Technician/Nurse Archives - Page 3 of 34

Alleviate Communication Anxiety

Alleviate Communication Anxiety

Finding Connections with Colleagues and Clients Communicating effectively with others is often challenging and stress-inducing. During this webinar, Dr. Maryse Osborn-Doser, DVM, Insights Discovery Client Practitioner with IDEXX, will walk through the value of a deeper understanding of psychology preferences in communications, along with tools to adapt and connect more effectively in conversations with your colleagues and clients. In this webinar, we will: Discuss how perceptions and preferences influence attitudes and decisions Describe the value of recognizing and adapting to personality preferences in communications Identify your psychology of preferences Evaluate how color preferences look in real life

Brought to you by our friends at Idexx.

Press Pause on the Parvo Panic!

Press Pause on the Parvo Panic!

Preventing a case from becoming an outbreak; Parvo is a widespread issue, despite effective vaccination protocols. Dogs and puppies who enter shelters often have little to no protection, and are vulnerable to parvo’s devastating effects. For veterinary professionals working in shelters, a parvo outbreak is a constant threat. Join Fear Free Certified® Veterinarian, Dr. Brian DiGangi, DVM, MS, DABVP (Canine and Feline Practice, Shelter Medicine Practice), Elite FFCP, as he discusses how to prevent a parvo outbreak in a shelter setting. In this webinar, we will: Discuss resources needed to manage canine parvovirus in shelters with respect to Fear Free principles Identify gaps in preventive care and biosecurity that increase parvo risk Understand the impact of treatment options on disease course and fear, anxiety, stress, and frustration

Brought to you by our friends at Elanco.

Managing Patients with High Fear, Anxiety, and Stress: When Clients Refuse Your Recommendations

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Four 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

Despite our best efforts and education, we may encounter client barriers with providing Fear Free care such as refusal of PVPs or sedation, objections to safety tools like basket muzzles, and declining referral to a positive trainer to help with vet visits. It’s worth exploring other ways to help lower FAS such as regular happy visits, outdoor exam rooms, and calming supplements. However, these options are often insufficient for staff members to handle a high FAS pet safely and compassionately.

Emphasizing the safety component can help get some of these clients on board. Just as with other signs of FAS, we should educate clients when their pet is growling, hissing, snapping, swatting, baring their teeth, or showing whale eye. Some high FAS pets are in such a state of panic and “flight” that they bruise, scratch, and otherwise injure staff members when trying to get away. Clients should be informed that staff safety is non-negotiable (“We need to keep our team members safe”), and that because their pet is showing the highest level of stress possible, we are unable to proceed safely without a change in the plan. The client-facing FAS spectrum handouts for cats¹⁷ and dogs¹⁸ help illustrate these body language cues in a non-judgmental way. We should think as well about the safety of the pet as they could easily come to harm themselves. I had one high FAS canine patient who became so stressed at one visit that she had a seizure the second she walked through the clinic door, and have seen multiple dogs rub their noses raw or bite frantically at kennel bars after being dropped off.

Unfortunately, team safety, emotional health, and all of the myriad reasons to take a Fear Free approach may not be enough to convince some clients. The thought of giving their high FAS pet an anxiolytic or briefly placing a basket muzzle may be so antithetical to a client’s personal beliefs as a pet parent that they will not be swayed regardless of how many options you present.

At this point you need to ask yourself: What will be the emotional toll on me, my team, and my patient if I continue? Is it worth placing myself and my team at risk of injury? How will my decision affect Fear Free clinic culture? These are especially important questions to consider if you’re a hospital leader. Staff members may not feel comfortable voicing their ethical concerns, and leaders must always advocate for the wellbeing of their team. In 2018, the Journal of Veterinary Internal Medicine surveyed nearly 900 North American veterinarians regarding ethical conflict and moral distress¹⁹. When respondents were asked, “How often have you had a conflict of opinion with pet owners about how they wish to proceed in the treatment of pets?”, roughly 53 percent noted “sometimes,” 32 percent replied “often,” and 1 percent answered “always.” In the same survey, over 73 percent of vets responded that “not being able to do the right thing for a patient caused their staff moderate to severe stress” and 78 percent responded that this caused moderate to severe distress in themselves.

In many cases, it will be best for your team to set a boundary and either decline to continue with the visit, or even initiate a respectful conversation about why your clinic may not be the best fit. Boundaries can be scary because many of us in vet med are people pleasers²⁰, and we feel guilty or “bad” for saying no to a client. However, boundaries are essential for protecting the emotional and physical welfare of every member of the team. When it comes to setting a Fear Free boundary, it’s also an animal welfare issue. We shouldn’t feel guilty for refusing to perform surgery on a pet when a client is against pain medications; adequate analgesia is the surgical standard of care. Similarly, we shouldn’t feel guilty for stopping with a high FAS pet when a client doesn’t respect team member safety or value their pet’s emotional health, because Fear Free is the emotional standard of care. Cultivating and retaining clients who are invested in their pet’s emotional needs will help the pet, the client, and the team succeed.

Summary

Vet clinics are often highly stressful places for pets, making high FAS pets common. Focusing on client education, being flexible during the visit, and knowing when to draw an ethical boundary will help team members navigate a safe and humane approach to the patient while keeping their own wellbeing at the forefront.

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

Dr Julie Liu is a Fear Free and Cat Friendly veterinarian, speaker, and freelancer based in Austin. She serves as the Vice President of the Relief Veterinary Medical Association and recently launched My Family Cat, an in-home and virtual feline behavior consulting practice serving the cats of Austin. Learn more about Dr. Liu and her work at www.fluxvet.com and www.myfamilycat.com.

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

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Managing Patients with High Fear, Anxiety, and Stress: Communicating with Owners

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Three 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

Communicating with clients is an art and can be especially difficult when managing a high FAS patient. Clients don’t always see what we do when it comes to signs of FAS, and they may have different priorities or ethics as a pet parent compared to us as Fear Free practitioners. Words such as “fearful,” “anxious,” or “stressed” may seem meaningless or exaggerated from their perspective.

Communicating Fear Free techniques should start with a discussion of body language, which transforms emotional abstracts into non-judgmental, objective observations that the client can see and hear. You don’t have to be a veterinary professional to witness when a dog is panting and whining or when a cat has flattened ears and dilated pupils. Once the client understands the body language of FAS, we can then communicate the implications of untreated FAS and suggest interventions.

One common scenario is when a pet’s FAS levels escalate during a visit, and none of the Fear Free techniques you’re using are helping. At this point you need to initiate a client discussion about PVPs, sedation, or otherwise changing the initial plan to achieve a Fear Free approach.

This can be stressful because you can’t predict the client’s reaction. Will they be open? Angry? Frustrated? Shocked and skeptical, because “They always do great at the vet!” and “No one’s ever mentioned anything before.” As discussed in Fear Free level 2 module 4¹⁵, understanding the client’s needs and finding ways to meet those needs will help the pet parent get on board with your recommendations. For clients with time constraints, offer a drop-off slot or reschedule with PVPs on a day that works for them. For clients with budget concerns, consider invoicing a lower, “brief exam” fee for the follow up and setting in-hospital PVPs/sedation fees at a price that improves compliance. For clients who feel embarrassed or upset about their pet’s FAS, normalizing signs of FAS and using success stories of your own pets can help clients relate.

Think creatively and have some flexibility when making a plan for a client. I recently saw a dog for acute, non-weight-bearing lameness in a rear leg. While I suspected a torn CCL, on examination the dog was so tense and anxious that I couldn’t be sure. I recommended sending the dog home with pain medications and returning them for sedated rads and a repeat orthopedic exam, but the client had budget concerns, time constraints, and concerns about sedation. We made a plan to administer gabapentin at drop off, wait a couple of hours, and then give an opioid injection about 20 minutes before trying the rads, with the agreement that we would not continue if the dog was still painful or stressed. The tech informed me that she was unable to administer gabapentin because the dog was trying to bite. I asked the client to return to the clinic to help us give the medication, and when the client offered the meds in a treat, the dog took them immediately. After an hour, he was lying down sternally in his kennel, had stopped whining, and was coming to the front of the kennel for petting. When it was time for his rads, we still placed a basket muzzle as a precaution, but the dog was an FAS of 1, semi-sedate, eating treats, and much more amenable to the ortho exam and imaging. It wasn’t my initial plan, but it still worked for the client and the pet, who did have a torn CCL.

According to the AVMA Language of Veterinary Care Initiative¹⁶, “Clients want a strong relationship with their veterinarian. To clients, the word ‘relationship’ signals that the veterinarian is trustworthy, will make their pet feel comfortable, and goes out of the way to provide personalized service.” Focusing on long-term thinking and relationship-building can also help with client communication and Fear Free, especially for high FAS pets. We’re not just thinking about how to get through this visit, we’re thinking ahead to the next 5 or 10 years of vet visits. If we push your pet now when he’s already so stressed, the next visit is going to be that much harder for him. We want to build a relationship with you and your pet, and provide them with a lifetime of humane veterinary

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 Two & Part Four of this series.

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.

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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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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.

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 Two, Part Three & Part Four of this series.

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Resources

Serene Vaccines: The Fear Free Vaccine Experience

Serene Vaccines: The Fear Free Vaccine Experience

There are many lifestyle factors that influence the decision to vaccinate or not, and we must learn to be proactive in addressing potential concerns that may arise for pet parents. Brought to you by our friends at Elanco.

Fear Free Spaces: Designing your Fear Free Environment

Fear Free Spaces: Designing your Fear Free Environment

Do you want to create a space that better reduces fear, anxiety, and stress (FAS) in pets? Join us as Roger Layman, Elite FFCP, AIA, NCARB, discusses how Fear Free can enhance your clinic or shelter design, whether you are rearranging, remodeling, or building a brand new space. A new building or remodel provides the perfect opportunity to interweave FAS-reducing design into your plans, but your current space can also be reimagined to reduce FAS. Register now to learn how to create a safe and serene space for pets, pet parents, and your team!

Basket Muzzle Training

Link to Schoox Content

Muzzle training is essential training for a new dog. Creating comfort and ease with wearing a muzzle can help build confidence and make treatments easier for both you and the dog. Mikkel Becker, CBCC-KA, KPA CTP, CDBC, CPDT-KA, CTC, and Debbie Martin RVT, CPDT-KA, KPA CTP, VTS (Behavior), will show you how to safely and effectively muzzle train.

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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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