Fear Free Veterinary Visits
- You can watch our videos on Low Stress Veterinary Visits on our YouTube channel, BFVCTV.-
The veterinary hospital can be a scary place for a pet. Strange people, unfamiliar smells and noises, poking, prodding, and sometimes pain from procedures, all add up to a very frightening experience. Some cats are fearful of their transport carrier and some pets are afraid of car rides or become car sick. This means that many pets are fearful before their visit even starts! Simple things we don't think would be frightening for our pets can be perceived as such. For example, the rubber mat on the scale looks like a hole in the floor to a dog. Other dogs barking can be very intimidating, especially to cats. White coats or strange objects such as laser or anesthetic machines can be frightening. Noises that we don't notice, like beeping timers or a whirling centrifuge, may startle a pet.
Anxiety has Consequences
ANXIETY is the anticipation of danger - it's being worried about what will happen next. When anxiety occurs the body has what is termed a stress response, triggered by the release of stress hormones such as adrenaline and cortisol. FEAR is the next step above anxiety, and occurs when pets perceive that the danger they were anticipating is now upon them. It is the normal reaction of an animal faced with a situation that it perceives as dangerous. Signs of fear are usually more apparent than those of anxiety. TERROR is the most extreme sign of stress, when a pet is in full Fight or Flight mode.
An example of anxiety for a human is heading off to a checkup at the doctor or dentist office, which is not painful but not any fun either. Fear might happen if you were going in for surgery. You know it will be both scary and probably painful. Terror is how you would react if someone was coming at you with a gun or large knife to kill you. It's a much higher level of fear than we commonly experience.
It's easy to underestimate or discount a pet's fear. It's often our response to think that the pet should just "suck it up" because "it's not that bad" but we don't have the pet's perspective. The point is, we are not trying to kill our patients, but they may think we are. Most of our patients are nervous or fearful but a few probably believe they are going to die when they come here, they are that frightened. This is an unfair amount of fear to put a pet through, even if it's only once a year, plus it often gets worse over time. Eventually, it's dangerous for both the pet and the veterinary staff.
The STRESS RESPONSE is a normal and adaptive mechanism that prepares an animal for activity or defense, but it also has adverse consequences such as increasing heart rate, blood pressure and blood sugar. These are all things that we like to measure during a veterinary visit. The more stress, the less accurate our measurements are going to be. Long term stress, which can happen when a pet is hospitalized or boarding, has even more adverse consequences - inability to sleep, poor appetite, decreased immune function, risk for diarrhea, etc.
Our goal is to minimize the stress response and to reduce it whenever possible, preferably avoiding the Fear and Terror stages altogether. This means we have to address anxiety early so it doesn't progress to a more severe response. Anxiety itself can often be reduced so veterinary visits are more pleasant. We tend to take it for granted that our pets are frightened at the vet but it doesn't have to be that way.
So How Do I Know if My Pet is Anxious or Stressed?
Your pet may be more frightened than you realize. Most people are familiar with at least some of the behaviors that indicate a dog or cat may be stressed or frightened; shivering, cowering, hiding - we all understand those. But many times people miss more subtle cues of anxiety, like yawning, lip licking or leaning backwards in dogs, or tucking the front paws underneath themselves in cats. Looking or moving away, a wrinkled forehead with ears to the side and refusal to take treats are other signs.
There are four basic ways in which animals behave when stressed or afraid. These are FIGHT, FLIGHT, FREEZE and FIDGET.
FIGHTING includes growling, hissing, biting and other aggressive behaviors. Cats are more likely than dogs to try and defend themselves from unwanted handling by becoming aggressive.
FLEEING is when the dog or cat tries to get away from us. Digging or chewing in a carrier or at cage bars or the floor of an enclosure are also attempts at fleeing.
Dogs are likely to FIDGET when anxious, including yawning, lip licking, pacing, panting, getting up and down, or nudging their owners. If you see your dog yawning in the waiting area that's a clear sign of anxiety.
Cats are more likely to FREEZE but some dogs do this, too, where they hold rigidly still or stiff with their pupils dilated. Cats may lie in what's called the "meatloaf position" with their front paws curled protectively underneath them. Freezing also includes walking in slow motion.
About 75% of dogs and cats show at least a couple of these signs when they visit the veterinarian. Sometimes this is situational - for example, a dog is fine until lifted on to the exam table and then he gets scared. Be alert to the signs so we can address the fear.
Once you know what to watch for and you see that your pet is stressed, what can be done?
We use lots of treat rewards, praise and petting. We try not to use what we label in veterinary medicine as "brutacaine," where you get a procedure done by brute force. We would much rather bribe a dog with peanut butter or cheese whiz to trim the nails than need 3 people piled on top of the frightened, struggling animal to hold it down.
We use pheromones a lot nowadays. Adaptil contains a pheromone that smells like a mother dog when she is nursing puppies. It'a a comforting, reassuring smell to a dog, whether or not they actually remember nursing from their mother. Wearing a bandanna sprayed with Adaptil during a veterinary visit can keep a dog much more calm and relaxed. The doctors and techs can spray Adaptil on our lab coats so we can smell calming to our patients. We also have diffusers in the exam rooms and kennel areas that release Adaptil into the air.
For cats, the equivalent product is called Feliway. Not only do we use it here in the hospital but there are two different formulations for use at home, pone that helps with litter box avoidance and the other with intercat aggression. Pheromones also come in collar so the anxious pet can wear the smell all the time if needed, say for separation anxiety or thunderstorms in summer.
Another product that we recommend is the Thundershirt. Thundershirts, and similar products, squeeze dogs like a hug, which relaxes them. Similar wraps are used for autistic children to help calm and settle them. The pressure of a wrap like this stimulates the release of endorphins. Not only are Thundershirts good for thunderstorms, they work here in the hospital as well. Some cats do well with Thundershirts as well but the effect isn't as predictable in cats as it is in dogs.
If these easy options are not enough, It's time for something stronger. An anxious or fearful animal should be treated as early as possible. Fear is accompanied by physiological signs such as trembling, excessive salivation, high heart rate and respiratory rate, panting, piloerection (the hair standing up along the back), or submissive urination and defecation. If you see any of these, your pet would benefit from medication.
When a pet has a persistent and excessive fear in the face of a specific stimulus that may not present a real threat, that's called a PHOBIA. Animals can develop phobia's to loud noises (thunderstorms or fireworks), specific situations (car rides). to certain individuals (small children, veterinarians or groomers) and other animals. Coming here can be a big phobia for dogs and cats.
Each fearful event that does not have a positive outcome is likely to lead to a worsening of the problem. Over time, if the event is not as bad as the animal feared, anxiety can lessen. If the experience is as bad or worse, the anxiety can progress to fear and then to phobia, which is no fun for anybody, least of all your pet. No human or dug should have to be that traumatized if there is a way we can prevent it.
Clients are often hesitant to give their pets prescription antianxiety medication but the risk of problems from these drugs is very low. We want to give your dog or cat the medication he or she needs in order to have a reasonably calm and quiet visit, with less stress for everyone involved. Fear and stress affect the immune system, blood pressures, blood sugar and the mental health of your pet. The danger is not in giving your pet the medication but rather from fear behavior, which can injure the pet, our staff or you. To us, it also seems cruel to let pets be so scared when we could do something about it.
For cats, we usually use Gabapentin as our anxiety medication. Most cats will take it mixed in canned cat food, especially when something else tasty, like FortiFlora, is mixed with it. We have you pick up the medication ahead of time so you can administer a dose the day before your appointment and another the day of the appointment. FortiFlora is a probiotic that not only tastes good but helps to prevent the GI upset that can accompany fear.
There are several medications we can use for anxious dogs. It often takes us a few tries to find a medication and dose that works best for a particular dog but once we do, visits tend to go much more smoothly. Trazadone is the one we use most commonly. Fearful dogs should be given the medication about 2 hours before their appointment in order to have it working by the time they arrive. Dogs may also benefit from probiotics like FortiFlora.
Pets that suffer from car sickness can get antinausea medication before traveling along with antianxiety medication.
Can Anxiety be Prevented?
When puppies and kittens come in to see us, we work especially hard to make their first visits fun and not scary. What they learn as youngsters will stay with them for the rest of their lives and we want them off to a good start. We snuggle them, give them baby food, carry them around and try not to have them feel the poke of the needle when we vaccinate them - it's amazing how they won't notice an injection as long as they are eating a tasty treat!
Socializing your puppy or kitten to people, other pets and different situations is very important. Puppies who have fun attending our puppy preschool classes love coming here for the rest of their lives and that is what we aim for - dogs who are happy here instead of being frightened. The more people a young puppy or kitten meets, the more relaxed he will be around humans all his life. So, youngsters should get lots and lots of socialization to other people.
It's helpful if we can tour a dog around to get used to the kennel area and the equipment. Just bringing a pet in and sitting quietly in the waiting area or exam room and then leaving without anything scary happening can be helpful. We are always happy to work with you and your pet at a quiet time to introduce unfamiliar items.
Your prep work ahead of time can also make a big difference. The more you handle the feet and toes of puppies and kittens the less they will struggle when it's time to trim the toenails or treat a foot wound. Getting your dog or cat used to having the ears and mouth handled means examining those areas will be easier in the future.
Here are some things you can do to make veterinary visits less frightening for...
1.) Know the signs of anxiety so you can address the issue
2.) Let us give him lots of treats. Bring along any he particularly likes.
3.) Use an Adaptil bandana.
4.) Try a Thundershirt - we have them at the front desk for your dog to wear while he is here.
5.) Bring your pet in for happy visits, where nothing bad happens.
6.) Enroll your puppy in a socialization class and make sure he or she meets as many people as possible between 6 and 12 weeks of age.
7.) Between 12 and 15 weeks of age, introduce other puppies and calm adult dogs.
8.) Try some over-the-counter antianxiety remedies, such as melatonin.
9.) If your pet is still anxious, go for the big guns and let us use prescription medication. We can't stress this enough - your pet doesn't have to be afraid!
10.) Be patient if our first try isn't successful and we have to try a different drug.
1.) Think ahead. Cats should be accustomed to carriers and car rides before they are needed.
2.) Use pheromones. Feliway applied to the carrier or bedding makes cats feel more secure.
3.) Play soothing music in the car.
4.) Limit food before your visit so your cat is hungry and more likely to take treats from us (and also less likely to vomit on the way here).
5.) Let us know if you have problems getting your cat into the carrier, with car rides or with any other stressful aspect of your visit so we can help.
6.) Don't put your cat carrier on the floor, keep it up on a bench or table while you are here, and don't let your cat see strange dogs.
7.) Let us know if your cat has preferences as far as restraint or handling. We may experiment a little bit to see what works the best.
8.) Cats often feel less frightened if they are hiding, so keep the carrier covered with a towel or blanket. We often cover a cat's head with a towel during our examination or procedures as well.
9.) Use anxiety medications when needed. We can't stress this enough - your pet doesn't have to be afraid!
10.) Be patient if our first try isn't successful and we have to try a different drug.
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