Recent years have seen veterinary clinics make great strides to alleviate patient stress during routine exams and procedures. Notably, many clinics have taken measures to provide stress alleviation for pets through various desensitization and counterconditioning techniques. This may include having treats on-hand as a positive distraction, providing separate waiting areas for dogs and cats, and timing appointments to allow nervous pets to bypass waiting areas and go directly into an exam room. Nonetheless, it can be very difficult to de-escalate a dog when the animal is experiencing a high-stress level before it even walks in the front door. Suddenly, a routine visit demands muzzling or overly restrictive restraint to get the job done in a limited appointment window. Curbside drop-offs have contributed to escalated stress in dogs, particularly for pets that might take comfort from their owners’ presence during examination. This is stressful for everyone and, for pets, creates a learning history that will increase a negative conditioned response to the clinic. High-stress appointments can result in dogs who may escalate up the aggression ladder, shut down completely while in clinic, or become increasingly unmanageable with every subsequent visit. A very discouraging scenario indeed. Unintentional anxiety New environments and experiences can create stress for some pets. While offering a treat may seem like a quick fix to diffuse the situation, desensitization and counterconditioning is a process that takes time. It is unlikely to have immediate results. In some cases, if an animal is experiencing a high level of stress, offering a treat can actually poison the reinforcer: the intensity of the fear experienced creates a negative conditioned response to the treat offered and, in subsequent visits, the presentation of food may elicit even more fear. Effective desensitization and counterconditioning introduces an animal to a stimulus at a low intensity that does not create a fear response. It then pairs this stimulus with a primary reinforcer, such as food. Gradually, the intensity of the stimulus is increased based on the animal’s comfort level. This process creates a positive association to the stimulus. Providing owners with some guidance to help desensitize their pet will help prepare the animal for the veterinary visit. This allows for a much better opportunity to set the pet up for a stress-free and successful appointment. What follows are a few “do-ahead” desensitization and counterconditioning activities dog owners can incorporate into their animals’ lives to create a lower-stress visit for all. ‘Victory Visits’ during critical socialization period First introduced by Fear Free Pets (fearfreepets.com), the goal of a Victory Visit is to make dogs more comfortable and familiar with the veterinary practice. Key to this concept is the introduction of clinic visits during a puppy’s critical socialization period, which normally occurs between eight and 16 weeks of age. During this period, puppies should be brought into the clinic to familiarize themselves with the sights and sounds that normally occur during trips to the vet. Victory Visits can be as simple as bringing the puppy to a clinic to get some treats from the front-line staff, allowing them to sniff and climb on the weigh scale, or going on a “tour” of the facility, starting with the reception area, and concluding with the exam room. The experience is paired with lots of puppy-suitable treats to create a positive, conditioned response. During these visits, shy puppies should be allowed to explore at their own pace and solicit petting when ready, while outgoing pups may benefit from lots of praise, pets, and cuddles. The goal of these visits is to create normality and set the environment up as one in which good things happen. While most effective during critical socialization periods, Victory Visits can also be useful for adult dogs through a series of low-stress visits. These “hellos” can be incorporated into a neighbourhood walk, whereby owners simply pop in with their dog and get a couple of treats. As the pet’s comfort level grows, exploring different parts of the clinic and interacting with staff through treat tosses or petting can progress as the dog’s comfort levels dictate. Desensitization to car rides One of the biggest barriers to providing lower-stress care occurs when a dog’s first trip in a car or on public transport culminates in their first visit to the veterinary clinic. Indeed, this represents a lot of potentially scary “firsts” piled on top of each other. Aside from possible motion sickness that may arise, car/transit rides can overload a dog with frightening sights, sounds, and smells. This leaves clinic staff attempting to provide care to an animal that has already escalated, and who may require more aversive or restrictive restraint to be examined or to be administered medication. Counselling owners to provide valuable desensitization training for rides in the car or on public transportation can go a long way in setting the animal up for success. The desensitization process for an individual dog varies depending on the pet’s confidence level every step of the way. Generally, owners should begin with very short rides, pairing trips with lots of positive reinforcement and ending with a fun hike or favourite activity. For very fearful dogs, the process may start with simply observing a vehicle. Owners can then pair this visual cue with treats before gradually working toward entering the vehicle, then going for a short ride, and so on. Once the dog is desensitized to transportation, pairing car rides with a few Victory Visits to the clinic will set the dog up for ultimate success. Of course, owners should be counselled to leave plenty of time when arriving for an appointment, as this will give their animal an opportunity to take a quick stroll around the vicinity to urinate or defecate prior to their visit to further ease stress. Desensitization to handling The author, Beverley McKee, and Bossy. Photo courtesy Beverley McKee Both puppies and adult dogs can benefit from becoming familiar with handling and light restraint, which can be practiced at home. Many puppy socialization classes taught by certified trainers include handling components to set puppies up for success through familiarity. As an added bonus, these classes provide an opportunity for puppies to experience being handled by someone other than their owner through the introduction of non-threatening handling from other class participants. Generally, exercises will involve gentle handling of the collar area, ears, body, and paws, paired with reinforcement via treats. It is important to note individual puppies or dogs will have their own unique comfort levels with handling. As such, starting at an intensity and duration the pet is comfortable with and gradually increasing over time will allow the dog to become familiar with the exercises. Experiencing “too much, too fast” may result in the opposite effect (i.e. sensitization). For very fearful or shy puppies, handling exercises may start with a simple three-second petting motion at the shoulder, paired with food. From there, handlers can gradually work up to more prolonged handling. Once the dog is comfortable, they can then move to more sensitive spots, such as the legs, feet, belly, or tail area, and, ultimately, to simulations of light restraint or intentional handling that would take place during an in-clinic examination. Counterconditioning dogs with existing fear response Dogs displaying fear or fear-based aggression can also benefit from methodical training at home prior to attending appointments. To be effective, clients should work with a certified trainer to determine an appropriate plan that meets needs of veterinary care or procedures. These may include desensitization and counterconditioning to strangers, touch, vaccinations, intramuscular sedation, blood draws, muzzle training, or any procedure necessary as determined by a veterinary team. Counterconditioning an existing conditioned fear response to veterinary care takes time and dedication; however, the benefit of setting an animal up for success for future care is well worth the investment and effort. Case study: Bowser This example will focus on Bowser (not her real name), a large mixed-breed dog who exhibited fear aggression during care, including growling and lunging behavior in exam rooms with a veterinarian or RVT present. Bowser had orthopedic issues with her hip due to an injury and needed radiographs to determine progress. Due to previous examinations, which had involved forcible muzzling and forcible restraint, she had become very sensitized to veterinary visits and would growl and lunge when the veterinarian or RVT entered the room. This made sedation difficult. We took a multi-faceted approach to the desensitization and counterconditioning process, which involved the following in this order: 1) Muzzle training The owner was given instructions to desensitize the animal to wearing a muzzle. This was to be carried out initially at home, then generalized to different locations. 2) Touch gradient The owner was given instructions on how to desensitize Bowser to handling using touch gradient culminating in a pinch. The purpose was to desensitize and countercondition to intramuscular sedation. 3) Victory Visits with counterconditioning exercises Given Bowsers fear began when she approached the clinic doors, counterconditioning was combined with systematic desensitization and logistical management of veterinary visits. We started the counterconditioning process by entering the clinic during low-volume or off-peak hours and feeding high-value food reserved for clinic visits only. Once we exited the clinic, the food stopped. From there, we progressed to the exam room location, following the same process outlined above where the sedation would occur. 4) Victory Visits with RVT present When Bowser was able to enter the clinic and show neutral body language, we increased criteria to have the dog enter the clinic, visit an exam room, and have a RVT familiar with lower-stress protocols present. Again, counterconditioning following the above process took place during these visits. 5) Touch gradient by RVT Next, we upped criteria again, with the RVT performing touch gradient starting at the shoulder area, running her hand to lumbar area, and ending with a slight pinch following the verbal cue, “Poke.” High-value food was, again, offered during this procedure, though it is important to note we have, at this point, added a cue to warn the dog of the pinch. The goal was to be able to sedate the dog without restraint. The dog was muzzled for safety during these procedures. 6) Proceed Finally, when Bowser had been counterconditioned to feel comfortable with this level of handling with the RVT present and performing touch gradient, we went ahead with the inter-muscular injection to sedate. It was important to practice the procedure quite a bit prior to the sedation and ensure we had counterconditioned properly because, when it was time for the actual sedation, we would be unable to use food to distract. In the end, it was a very successful procedure, and the dog was able to have the radiographs done without stress. Conclusion Of course, owner compliance is essential to the preventative measures outlined above. Anecdotally, in the past 10 years, the animal community has seen a notable embrace of proactive training, with owners adding behavioral and socialization classes to the standard list of necessary care for their pets. Generally, trainers should have certification through recognized certifying associations, such as the Certification Council of Professional Dog Trainers, The International Association of Animal Behavior Consultants, or the Karen Pryor Academy. Further certification through Fear Free Pets or Low Stress Handling are also valuable. Each of these organizations provide searchable databases listing their certified members, which helps dog owners choose their trainers wisely. Beverley McKee, BA, CDBC, CPDT-KA, is the program manager, public training services and care support, at Toronto Humane Society, where she leads a team of animal trainers who provide behavior consultations and training services to the general public. She is a CDBC through the International Association of Animal Behavior Consultants (IAABC), and a CPDT-KA through the Certification Council for Professional Dog Trainers. She is also a Fear Free Certified Professional, holding an animal trainer certification through Fear Free Pets, a Fear Free Shelter graduate, and serves as secretary of IAABC’s board of directors. Resources Certification Council for Professional Dog Trainers: https://ccpdt.org International Association of Animal Behavior Consultants: https://m.iaabc.org Karen Pryor Academy: https://karenpryoracademy.com/dtf-vs-dtc-vs-dtp Fear Free Pets: https://fearfreepets.com Low Stress Handling University: https://lowstresshandling.com
