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Managing Patients with High Fear, Anxiety, and Stress: Navigating Roadblocks

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Two of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

You see a historically high FAS dog on your schedule for planned sedation and feel confident in your plan. The client has done a great job with positive basket muzzle training and administering PVPs as directed, and while the PVPs don’t really seem to have had much of an effect, surely the sedation you just gave will help her feel calmer. So, you wait. And wait. No effect. Did you miscalculate your doses?

Unfortunately, despite all your careful planning, you will encounter some hurdles when managing high FAS patients, particularly during procedures that are more painful or aversive. Here are some tips on circumventing roadblocks during Fear Free care:

Re-evaluate wants vs. needs. It’s easy to lose sight of this Fear Free fundamental when you’re in the middle of handling a pet, especially since vet professionals tend to be very goal-oriented. When a patient’s FAS escalates, take a mental step back and ask yourself whether your current task is truly medically necessary for that pet at that moment. With a Fear Free approach, much of what we do in general practice is considered a want, not a need. Making the ethical call to stop before you cause further emotional damage to that pet can be difficult, but it’s amazing how much further you get when non-urgent concerns are deferred for a follow-up visit.
Reassess your analgesia and decide if sedation or anesthesia is more appropriate. Sometimes we underestimate the level of pain caused by procedures we want to accomplish. When a high FAS pet escalates from pain, upgrading to stronger analgesics such as a full mu opioid or engaging multimodal pain relief can help bring FAS back down. However, in some pets this will be inadequate, and stepping up to sedation or even general anesthesia may be needed. One high FAS dog I saw would take treats readily during the initial visit, but would try to bite whenever I tried to examine the area of matted hair on his rear leg. He was rescheduled to come back the next day, but PVPs, analgesics, initial sedation attempts, and adding on more sedation medications didn’t touch him. He finally ended up needing general anesthesia, and what I thought was a matted hotspot was actually a several cm region of semi-necrotic tissue that was much more painful and inflamed than I ever could have guessed.
Teamwork makes the dream work! When interacting with a high FAS pet, think of your team outside of the vet clinic as well, particularly if you encounter a roadblock. I’m eternally grateful for the veterinary behaviorists, in-home providers, positive trainers, behavior consultants, groomers, and pet sitters in my area. Establishing a referral network of ethically aligned pet and vet professionals will help that pet receive the care they deserve throughout their life, while also making your job easier. For example, since most vet clinics don’t have trainers on staff, I routinely refer to reward-based trainers to help with skills that can reduce FAS during vet visits such as reducing arousal around other dogs: desensitization and counterconditioning to restraint, basket muzzles, nail trims, injections, Elizabethan collars, going into carriers; and training for veterinary cooperative care. And if you aren’t lucky enough to have veterinary behaviorists in your area for direct patient referral, many provide virtual behavior consulting with other vets to help manage challenging patients.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for fear free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Continue learning about managing patients with high FAS through Part One, Part Three & Part Four of this series.

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Resources

Managing Patients with High Fear, Anxiety, and Stress: A Guide to Effective Handling

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part One of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

At least once a day, I see a high FAS patient. While I don’t always know their detailed backstory, the alerts on their patient files are like a roadmap to how they got there, as a “wiggly” puppy transforms into an adolescent that “may urinate” to a 3-year-old who’s a “CAUTION, WILL BITE!!!” Some days it seems like every pet has an FAS score of 4 or 5, and for Fear Free Certified Professionals, those days can be both emotionally and physically exhausting. It’s even more disheartening when we encounter ethical quandaries such as a pet parent who’s not on board with our Fear Free plan for their highly stressed pet. These situations are common, and according to psychotherapist and compassion fatigue expert Dr. Elizabeth Strand, moral stress is the number-one contributor to compassion fatigue in vet med¹.

So what do we do with these high FAS patients? How do we care for their emotional and physical wellness, while also caring for our own wellbeing and balancing the needs of the pet parent? Flexibility, communication, and supporting the Fear Free team culture are key to approaching these challenging cases.

After becoming Fear Free certified, I started realizing that a patient would be a lot less stressed if I approached the interaction like jazz–with a general sense of where it might go, but incorporating improvisation and responding to what the pet was communicating at that moment. This may mean giving the pet a brief break during handling to allow de-escalation, or even backing off completely on what I was originally trying to accomplish. Fear Free handling is a dialogue, not a monologue. When handling a patient with high FAS, a few other guiding principles can help:

Location, location, location. When handling any pet, try to choose the area where the pet prefers to be and is most comfortable. There are multiple places where a pet can be handled other than an exam table, such as the floor, on a lap, on the bench, or in the bottom of their cat carrier. In general, many pets with high FAS also do better with the owner present.
Give every pet a sense of choice and control where possible. Encourage voluntary movement by calling the pet using a happy voice, asking the owner to call them over, or luring them to move of their own free will with a treat or toy. Many dogs also know cues for sit and down, so instead of pushing a dog’s rear end down and pulling their legs out to get them sternal, ask or lure the dog to a sit and down. Respect the cat’s choice to stay in the carrier and access them by removing the top of the carrier and covering them with a towel to facilitate hiding. When restraining a pet, especially a high FAS pet, allowing them to stay in the position they prefer goes miles toward keeping them calm, whether it’s allowing a dog to stand instead of sit for a jugular draw or allowing a cat’s front end to remain sternal instead of forcing them into full lateral to reach the medial saphenous.
Less is more. Use the minimum number of people needed and the least amount of restraint needed while staying safe. The more hands on a pet and the more people crowded around them, the more likely they are to become stressed.
Prevent and treat for pain. Pain contributes to FAS and vice versa, and as mentioned in a 2022 Fear Free roundtable³, pain and fear are “two sides of the same coin.” Dull needles also hurt more, so try to make it common practice during sample collection to not reuse needles. During unsuccessful blood draws, I often see people pulling the needle out of a pet’s skin, re-palpating the vein, and then pushing that same, microscopically shredded needle back into that pet’s skin for a second or third attempt as the pet gets more and more stressed.
Sedate early, not as a last resort. With many high FAS pets, you will often reach a limit for what PVPs can accomplish. Injectable sedation may be the best way to help minimize FAS. Sedating earlier when the patient is calmer will be safer for the pet and likely allow you to use lower doses of anesthetic drugs. Familiarizing yourself with Fear Free in-clinic sedation protocols, lowering the charge for sedation to get client buy-in ($70 is more palatable than $140), and getting staff members comfortable with sedation/monitoring will also prove invaluable. Another way to approach stressful procedures for high FAS pets is to tack them onto an already-scheduled procedure involving general anesthesia. Depending on the patient’s needs, these could include shaving a matted cat, microchipping, trimming or dremeling nails, performing a cystocentesis, aspirating a growth in a sensitive location, expressing anal glands, or performing an orthopedic exam/radiographs. For more info on Fear Free in-clinic sedation, check out Fear Free Level 1 module 7b⁸, Fear Free Level 3 module 1⁹, and these other Fear Free resources^{10, 11, 12, 13}.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Continue learning about managing patients with high FAS through Part Two, Part Three & Part Four of this series.

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Resources

Improve Wound Healing and Patient Recovery

By Dr. Natalie Marks, DVM, CVJ, Elite FFCPAs a practicing veterinarian and previous practice owner for more than two decades, I’ve witnessed quite a bit of evolution within our industry. There continue to be advances in diagnostic technologies, telemedicine, novel therapeutics for dermatology and osteoarthritis, and a dramatic shift from independent practice ownership to corporatization. However, one of the most important discoveries and initiatives has been the concept of Fear Free, the initiative dedicated to the physical and emotional health of our patients and clients through the reduction of fear, anxiety, and stress.

However, Fear Free is, and can be, more. It is a lifestyle and guide on how to practice and manage and educate. Client trust and compliance is key to a successful veterinary-client-patient relationship, and that’s difficult to achieve when fear, anxiety, and stress surround exam room interactions and associated communications. This is never more evident than when trying to manage wound care. The aftercare associated with an incision, a laceration repair, a skin lesion, or a superficial burn can be extensive and complicated, often with multiple medications, bandage care, an Elizabethan collar, and an incredibly stressed patient and pet parent. This negatively affects patient care and the veterinary team as frustrated pet parents call and email frequently, taking veterinary professionals away from patient care in hospital.

There’s now a single solution for improved wound healing for patients, reduction of the home care burden for pet parents, and preservation of emotional health for patient, pet parent, and the veterinary health care team. KeraVet® Gel is a first-of-its-kind wound care product. As a scientist, safety and efficacy of any new product is top of mind. I’ve been impressed with the initial studies with this product, which has a keratin-based patent-protected technology to promote a moist wound environment and barrier to the environment as well as a bitterant to deter licking behavior, enabling us to send a patient home without that collar that so often leads to increased stress for both the patient and our client. That said, it is important to note that there can be a risk to the human-animal bond when we frequently apply something to our pets that tastes unpleasant, and for some pets that can be more stressful than protective clothing, bandages, or an Elizabethan collar. Each animal is an individual and their needs should be taken into account when deciding on the best solution for wound healing.

In the right circumstances, though, this product can be a game changer. One of the tenets I lived by as a practice owner was “best medicine leads to best business.” Our clients want to see the value in the care they are investing in, that it’s convenient and safe, and that it addresses their family member’s physical and emotional health. When we choose to use KeraVet® gel, we give our clients a single effective solution addressing both of their needs, thus building trust and compliance, and strengthening the human-animal bond. These are the clients who return and refer and stay lifelong members of our hospitals.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Natalie Marks is a veterinarian, consultant, educator, media expert, an advisor for KeraVet Bio, on the Executive Committee of VANE (Veterinary Angel Network), and an Elite Fear Free Certified Professional. She is passionate about working with colleagues and mentees and moving the needle forward with innovation with companies like KeraVet Bio. Learn more about Dr. Marks at marksdvmconsulting.com and KeraVet Bio at https://keravetbio.com/

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Addressing High FAS About Switching to Cloud-Based Veterinary Software

By Shepherd Veterinary Software

Fear, anxiety, and stress (FAS) are not exclusive to our veterinary patients. For some practice owners, the mere thought of switching to a cloud-based software triggers a similar negative spiral. Fear of change can prevent them from appreciating how a serverless system could optimize their workflow and support future practice growth.

Like any fear, apprehension about changing software is best conquered with knowledge. Let Shepherd Veterinary Software address the most common fears and stressors. Learn about the comfort and peace of mind that comes with being in the cloud.

Fear: Data migration will be an enormous hassle

This is perhaps the biggest concern among veterinary practice owners and managers—for good reason. In the past, transferring inventory and patient records was painstakingly inefficient, not only because of data loss during the transfer, but also due to the financial loss from closing the practice during the process.

Reality: Modern cloud-based veterinary practice management systems (PIMS) such as Shepherd Veterinary Software provide step-by-step assistance that streamlines the data migration process. Shepherd’s experienced team understands the implications of switching from server to cloud-based software and provides a wealth of resources and advice to ease the transition and help you anticipate and minimize potential challenges.

Anxiety: My team will struggle to learn the new system and be less productive

No matter how inefficient or frustrating your current PIMS, most team members will find switching to a new, entirely unfamiliar software daunting.

Reality: Modern software options have intuitive, user-friendly designs that reduce errors and increase productivity for all skill levels. With the help of self-paced training modules, ongoing software support, and skill-building resources, most veterinary staff can feel confident using a new PIMS like Shepherd in as little as a few hours. And, if the team hits a snag during the learning process, Shepherd’s support team is only a call or click away.

Stress: My practice data will not be secure stored in the cloud

When it comes to practice data, on-site servers can provide practice owners with false peace of mind. A physical unit in your clinic or hospital may feel well protected, but server-based PIMS are often more vulnerable to cyber attacks and malware, not to mention physical threats such as fire and water damage.

Reality: Remote cloud-based storage safeguards your practice’s data through expert monitoring that will identify and address any threat. Automatic security updates and patches keep the system one step ahead of hackers and cyber threats, and automatic syncing ensures access to the latest patient and practice information. There’s also no costly downtime waiting for IT or the release of a system-wide update.

Fear: The benefits won’t be worth the effort

Cloud-based veterinary software is a significant investment of a practice’s finances and resources. It’s only natural to question its proposed benefits and value.

Reality: As veterinary teams quickly discover, serverless software delivers powerful, game-changing advantages that extend beyond practice management to elevate patient care, enhance the client experience, and shape future growth.

Improved accuracy — Automated charge capture ensures consistency across all documents, including the patient chart, estimate, and invoice.
Increased revenue — Smooth workflows and quick-fill SOAPs mean you can fit in more appointments and care for more patients without staying late.
Easier oversight and case management — Remote access allows you to view the practice dashboard, inventory, and patient records from any location with an internet connection.
More time to spend with patients and clients — Automated features and powerful integrations eliminate the need for time-consuming repetitive tasks so you can focus on patient care.
Stronger client relationships — Enhanced communication tools, such as messaging and pet portals, help develop the veterinarian-client-patient bond.
Better job satisfaction — Increased efficiency and smooth workflow put the joy back in veterinary medicine, resulting in a healthier practice culture.

Anxiety: Team members fear that remote access will blur the work-home boundary

Many professionals have discovered that working remotely has an unexpected downside—an “always available” mentality that erodes the work-home life boundary. As a result, some practice owners and veterinary team members may hesitate to embrace remotely accessible cloud-based PIMS. They fear that because of the flexible software, they will be pressured to always be available.

Reality: Remote access can re-envision rather than add to the workload. It allows veterinarians and practice leaders to check in on daily operations, review the schedule, answer questions about a specific case, and take much-needed breaks without losing touch—or control—of the practice.

Stress: Clients won’t understand the change, especially if service is disrupted

Successful software transitions rely on careful planning. It’s important to notify clients as early as possible about anticipated schedule changes or closures. Instead of explaining that your practice is “changing software,” talk in terms of client benefits (e.g., better communication, reduced wait times, simplified check-in).

Reality: This change can build excitement! Upgrading your software demonstrates your practice’s commitment to exceptional client and patient service. With the right approach, you can help anxious clients understand that the temporary inconvenience will result in long-term gain.

Change is never easy, but the transition to cloud-based software is nothing to fear. Discover how veterinarian-designed Shepherd Veterinary Software can elevate your practice’s performance, increase efficiency, and help you rediscover the joy of veterinary medicine. Contact the Shepherd team to schedule a personalized demo and let your software-switching fears float away in the cloud.

How to Make Exam Rooms Fear Free and Friendly for Cats

Julie Liu, DVMSeveral years ago, when I was still a staff vet, I would routinely walk into the doctors’ office in the morning to see one of my associate-mates typing away at her computer with the overhead light turned off. The exterior wall to the office was a large window that faced east so there was always some early morning light coming through, but still, I didn’t get it. Wasn’t it always better to have more light? Why toil away in the dark like a cave creature?

After a few mornings, I started getting used to only having natural light in the office and noticed that I felt a lot calmer. If another doctor turned the light on, it felt way too bright and jarring. I realized that something as simple as decreasing the intensity of the light source in my environment could magically decrease my stress levels without me even noticing.

When it comes to our feline patients, many of the surroundings in a vet hospital can seem similarly disruptive, and may even lead to fear, anxiety, and stress (FAS). By reimagining the veterinary environment and catering to the feline senses, we can promote relaxation and a less stressful experience for both cats and humans. Here are some simple, budget-friendly tips for creating Fear Free feline exam rooms.

Provide a Safe Place

In 2022, the AAFP/ ISFM released an update of their guidelines for a Cat Friendly Veterinary Environment, in which they reference the 5 Pillars of a Healthy Feline Environment. While you may not be able to achieve all 5 Pillars in every exam room, being mindful of them will go a long way towards keeping your feline patients calm.

Pillar 1, “Provide a Safe Place”, is paramount. So what makes cats feel safe? When cats are experiencing FAS, hiding becomes a major way in which they cope. Think of all of those patients you’ve seen hiding under their bedding or overturned litterbox in the treatment area, or hiding under a chair in the exam room–they’re trying to cope with the stress of being in a scary place. Ensuring that every exam room is stocked with towels and a cat bed with high sides will facilitate hiding and comfort during the visit. You can even go next level and place a towel warmer outside the exam rooms. The thermoneutral zone for cats is 86-100.4℉ (30-38°C), so grabbing a warm towel as you’re heading in will allow your feline patient to feel even cozier.

Cats also feel safer when they can be elevated. If the cat chooses to explore the exam room, non-slip cat shelves, perches, and cat cubby holes mounted onto the wall will allow them to survey their surroundings from a height while also remaining hidden. Just ensure that any cubby can be opened easily to access the patient for their exam, as removing a cat from their “safe” place will increase FAS. Along the same lines, if budget allows, replace any exam room chairs with a bench that extends to the floor so cats don’t have to be pulled out from their hiding spot when it’s time for handling.

It can also take several minutes for cats to acclimate to a new area, so if you’re taking all feline appointments to “the back” where it’s noisy and full of dogs to collect samples, expect their FAS levels to escalate. Instead, treat each exam room like a private, “safe” treatment area for that kitty and stock it appropriately with everything you might need for samples: tubes, syringes, smaller gauge needles, butterfly catheters, slides, and EMLA cream to reduce the pain of needle pokes. If your team members aren’t comfortable collecting samples in front of the cat parent, I’ve found that most clients are more than willing to hang out in the waiting area and drink a coffee or play on their phones until you’re done.

Considerate Approach

As Fear Free professionals, we should always use Considerate Approach with our patients, which means we want to consider how our felines are experiencing their environment during care.

Touch. Exam tables are slippery, cold, and uncomfortable. To provide stability and extra warmth, ensure all exam tables have a non-slip surface such as a yoga mat to act as a base under your warm towel. Every room should also have a non-tippable cat scale with a non-slip surface, which could be a Feliway-sprayed towel that you “tare” prior to weighing the cat.
Taste. Does your clinic have treats for dogs, but not cats? While many cats will be too fearful to eat treats, others can readily be distracted by catnip, Temptations, Churu, squeeze cheese, tuna, whipped cream, and other delicious snacks during interactions. Also be mindful of taste the next time you’re dousing your feline patients with alcohol to collect samples–unless you wipe the alcohol off of their fur with a damp washcloth, you’re contributing to their negative experience when they groom themselves after the visit. Consider using water instead of alcohol.
Visual. Photorealistic depictions of cats or other animals may cause cats to react, so abstract art often works best. If you’re lucky enough to have a quiet exam room with a window, consider making that a feline-only room. Many cats will explore the room and gaze outside during a visit, which works great as a distractor. Cats are also better able to see in lower light than people, so try installing a dimmer switch to decrease the light intensity.
Auditory. Vet clinics are loud. Dental scalers, cage doors slamming, and dogs barking can significantly increase FAS during a feline visit. Installing soft closers on cabinets and doors and hanging a “Shhh….feline appointment in progress!” sign on the treatment area side of the door will remind team members to use their inside voices and keep environmental noises low. You can also hook a speaker up to the exam room computer and play soft, cat-specific music. A 2019 study published by the Journal of Feline Medicine and Surgery found that cats listening to cat-specific music in a veterinary clinical setting had lower cat stress scores and lower mean handling scale scores than cats that were exposed to silence or classical music.
Olfactory. Pets leave behind lots of scents during visits, and smelling them may increase FAS, particularly if a dog was just in that room. Having a cat-specific exam room helps prevent olfactory stressors, and Rescue will allow you to disinfect and remove traces of the previous patient while minimizing harsh smells from scented cleaners.
Pheromonal. When your cat rubs their cheek against your leg or the furniture, they’re depositing the feline facial pheromone that marks an area as “safe”. Feliway Classic mimics this pheromone and comes in user-friendly diffusers that can be plugged into every exam room. You can also pre-spritz your scrubs at the beginning and middle of each shift and room towels with Feliway spray at least 15 minutes before your first appointment, then reload for afternoon kitties since it wears off in four to five hours. Don’t forget to label your diffuser with some client education so cat parents see the Fear Free value.

The exam room can be a scary place for many cats, causing them to experience FAS even before handling. Adding some Fear Free tools and considering the feline senses will help turn your exam rooms into kitty havens.

Resources

https://fearfreepets.com/cat-friendly-exam-room/#:~:text=Avoid%20chairs%20cats%20can%20get,Choose%20light%20colors

https://fearfreepets.com/top-10-treats/

https://fearfreepets.com/helping-our-feline-friends-feel-fear-free-with-dr-tony-buffington/

https://fearfreepets.com/providing-the-optimum-environment-for-cats/

https://fearfreepets.com/creating-a-comfortable-environment-in-the-clinic/

JFMS: https://journals.sagepub.com/doi/full/10.1177/1098612X221128763

JFMS: https://journals.sagepub.com/doi/10.1177/1098612X19828131

Cat music: https://www.youtube.com/watch?v=vGyElqvALbY

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Words Count: The Language of Fear Free

Julie Liu, DVMLast year, I watched a great webinar on Fear Free Pets by Dr. Tony Buffington called “Helping Our Feline Friends Feel Fear Free.” He shared a number of helpful tips on helping reduce stress for feline patients, but one of the points he made really resonated with me. He talked about going to an exhibit hall at a conference and seeing a booth selling signs that can be clipped onto the front of the cage, including a red sign that said, “Caution, fractious cat.” He asked if there were any signs that said “Caution, fearful cat,” because when he saw “fractious cat” his instinct would be to take care of himself to prevent injury, whereas if he saw “fearful cat” his instinct would be to take care of the cat.

Based on that conversation the company started making “fearful cat” signs, but it got me thinking about the language of Fear Free and the terms I routinely hear vet professionals use for pets exhibiting FAS (fear, anxiety, and stress): “fractious,” “angry,” “spicy,” “CAUTION!!!”, and of course, a variety of R-rated terms used only in the treatment area. And I totally get it. No one wants to get bitten, scratched, snapped at, or injured, and it seems like these terms will keep us safer when approaching stressed patients. So why could this language be problematic?

Well, I’ve noticed that when there’s a patient alert such as “fractious” for a cat, people tend to approach the pet in an adversarial way. They put on their cat gloves, take a deep breath, and go into the exam room ready to do battle with their patient, which usually includes scruffing the cat to immobilize them. Unfortunately, this approach often has the opposite desired effect. Cat gloves can cause fear in patients, and scruffing is painful and takes away the cat’s sense of control. The “fractious” cat’s FAS levels then escalate, which increases the chances of getting injured.

Changing our language so that it describes and advocates for the emotional health of the patient can keep us safer. Instead of “fractious,” what about, “Fearful, keep in carrier until doctor is ready, prefers hiding under towel for exam and vax”? It’s rare to see these types of patient alerts, yet they take only a few seconds to update in a medical record.

Terms like “fractious,” “angry,” and “&#%!@” also shut down the empathy we should strive to bring to our patients, both feline and canine, and joking that a pet is “spicy” trivializes their emotional experience. Instead, see how it feels when you use patient-focused language such as “fearful,” “anxious,” and “stressed.” Just as most of us felt at least one of these emotions during the pandemic (or even all three at the same time), most of your patients are feeling at least one of these emotions during their vet visit. In fact, many of these “spicy” patients are utterly terrified and completely justified in their emotions considering all of the scary things they experience at the vet. Using terms like “fearful” and “anxious” also contributes to a Fear Free culture and sets the tone for how we’d like fellow team members to approach their patients–with empathy, not as adversaries.

As Fear Free professionals, we have the tools to identify, prevent, and alleviate FAS. Modeling Fear Free language is another important step we can take to bring compassion to the patients in our care.

Resources

https://fearfreepets.com/helping-our-feline-friends-feel-fear-free-with-dr-tony-buffington/

FAS Spectrum Handouts

https://serona.vet/collections/cage-tags-signs?page=1

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Taking Cats to the Back: What the Science Says

Christie Keith
Are pets calmer and less stressed without their owners present during veterinary exams? A recent study partially funded by Fear Free sheds some light on this often-controversial subject.

There’s a lot of disagreement among veterinary professionals on how to interpret the emotional cues displayed by pets when removed from their owners. Many pet parents also object to having their pets taken away to a treatment area. While this practice was extremely common during the COVID pandemic, it was a normal part of many veterinary visits before lockdown became a household word and continues to be today as well.

The reason many veterinary team members offer for the practice is that pets seem calmer and easier to handle when separated from their owners. Others say this isn’t because their fear, anxiety, and stress (FAS) are reduced but because the pet is shutting down out of fear and/or in a state of learned helplessness. What exactly is the effect of separation from owners and transport to a different room during a veterinary visit on a pet’s FAS?

In a study published in the Journal of Feline Medicine and Surgery, researchers conducted a prospective non-blinded randomized two-period two-treatment crossover trial with 21 healthy adult cats. Each cat received an initial examination with their owner present to establish a baseline, and then they were divided into two groups. The cats were chosen from patients of a university veterinary teaching hospital’s wellness and dental care service and had previously been seen without any history of needing “undue restraint,” sedation, or anxiolytics to be examined.

The first group of cats received an examination in a treatment area without their owner, and the second received an examination in an exam room with their owner present. The actual order of the exam itself was randomized, and handling techniques described as “low-stress” were utilized. All veterinary team members had completed Fear Free certification to standardize handling and assessment.

The examining veterinarians recorded heart rate (HR) as measured by auscultation and also established a FAS score for each cat. The baseline HR for cats in the study averaged 176 beats per minute (BPM). For cats examined in the treatment area without their owners, mean HR was 226 bpm and 195 when measured in the exam room with owners present.

The most frequent values when measuring FAS scores were 3 at baseline (moderate stress), 4 in the exam room with owner present, and 5 in the treatment area without owner.

The authors wrote, “Results from this study indicate that minimizing transfer between examination areas and including the owner during wellness examinations can reduce some of the more overt signs of stress in cats during clinic visits. The data also suggest more proactive owner education measures may be of benefit, such as methods of owner habituation of their pet for transport and handling ahead of scheduled clinic visits.”

Note: This study was partially funded by Fear Free, which had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Christie Keith is a journalist, editor, and communications consultant with an exclusive
focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate
and Elite Fear Free Certified professional.

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Fear Free Grooming Strengthens Relationships with Pets and People

By Elsebeth DeBiaseLearning to groom pets is a challenge. At first, the focus is on mastering equipment, proper trims, and avoiding a bite or nicking an animal. Great workdays for a groomer are filled with cold noses and friendly tail wags. So, what do bad days look like? Hard grooming days look different for everyone, but for me, explaining to an owner that I can’t groom their pet due to behavior is the worst. As a veteran groomer of over 20 years and a graduate of the Animal and Veterinary Sciences program at the University of Maine, Orono, I have always been committed to providing the highest quality grooming services possible with the help of industry continuing education. When the Fear Free Groomer Certification Program was released, I jumped at the chance to be Maine’s first Fear Free Certified Groomer. Fear Free planted a seed that changed my approach to the business of pet grooming. Fear Free enabled me to help more pets who were apprehensive of the professional grooming environment by focusing on the animal’s emotional well-being and forging good groomer-client relationships.

Necessary, but Never Urgent

Pet grooming provides many physical benefits to pets, including healthier skin and coat, shorter nails, and overall cleanliness. Pets and owners have more quality interactions when pets are regularly groomed and feel good. I am a firm believer that grooming enhances the canine-human bond. However, grooming is never urgent enough to sacrifice a pet’s emotional well-being. Sometimes groomers, myself included, feel pressure to do a perfect trim, but this is not always practical or possible. Often, pets require comfort grooms focusing on sanitary issues rather than esthetics; this is especially true of young and old pets. Nevertheless, it is critically important that the pet owner is on board with a pet professional’s care plan.

Individualized Care Plans

Fear Free gives pet professionals the tools to constructively advocate for pets experiencing fear, anxiety, and stress. By incorporating Fear Free practices into my grooming business, I was able to educate clients regarding fear, anxiety, and stress in pets and confidently manage client expectations. As a Fear Free Certified Groomer, I can skillfully demonstrate to a client the need for an individualized approach to grooming their pet, thus reassuring them the pet is in good hands. I have built long-lasting relationships with my clients using Fear Free principles and a sincere desire to help. Additionally, Fear Free techniques are most successful when I actively encourage owners to participate; after all, Fear Free starts in the home.

The Fear Free Difference

Fear Free is a mindset encompassing knowledge, skill, integrity, and compassion backed by behavioral science. Fear Free values helped me develop my pet care philosophy: helping every owner will help every pet. As a result, veterinarians, groomers, local business owners, and clients often refer potential customers to me. I have gained many wonderful customers this way, and I encourage all groomers to continue their education with Fear Free.

Lastly, Fear Free practices are rewarding and fun. There is no better feeling than helping a struggling pet succeed. When it comes to grooming, you can’t always do the “good dogs,” but why can’t all dogs be good with an individualized approach? The answer is they can.

Bio

Elsebeth DeBiase is an award-winning IPG Certified Master Groomer with 22 years of experience in the pet industry. As a graduate of the University of Maine Department of Animal Sciences, she has an understanding of the animal industry that encompasses farm, veterinary, and pet industries alike. In 2011, Elsebeth opened Coastal Creations Pet Salon with the goal of providing individualized services to her four-legged clients while utilizing state-of-the-art equipment, compassionate handling methods, and modern styling techniques. Her specialties include small dogs, cats, and disabled and senior pets. Elsebeth is Fear Free and Low-Stress Handling Certified. She recently completed the Canine Arthritis Management (CAM) training for pet professionals to help raise awareness of the symptoms and prevalence of canine osteoarthritis.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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5 Steps to Heartworm Disease Awareness

By Jennifer Merlo, DVM, CVBMC, Fear Free Director of Veterinary AffairsWe mention heartworm prevention to pet parents during almost every veterinary visit. So how is it that more than 1 million pets in the United States have heartworm disease¹? American Heartworm Society (AHS) study data collected in 2022 shows that rates of heartworm disease continue to trend upward in both recognized “hot spots” and in locations where heartworm disease was once rare.²

Due to the increased incidence of travel and remote work career options, the United States is experiencing spread of heartworm prevalence throughout the country. Despite our best intentions, our pet parents are still unclear on the severity of the disease and the importance of maintaining proper heartworm prevention.

Here are five ways to help increase your client compliance and decrease the incidence of heartworm disease in your area:

Discuss heartworm prevention at every visit for every pet.

Veterinarians and veterinary staff recognize the importance of discussing heartworm prevention at puppy appointments. However, often we forego discussing it during adult and senior canine patient visits. The AHS reports that only 37 percent of the U. S. canine population is on heartworm prevention!³ This is a staggering number, and it is our job to educate our clients on the importance of prevention for every pet, year-round. We must make it a point to have this discussion with them at every visit and reinforce the importance of prevention rather than treatment.

Cats get heartworms, too!

Too often we neglect to have this important conversation with our feline pet parents. Fewer than 5 percent of cats are on heartworm prevention³. Most feline pet parents do not think about their cat being at risk, since most of them are indoor-only pets. It is important to have open discussions with cat owners about the spread of heartworms. Educating them that even “indoor” cats are still at risk for mosquito bites and heartworm disease can help reduce the incidence within our feline population. Pet owners may not be aware that there are multiple options for adequate heartworm prevention in cats that do not include giving an oral medication; something we know that causes lower compliance rates in cat owners.

Heartworms travel and so do our pets.

The last few years have seen an increase in the number of remote workers, as well positions that require travel across state lines. Our pet owner population now looks at their dog companions as part of the family who often travel with them. As veterinary professionals, we can no longer rely on heartworm incidence maps as they relate to our direct location since our patients are traveling on a regular basis. Heartworm disease has now been diagnosed in all 50 states and without proper education our pet parents may not be aware that they are unintentionally putting their pets at risk. Be sure to ask questions about travel, including vacations as well as work travel, and be sure that pet owners understand that all pets, in all states, are at risk for contracting heartworms.

Ensure that pet parents are regularly giving heartworm prevention.

When I was in practice, I was always in awe of the fact that most pet owners had an ample supply of heartworm prevention at home, yet our records indicated they should need to buy more. This is often because most pet owners only give their pet’s heartworm prevention one-third of the time. With the numerous options available on the market today, there is an option available for every pet parent to become compliant with their pet’s prevention routine. Discuss different prevention options and gauge what your client feels they can be most consistent with. By opening the conversation and talking through what works best for them, you increase your veterinary-client bond while simultaneously reinforcing the human-animal bond.

Recommend heartworm testing annually.

Despite everyone’s best intentions, sometimes doses of prevention get missed, and it’s our job to help our pet parents provide the best medical care for their pets. Recommend yearly heartworm testing to ensure that their pet is free of heartworm disease. Make obtaining the blood sample a Fear Free experience by using a Considerate Approach through positive rewards such as delicious treats or petting and using small-gauge needles to minimize discomfort. My staff was great at using insulin syringes to obtain the minimal amount of blood necessary to perform this annual test while the pet parent offered the patient treats. Most of our patients did not even realize venipuncture had occurred! Remind owners that unless we test, we won’t know, and that it’s just as important to monitor for heartworms as it is to prevent them.

It only takes one bite from an infected mosquito to transfer heartworms to a cat or dog. Let’s join with our pet parents to ensure that all our canine and feline patients are well protected.

Resources

American Heartworm Society, 2023; https://www.heartwormsociety.org/
American Heartworm Society Incidence Map, April 11, 2023
The Truth About Cats and Dogs, American Heartworm Society

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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How Clients Can Train Their Birds for Transport and Reduce Travel Stress

Barbara HeidenreichBefore you can care for avian patients, clients must first get them to your clinic. Often, that’s easier said than done. Most companion birds are not used to leaving their home or riding in cars, and it can be frightening for them.

Reducing or eliminating distress for the avian companion starts before the patient arrives at the veterinary clinic. This is because transportation to the clinic can be a critical part of the process. Most avian companions rarely travel outside of the home. This means travel may have the potential to be challenging. Training birds for transportation in advance can give clients peace of mind and make it more likely that avian patients will receive regular annual examinations and necessary medical attention in a timely manner.

Transport Container Selection

Training for transport first requires finding an appropriate container. Some manufacturers have designed small travel cages, crates, and backpacks specifically for companion birds. However, other products such as plastic kennels or wire crates designed for dogs and cats can be adapted to work well for birds. Buyers should examine these products closely to ensure that the materials are safe and suitably indestructible, depending on the species identified for training.

An ideal container is comfortable, inviting, and easy to train the bird to use. This may require that the client add and position perching of the appropriate size for the species in training. Birds with long tails, like macaws, may require perching to be placed closer to one end to allow them to sit comfortably in the crate or cage. The container should have enough space for the bird to easily turn around.

Some containers provide more than one door, large doors, or unobstructed openings that make it easier for birds to enter voluntarily. This can facilitate training the bird to willingly enter a container for transport.

While it is tempting to put many toys inside a travel container, be careful to avoid hanging toys that can swing into the bird during car movement. This can create an unpleasant experience. Alternative options to consider include small foot toys that can be placed on the bottom of the crate or items that can be secured to the sides that won’t move.

Training to Enter the Transport Container

Training the bird to enter the travel container involves a series of steps. The first step is to give the bird time to habituate to the new crate or portable cage. This involves giving the bird time to see the travel container without any requirement to engage with it. This can be done by placing the crate or cage within viewing distance, while making sure the bird is calm and relaxed in its presence.

The next steps are to encourage interaction with the travel container. The initial interaction can be started by luring. Luring involves placing preferred items in a trail from outside that leads to inside the travel container. This can include food items and toys. For some birds, providing attention can also work.

If the bird knows how to orient their beak toward an object, like a ball on a stick or the tip of a chopstick to earn desired outcomes (also known as targeting), this behavior can also be used to guide the bird into the crate.

Subsequent steps include reinforcing for allowing the door to be closed for short increments of time. This is followed by reinforcing for allowing the container to be picked up with the bird in it. Over time, the container, with the bird inside, is moved for short distances.

Another important step in the shaping plan is to practice driving the bird in the container in the car. It is recommended to start with short trips around the block. Placement of the container may be important to prevent motion sickness for some individuals. Being able to see where they are going can help. If possible, advise clients to place the carrier in the front seat, raised so that the bird can see out the window. They shouldn’t cover the carrier or place it on the floor or in the back of the vehicle.

If clients report regurgitation, advise them on options to prevent motion sickness. Additionally, driving prior to feeding a meal can help reduce nausea.

Addressing Fear Responses

If the avian companion shows a fear response to transport containers due to prior experiences, another strategy is to use distance as a reinforcer for calm behavior in the presence of the travel container. This is done by starting far enough away from the container that the bird’s behavior is relaxed and calm.

Rather than getting closer and closer to the container, the client should approach the container only to a point at which the bird remains relaxed and comfortable, and then retreat from the container. This teaches the bird that calm body language at that distance results in moving away from the container. This is repeated and the distance between the bird and the container is decreased with each approximation.

Eventually the bird is very close to the container, showing relaxed behavior, and the procedure is switched to the steps utilizing the approach previously described. Learn more about how to use distance as a reinforcer in the Fear Free course Addressing Fear & Aggression in Avian Patients: A Constructional Approach.

Training for transportation is a behavior that can be taught even if a bird doesn’t know how to step up on hands or is not entirely comfortable with people. It is an important first step toward making an avian veterinary visit Fear Free. More details about training for transportation and how to train other behaviors to facilitate caring for avian patients are available in the Fear Free Veterinary Certification Program – Avian.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Barbara Heidenreich is an animal training consultant specializing in exotic animals. She consults worldwide working with zoos, universities, veterinary professionals, and conservation projects. She has worked onsite with over 80 facilities in 27 countries. She is an adjunct instructor at Texas A & M University. She has authored two books and contributed to four veterinary textbooks. She is a coauthor of two Fear Free® Avian Certification Courses. Much of her work focuses on training exotic species to cooperate in medical care. Barbara is an advisor for the Animal Training Working Group and the Parrot Taxon Advisory Group for the European Association of Zoos and Aquariums. She has provided her expertise to conservation projects The Kakapo Recovery Program and The Borneo Orangutan Survival Foundation. Her goal is to leave behind a legacy of kindness to animals by sharing her expertise.

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Older posts

Newer posts

Fear: Data migration will be an enormous hassle

Anxiety: My team will struggle to learn the new system and be less productive

Stress: My practice data will not be secure stored in the cloud

Fear: The benefits won’t be worth the effort

Anxiety: Team members fear that remote access will blur the work-home boundary

Stress: Clients won’t understand the change, especially if service is disrupted

Provide a Safe Place

Considerate Approach

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Christie Keith is a journalist, editor, and communications consultant with an exclusive focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate and Elite Fear Free Certified professional.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Necessary, but Never Urgent

Individualized Care Plans

The Fear Free Difference

Bio

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Transport Container Selection

Training to Enter the Transport Container

Addressing Fear Responses

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Christie Keith is a journalist, editor, and communications consultant with an exclusive
focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate
and Elite Fear Free Certified professional.