Saturday, November 13, 2010

More Medical Procedures

Peggy Hogan, in California, hosts a great group and site on Facebook called Clicker Training Horses. If you're on Facebook, I highly recommend you check it out. The subject of training for medical procedures came up recently, right as I was dealing with the same issue myself.

Percy, my TB x WB, age 2, came in with a fat hock. Fat hocks make me nervous. This was unusual in that it was high and inside. There was very little heat, and no pain or lameness. I didn't really think it was joint related but hocks aren't something I like to ignore. I was torn because I know how to throw the book at a hock on sport horses (icing, medicating, wrapping, sweating, x-rays, injections etc) and I know how to look the other way when a lesson pony has a puffy spot (they just get better). But Percy didn't fit either of those categories. I didn't need to worry about losing training days but I also didn't want to ignore anything which could cause problems for his career as a sport horse down the road.

Oh, and one other problem. We've been working on having him pick his feet up nicely with just a touch on the hind leg. Oops. Now I needed him to leave his foot DOWN so I could palpate. I decided to give the leg 24 hours to get better by itself. It didn't. I called the vet. He offered to come out immediately as it was the only time in the next 2 days he could get here. I decided it was a good idea. Time to panic train. I had 20 minutes to convince Percy that leaving the leg down was as reinforcing as picking it up. Thankfully, that was a breeze- a much smaller problem in reality than it was in my mind. I just clicked for leaving his foot on the ground when I touched his stifle (not anywhere near where I touch him for picking up his foot) and then worked my way down. I was also careful to maintain a very different body position- squatting and facing him, not bending over toward the rear. He got it in minutes. By the time the vet arrived, I could poke, rub, massage all over that rear leg from either side.

Feeling confident, I led the vet to him. Percy was in the round pen because it was bright natural light and we have had so much rain this fall, it was the driest place outside. The only problem with the round pen is that Percy feels Important when he's in there and likes to puff up a bit and show off. Funny boy. As the vet approached him and reached out to stroke his neck, Percy flattened his ears back. Wow. I realized that was the first time in his life I had seen him do that. He is SUCH a sweet and inquisitive soul, but I had never realized that he never put his ears back until I saw him do it and it was a shock. (Ande used to pin his ears at only days old when his mother tried to move when he was nursing!) I have to admit that I was struck incapable at this. I just did not know how to react.

I really like our vet- he's capable, common-sense, quiet and unafraid. But he's not a clicker trainer. I have never felt comfortable asking either my vet or farrier to adapt to my training techniques. I know I could make their work with my horses go better if I did and I should get over it but for some reason, I just feel that they are professionals and I shouldn't be telling them how to do their job. Perhaps if I felt that either one was too harsh, I would feel differently. But they both have wonderful, if traditional, approaches that do not intimidate the horses. And while I can get the horses to do things for me with CT, sometimes they need to learn that others need to work with them as well. I can do the prep work, but I can't BE somebody else.

So here was Percy, head up in the air, ears back and my vet simply continuing on slowly. OK, so he wasn't being reinforced for his behavior- the vet did not back off. But I also know how talented Percy is at standing up (he demonstrated that at his first hoof trimming as a baby and practices regularly in the field while playing with others) and I feared that was next. I needed to redirect this before we went there because that WOULD stop forward progress and be reinforcing. I tried putting a fist out to target, but his eye was on the vet. So I said "HEY!" to get his attention and instantly put my hand on his poll (I could barely reach it). Thankfully, we have practiced that a zillion times and he reacted instantly by dropping his head a couple inches. Click and treat and hand on the poll again. Rapidly. Normally a hand on his poll instantly puts his nose in the dirt, but even in this tense situation, I got an immediate reaction of some kind which I could reward and we were on the road. I continued to CT as the vet worked his way back toward his hind end and down the leg. He lifted his leg once, I put a tiny bit of pressure on the lead and was quiet. When his head came down a fraction, his leg did as well- CT and we were making progress again. He put his leg all the way down and left it on the ground. Phew.

The vet agreed it was probably not the joint (another big Phew!) but a sprain/strain in the lower gaskin area. We discussed hosing but Percy hates being hosed. We have worked on it I know his mother hates it as well, as do most TBs unless the air and water temperatures are just right. They just have very sensitive skin. In northern VT with no hot water in the barn, I had 2 days this summer when it was hot enough that he enjoyed being hosed with icy water. Now it's fall, cold and muddy. Luckily the vet understood that and thought bute and massaging would be good as long as we saw progress. He suggested an IV injection of banamine and dexamethazone to get the healing started. I let Percy loose for a moment in case he wanted to let off steam while the vet went to his truck for the meds. No, he wanted to follow us.

When we went back in, Percy's ears went back again. It made me so sad! It reminded me of a certain little girl who needed some nasty medicine when she was about 2 years old. Normally a very cooperative child, she did not want that medicine! She fought like a wildcat kitten and it took three adults to hold her down to squeeze it in her mouth. At the same time, she was using her best adult verbal skills to bargain with us to no avail. With Percy, there were only two adults and he weighed a lot more than that little peanut of a girl. My Clicker Training skills were all I had to explain the process. Thank goodness they worked! Head down= CT. Any level was accepted as long as it kept getting lower. My vet slipped the needle in in a split second and I just kept clicking away as long as the head came down when asked. The ears waffled between back and sideways but he stood like a rock for 2 syringes worth. My biggest concern at that point was Ande who was reaching through the round pen to chew on him! The vet kept saying, "he's really doing quite well, don't you think?" Amen!

Next project: twice daily bute paste. I hadn't done anything with a paste syringe since worming him a couple weeks ago. The first time with the bute, I tried putting a halter on him and CT'd him to stand while I approached his lips with the syringe. I got it in but it really didn't feel right. So the next time I went in his stall without a halter and just stood with the syringe. Being friendly and curious, he couldn't stand it and took a step toward me. CT. That continued to be my approach. I kept my standard to 10 clicks before increasing the criteria. He usually increased it on his own before I had to. I think the important part of letting him approach rather than me approach him, along with the 10 clicks at the same criteria level, was that it gave him a LOT of opportunities to sniff the bute paste. He got a little in his nose just from the end of the tube, he got to walk away and come back. He got to sniff and sniff and sniff without being at all threatened by it. He volunteered to take it in his mouth and then I walked a step forward between each click until he was pursuing me around the stall trying to grab the syringe. Mentally, that was a big step for him.

Then I stepped back by his shoulder so he had to turn to touch it and that's how I managed to get him to target it with the corner of his lips rather than his muzzle. I made sure to get a full 10 trials with it in his mouth before squirting the bute in on the 11th. Then I clicked and offered the hay stretcher pellets. He took them and dropped them. I continued to CT for any interest in the syringe. This is the hard part because he got "punished" by the nasty medicine and I wanted to override that with many more positive experiences but they can't taste anything good afterward. He has a lifetime of reinforcement for the click though and it seemed to work for me here because he kept touching it for the clicks, even though he dropped the treats each time. After a few times like that, he stopped taking the treats so each time I dropped the treats into his feed tub. Even though he wasn't eating them, I think the noise of them falling into his tub was reinforcing and they would be there for him. I also unwrapped a couple peppermints. I think the noise of those unwrapping is highly reinforcing and hoped that their strong smell would overpower the bad taste. I kept this up until he was taking the syringe in his mouth again and then just dropped a handful of hay stretcher pellets in his tub along with a couple more peppermints and left him. He had been trying to eat a couple and so I was pretty sure that left alone, he would commence to eating, which he did. AND he'd taken the syringe in his mouth many times without the punishing taste being repeated. So now I'm going to go back out and do it again.

There is a whole list of veterinary procedures on this discussion on Peggy's Facebook site that were put together by a vet who recently attended one of her clinics:
1. Intranasal vaccines
2. Clippers
3. Injections: intramuscular, intravenous
4. Eye meds
5. Handling ears
6. Handling the lips & tongue, giving oral meds
7. Handling the sheath or udder
8. Taking the temperature
9. Handling the feet
10. Just standing still

I think these are great winter projects!!!


Mary @ StaleCheerios said...

Sounds like he did great and that you handled everything very well.

I'd love to hear how the daily bute goes over the next few days. Bute and wormer are things that I think can be really hard to train for since at least part of the time, the training leads to a really nasty taste.

Hope his hock heals quickly!


Bookends Farm said...

Hey Mary-
Actually I'm pretty happy with the way the bute went. I tried to do all the reinforcing things I could when he wouldn't take treats. He allowed me to get far enough each time to get 1 g worth of paste in and then back to high rate of reinforcement for any association with the syringe afterward. He did a lot of "tasting" the past in the process of touching the syringe and I wonder if that wasn't a good taste but it wasn't a shock. He had his last paste a couple days ago and I have been continuing the syringe work since...still using the same syringe that smells like bute but he doesn't get any punishing squirt. I am going to do this until he willingly and happily takes it in his mouth for a long time. Then I'll feel like when I have to bring it out again, the memories will be good ones. And that should lead into the mouth handling procedures I'd also like to get him used to!

Bookends Farm said...

Oh- and tonight the procedure was to begin liniment rub on the area. It looks great but I'm going to use this excuse to get him used to yet another smell and feel! My hands are still tingling from the rub so I imagine his leg is too. But he didn't object at all...we'll see how he feels about it next time :)