Originally published in the September 2015 issue of Veterinary Practice News. Here is the scary reality of our profession: Despite our best efforts, 37 percent of dog owners and 58 percent of cat owners say their pets hate going to the veterinarian, according to the 2014 Bayer Veterinary Healthcare Usage Study. In addition, 26 percent of dog owners and 38 percent of cat owners report that just thinking about going to the vet is stressful. Most patients, even the silent or seemingly happy ones, experience some level of anxiety, stress or even fear. When they are driven to a strange-smelling building, are circled or feel cornered by other pets and people, and have strangers grab them, lift them, hold them down and stick things into places they thought were one-way only, why are we surprised that pets are stressed out? The entire process is frightening. Stress makes the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis release multiple hormones that lead to negative physiological and metabolic changes. The fight or flight mechanism sometimes starts before patients leave their driveway. Veterinarian Marty Becker’s Fear-Free concepts can easily be implemented at your clinic by team members and pet owners. Start by Reducing Stress Reducing stress starts at home. Ideally, client education should start before the patient’s first visit. Cat owners can make the carrier an everyday experience instead of a torture device into which cats are shoved when a trip to the vet is warranted. Owners can feed them in the carrier, offer treats inside or even use it as a play area. Dogs should get used to their collar or harness at home. Both cats and dogs can take non-veterinary trips in the car, with progressively longer distances. This also can help the pet owner identify and treat motion sickness or car anxiety if necessary. Multiple medications and supplements can help: tranquilizers, anti-emetics, trazodone, milk-protein derivatives, L-theanine, etc. “Just because” visits can be helpful. This means your patient just visits the staff and briefly explores an exam room or treatment area while play time and food bribery are provided. Handling and gentle restraint can be performed at this time. Some clinics offer puppy and kitten play sessions to help with hospital and staff acclimation and socialization. Species-specific waiting areas are becoming more common and for very good reasons. Sometimes, many of the patient’s triggers have been tested before they make it into the exam room. Here is a simple trick: Offer a feline pheromone-impregnated towel to owners to cover their cat’s carrier to block visual stimuli. Some progressive hospitals are eliminating the waiting area completely. Clients and pets are taken straight into exam rooms to be checked in. If they don’t have enough exam rooms, some clinics ask pet owners to come into the practice to check in, then go back and wait in their vehicle until an exam room is free and prepared just for them. The use of species-specific pheromone diffusers in species-specific exam rooms, on towels used for restraint, on scrubs and lab coat (for staff and doctors alike) and in kennels has been shown to reduce stress. Species-specific sounds and music may be used to help drown out potentially frightening background noises. Once you’ve chosen the appropriate exam room, let the patient—feline or canine—explore the room on its own time. Let the patient come to you. A full exam can suddenly be performed on once-aggressive patients by making a few changes. How to Reduce Stress in the Exam Room When the patient has settled, the support staff and the doctors need to continue the low-stress environment to avoid undoing all your previous efforts. Every patient needs to be handled uniquely. Staring directly into its eyes may be viewed by a patient as a threat or challenge. Quick movements or reaching down to pick up a pet may be taken as threatening. Movements from the side, with minimal eye contact, work best. And rather than do the tip-of-the-nose to the tip-of-the-tail exam on cats (like we do on dogs), reverse the process and start at the tail and move forward. Do what seems most comfortable for the patient. If the exam table makes things worse, examine them on the floor or in the carrier. Though pets are best behaved in their owners’ arms, this can be tricky from a liability standpoint. Cats often prefer a safe place to hide, so a warm towel sprayed with feline pheromone works wonders. Towels may help small dogs. Your patient may seem fine with the support staff, yet as soon as the doctor enters the room, the pet may experience the dreaded “white coat syndrome.” Don’t hesitate to take your lab coat off. It’s OK. Owners will appreciate your efforts to make their pet comfortable. Dr. Becker has had some success using Class II cold therapy laser to overstimulate the sympathetic nervous system, causing a relaxation response. By applying the laser at the base of the pet’s neck while you talk to the client, you should note a relaxed response within a few minutes. If your patient still seems apprehensive, several towel wrap techniques may be implemented. Towels secure your patients, make them feel safe and keep the restrainer in control. Techniques are demonstrated in multiple videos made by the late and beloved Dr. Sophia Yin or available on YouTube. Like veterinary team members, pets can be bribed with food. Ask owners to bring their pets in hungry along with their meal or favorite treats. Using treats should be constant throughout the exam or procedure and should not be discontinued until the stimulus has stopped. Most puppies and kittens don’t notice what you are doing to them if they have a tongue depressor full of canned food under their nose. Pets seen for injuries or painful procedures should be given analgesia ASAP. If you have to take radiographs on a potentially fractured limb, give pain meds first. If the ear canal is so inflamed that it’s difficult to examine, give pain meds first. Virtually no blood work abnormality will preclude you from giving an opioid, so treat the pain as soon as possible, before anything else is done. The more comfortable your patient is, the more you can accomplish and with minimal stress for the pet and staff. By following these suggestions, you will be able to follow Dr. Becker’s mantra: “Take the pet out of petrified and put pets back into your practice.” 7 benefits of Fear-Free Veterinary Visits Dr. Marty Becker says that when patients aren’t stressed out, they will: Have more accurate blood tests. Have more accurate TPR. Have more accurate physical exams. Require less sedation.5. Have less immune suppression. Experience less vomiting. Have less diarrhea. If their beloved pet is less stressed, owners will be, too, and will be more likely to come back for rechecks and yearly exams. Ryan Bragg, DVM, MS, Dipl, ACVECC, and others confirmed in a recent study (R.F. Bragg, et al. “Evaluation of the effects of hospital visit stress on physiologic variables in dogs.” JAVMA 2015, Vol 246, N 2, p. 212-215) that we “should consider stress from transportation and environmental change when canine patients have abnormalities of vital signs.” Specifically, he found significant differences in blood pressure, respiratory rate and pulse rate between home and hospital environments. Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. His traveling practice takes him all over eastern Pennsylvania and western New Jersey. You can visit his website at www.DrPhilZeltzman.com and follow him at www.facebook.com/DrZeltzman. AJ Debiasse, a technician in Stroudsburg, Pa., contributed to this article.
