this close to the summer solstice it would have been at least dawn if not full light at that time of the morning, but here it was still pitch black out. This may be due to being closer to the equator or to being farther west in the time zone, take your pick. Exercising the dogs was a little scary, because this town is home to the largest (flying) cockroaches you have ever seen, and they come out at night. (I survived.) My intern-mate arrived at my house at 6:15, and just as the sky was lightening we got in the car.

We drove for an hour and a half, getting to know each other on the way. We have known each other for a little less than a week now, but expect to be spending long hours together, so our relationship is sort of on the fast track. We talked about family and vet school. While I drove, she read aloud off her smartphone about a large hoarding case we will be working on in a few days.

We arrived at the shelter/hospital complex a little before 8 am. The senior resident drove up a few minutes later, fresh from the coffee shop. Warm drinks were distributed. I am still amazed that people down here drink hot drinks at this time of the year. At 8 am it was not yet sweltering, but well on its way.

We started the morning in the veterinary clinic, doing surgeries on shelter animals. Dr. Intern-mate and I had both gotten married after graduation from veterinary school but before the beginning of this internship, and we shared a moment of surprise when scrubbing in for surgery at discovering that now we had to deal with what to do with our wedding rings. It is a common problem with surgeons that rings get removed and then lost; neither of us had come up with a good plan yet for dealing with ours, and just stuck them in our pockets.

I neutered a cat and two dogs. I declined to spay a cat who was pregnant; I have spayed pregnant cats before and I will do it again, but it still makes me uncomfortable, and since I was offered a choice of two animals, I took the male. I may regret the decision, as spays are much more difficult than neuters, and I could have gotten some valuable instruction from Dr. Senior Resident on a new technique I’m learning.

While I only participated in sterilization surgeries that day, I observed two tail amputations. Why were so many cats with severe tail trauma coming in that day? (I saw a third get scheduled for an amputation as well.) Just lucky, I guess. I saw a dog get two stones the diameter of quarters pulled out of her bladder. (Ouch.) Then a technician appeared with a tiny kitten in a carrier, and announced that the kitten had some sort of wound in its neck which appeared to be infested with maggots. Dr. Intern-mate and I immediately bailed on surgery observation and went to give the kitten a physical exam.

She was a tiny grey kitten with a head way too big for her body. While an outsized head is somewhat normal for a kitten of this age, four to five weeks, she was clearly undernourished. Most of the fur was gone from the right side of her neck, and the nearby fur on her shoulders and chin was matted. She had a huge swollen mass on her neck, with a hole in her skin maybe 2 cm in diameter, and a dark mouth sticking out. It looked like a curled worm to me at first (though clearly not a maggot), but Dr. Intern-mate had seen this kind of thing before and declared it to be a fly bot. The mouth was pressed up against the hole for it to breathe. We cleaned the skin as best we could, and as we pressed against the bot it retracted deeper into the skin. (Everyone who encountered this bot reacted by exclaiming that it was gross, but after that you can divide the reactions into two camps: Tell me more! and I’m leaving the room now. Which are you?)

Image provided by Wikimedia

Dr. Senior Resident finished up her surgery and came over to see the kitten. We sedated her, then, when her eyes remained wide and her head remained up, put a mask on her to deliver anesthesia gas. When she was out we dripped a little local painkiller on to the area, and Dr. Senior Resident opened the hole up with scissors. She pulled the bot out with forceps. It was huge, almost as long as but much fatter than my thumb, and especially large to have been pulled out of such a tiny kitten. It was very definitely alive, and undulated sluggishly around the table while I filmed it on my smartphone. (Smartphones are the star of today’s story.)

Dr. Intern-mate and I also tried to draw blood from a stone, er, a very dry cat. She was dehydrated and sick but sweet. I felt bad poking her and wished once again that I was better at it. A tech saw how long the draw was taking, came over, and in the way of all techs, slipped the needle in and extracted plenty of blood in very little time. I try hard to get as much experience as I can with blood draws, because I think being able to do them is important, but it’s always hard when I feel that I am hurting an animal with my inexperienced prodding. I did fulfill my doctorly duties by reporting the cat’s dehydrated and flea-infested status to Dr. Senior Resident and making sure that both things would get taken care of, but I felt very much like a student at the moment.

After lunch, we began the medical (rather than surgical) portion of the day. Much of this consisted of checkups on animals who were either healthy (but we didn’t know that yet as they had just arrived at the shelter) or being treated for something previously diagnosed. I did physical exams on two teenage kittens. Both looked great, but one had a little bit of red around her eye. This is a good example of how shelter medicine differs from general practice. In general practice, a slightly red eye is not really worthy of note unless it goes on for a few days or gets worse. In a shelter, it is a sign of impending upper respiratory infection (URI), which about half of cats will come down with while in the shelter environment. URIs don’t kill very many animals, but they do keep animals from being adopted out of shelters while sick, and they of course add expense to managing animals. I recommended just keeping a close eye on this kitten, and Dr. Senior Resident agreed.

As the afternoon got hotter, Dr. Intern-mate and I headed over to the dog kennels to do some physical exams and give some rabies vaccinations. One dog was recovering from kennel cough, so we had to don Personal Protective Equipment (PPE) to go in to his run. This entailed putting on booties, a gown, and gloves over our scrubs. The dog runs were not air conditioned. On an already miserably hot day, it was almost unbearable: welcome to the South. Hopefully I will toughen up as this summer goes on.

Finally, Dr. Intern-mate and I headed over the the kitten house. Kitten house! It is an entire little house, a few blocks from the main shelter, entirely dedicated to housing kittens. It is staffed by volunteers, and the main room has rocking chairs for them to sit in with kittens on their chests. The cuteness was unbearable. Dr. Intern-mate and I were sent in to the Upper Respiratory Infection room (again in PPE, but this time there was A/C) to weigh, feed, and medicate about 40 kittens. They were in a rack of cages against the wall, and as they were mostly feeling pretty good with their medications (yay) they were all bouncing off the walls of their cages. It was hilarious. The next hour or two were populated by the sounds of kitten bodies hitting all possible sides of the cage (including the top), and Dr. Intern-mate saying things like “oh no, you mustn’t bite me in the face” and “it’s not nice to beat up on your sister like that.” My favorite moment was possibly when one kitten escaped from her and got under the rack of cages. I closed the door to the room while she fished him out. As she went to put him back, we realized from the records that he had come out of the wrong cage (which cleared up some confusion as to why there had been only two kittens in the previous cage, when the records suggested there should be three). So far as we could tell he had been in the wrong cage for several days. With the level of chaos in the room, we could easily see how it had happened. We had a good-natured argument about which cage to leave him in. I won with the argument that his original cagemates were on medications which he was supposed to be getting as well.

Finally the day was over. I was exhausted, hot, and hungry; we had been working for eleven hours. We piled back into the car and set off on the hour and a half drive for home. Twenty minutes in, Dr. Intern-mate realized her wedding ring was not in her scrub top any more. It must have fallen out. Yes, we turned around, and it was right were she suspected it would be, but at this point I was not sure I would survive the trek home without food. I pulled the hero of the story out of my pocket, and it told me that an excellent “fit for foodies” restaurant was very near by. We went, and ate the best fried zucchini you can imagine, along with a very good noodle dish which I could barely stuff in after the amazing appetizer. We finally got back on the road, missed a turn, drove for quite a while in the middle of very dark nowhere under a lovely harvest moon, hanging on every word of the smartphone as it guided us back to civilization.

I got home sixteen hours after I had left. I think this day was a sign of good things to come in the internship. I’ll let you know how it goes.

How to spay a cat fast

Yesterday I spent the day on a spay/neuter trailer. The shelter which owns the trailer sends it out to low-income areas to spay and neuter a large number of cats and dogs at low cost. Yesterday was a slow day; we spayed and neutered sixteen cats. Well, the vet spayed seven and neutered three; I spayed one and neutered three. Meanwhile, she explained high volume spay/neuter techniques to me.

The key to high volume spay/neuter is, obviously, speed. She can spay a cat in seven minutes. It takes me about thirty; a general practitioner who has more experience than I do, but isn’t as obsessed with speed, might take ten or twelve. This is what I learned:

• Keep your surgical field (the animal!) clear. Take the time to replace your instruments on your instrument tray when you are not using them, so that you have less visual clutter.
• Always know where each surgical instrument belongs. Don’t leave them in a pile or even a random row on your tray. Have an order for them — any order, so long as you are familiar with it and can reach for a particular instrument and know right where it will be.
•  Don’t waste movements. If you’re reaching to the right to grab a new instrument, don’t twist all the way over to face the tray; just reach your right hand over.
• Don’t get tangled up in your instruments. Be willing to take a second to switch hands if you have yourself in an awkward position.
• As you’re working on one step, have your next step in your mind. What instrument will you be reaching for next?
• Relax. Stand up straight. Breathe, breathe, breathe.

Shelter medicine externship

I recently spent two weeks of elective time at a shelter medicine externship at a different vet school. Half the time was spent in academic pursuits on campus — going to journal club, going to talks and lectures about shelter medicine, etc. The other half was at the shelter, doing high volume spay/neuter, temperament tests, treating sick animals.

Highlights:

• Pulling worms out of a kitten’s butt (“Wow, can I?”)
• STRAY GOLDFISH. It is more amusing not to explain, but I will say that it was found in a ditch in a grocery store parking lot.
• Ratlings! Five week old foster rats came in for a visit. They had been well socialized and were extremely friendly. I badly wanted to adopt one, but suspected it would not get along with my cat.
• Seeing exactly how fast 8 week old kittens recover from spay/neuter surgery. Spay surgery is no small deal, but those girl kittens were literally climbing the walls of their cage 30 minutes later. I am sold on pediatric spay/neuter.
• Helping to set up play groups of shelter dogs and getting to watch them play together. It was lovely.

Shelter medicine is in large part population medicine, or herd health. Of course you do need to pull the occasional worm out of the rectum of a kitten, but you also need to think about how to keep animals out of the shelter in the first place, and how to keep them from getting sick once they are there. Daily rounds in my vet school’s small animal hospital are about the specifics of what diagnostics were done on an animal yesterday and what needs to be done today; daily rounds in the shelter were about why an animal hadn’t been moved to the adoption floor yet or how to deal with the placement of a feral cat. I knew that shelter medicine had a large preventative component to it but was not prepared for quite how large the component actually was. I was enthusiastic; I really like this kind of medicine.