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Yes, You CAN Perform a Fear Free Canine Orthopedic Exam

In this webinar, Kristin Kirkby Shaw, DVM, MS, PhD, DACVS-SA, reviews the importance of diagnosing osteoarthritis (OA), how to perform canine exams, and pain management. Dr. Shaw also provides resources from the New Science of OA Pain website, which has canine and feline OA checklists, feline exam videos, and chronic pain teaching tools that can be provided for pet owners.

Brought to you by Zoetis Petcare.

Fear Free

Specific signals of fear, anxiety, and stress (FAS) differ slightly by species, but what remains constant for delivering Fear Free care is to attend to what animals communicate through their body language.

For exotic animal veterinarian Alicia McLaughlin, who practices at the Center for Bird and Exotic Animal Medicine in Bothell, Washington, paying close, constant attention to body language signals throughout interactions and care is vital for protecting the emotional experience and safety of her animal patients and the veterinary team.

In the case of Dr. McLaughlin’s exotic animal patients, signs of FAS may be slightly different and adjusted to depending upon the species. Avians in particular can be challenging for most people to read. But with practice, reading their signs of FAS becomes second nature.

Some signs of increasing fear, anxiety, and stress McLaughlin watches for in avian patients include eyes appearing more round as opposed to soft and almond-shaped. Stressed birds also do not preen themselves and are unwilling to eat even favorite treats. Birds may stand taller on their perch and lean away from a scary object or person, with feathers slicked and held close to the body. If these body language cues are ignored, birds may attempt to fly away or vocalize, or FAS may progress to defensive gesturing, with the bird opening the mouth, lunging, and threatening to bite.

Another aspect of body language to watch for is overexcitement.

“Overexcitement can lead to aggression quickly,” McLaughlin says.

Signs of overexcitement include feathers ruffling on the nape of the neck. A parrot may fan out tail feathers. Parrots have voluntary control over their pupils and can dilate and constrict them rapidly in what is referred to as eye pinning, another sign of overexcitement and a red flag for potential aggression.

Carefully and continually monitoring for signs of FAS throughout preparatory visits and actual veterinary care is protective both for the ability to handle patients in the immediate situation and for building their long-term comfort with care.

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, DVMPet parents will remember their animal’s euthanasia for the rest of their lives, and if their pet is agitated or anxious, they’ll remember that, too. Helping them to plan ahead can make the experience easier for your patients and their families.

When people make the difficult decision to euthanize a pet, there are many other smaller decisions they’ll have to make, such as when to schedule and whether they or their children should be present. Among the details that should be considered on your end is how you can reduce the animal’s fear, anxiety, and stress during their final moments.

When pets have a fear of the veterinarian and are brought in for euthanasia, their stress levels can escalate. The procedures that may take place before euthanasia can be scary or painful, such as being restrained by a veterinary staff member while their front leg is shaved and an IV catheter is placed. While this usually occurs away from the owner, the experience is often stressful enough that the difference is noticeable when the pet is returned to the exam room.

Even if a particular patient doesn’t routinely require anti-anxiety medications, consider them when clients are bringing pets in for euthanasia. Many pet parents have concerns about their sedating effects, but this is one instance where it truly doesn’t matter–sedation will only help the euthanasia go more smoothly. Dispense them at least a few days ahead of time to ensure that the client is able to give a test dose before the day of the pet’s euthanasia. Some anti-anxiety medications such as gabapentin also help reduce pain, so they can decrease discomfort to procedures such as IV catheter placement prior to euthanasia. If your patient is agitated or is still fearful despite oral pre-visit pharmaceuticals, consider injectable sedation prior to euthanasia. The last thing a pet parent wants to see in their time of grief is their pet flailing, vocalizing, or trying to escape. Sedation will decrease stress for the pet and their family.

If your practice routinely uses IV catheters for euthanasias, have clients rub a lidocaine numbing cream such as Supernumb on the tops of their pet’s forelegs several hours prior to euthanasia. IV catheter placement is painful, and numbing the area will make for a more compassionate experience, especially since multiple catheter attempts are sometimes needed in debilitated pets .

In your Fear Free practice, you use treats with patients during routine visits, and you can use them with euthanasia, too. Providing a smorgasbord of vanilla ice cream, lunch meat, cheese chunks, Churu, peanut butter, or whipped cream will allow clients to continue bonding with their pets while lowering their stress. Take care to avoid giving greasy foods such as burgers–while tempting to offer as a last meal, they can cause nausea and gastrointestinal upset.

If you don’t offer housecalls for patient euthanasia, I urge you to consider it. Even pets who don’t have a strong fear of veterinary visits will never be as relaxed at the vet as they will in their home, with their familiar bed and environment. You can even have classical music playing quietly in the background to help create a calming environment. I’ve euthanized several pets in their homes, and in every instance I felt that the experiences of the pet and the owner were better than they would have been in the clinic environment.

Pets deserve to have a Fear Free death as much as they deserve to have a Fear Free life. By considering a patient’s emotional health during their final days, you’ll help make their passing as compassionate as possible.

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, DVM, CVA (Certified Veterinary Acupuncturist) is a small-animal veterinarian who practices in Austin, Texas. In addition to advocating for Fear Free handling of pets, she is passionate about feline medicine and senior pet care.
 

Using Fear Free Principles to Improve Anesthetic Safety In Complicated Patients

Decreasing fear, anxiety, stress (FAS), and pain leads to safer anesthesia by allowing a lower dose of sedative and anesthetic drugs needed for anesthesia premedication, induction, maintenance, and recovery. Lower drug dosages are especially critical in complicated patients with underlying disease and physiologic compromise. In this discussion, Tamara Grubb DVM, PhD, DACVAA, will explore the role of Fear Free principles in anesthetic safety, especially in the compromised/complicated patient.

Brought to you by Zoetis Petcare.

Linda LombardiSome aspects of the experience of visiting the veterinarian are generally recognized as stressful to pets, such as strange noises, unfamiliar people and animals, and being handled in uncomfortable ways. Less clear – and now even more relevant in the wake of the pandemic – is a question asked by a recent study: how are pets affected by whether or not their owner is present during the exam?

In research published in Journal of the American Veterinary Medical Association in November, 32 dogs underwent a standardized exam consisting of examination of the head, palpation of lymph nodes and body, axillary temperature measurement, heart rate assessment, and respiratory rate assessment. The exams were recorded on video under two conditions, with owners present or absent. Behaviors indicating fear were assessed, including reduced posture, avoidance, escape, lip licking, body shaking, yawning, and vocalizing; physiological measures were also taken.

Based on their findings, researchers concluded dogs were less stressed when the owner was present during the exam.

“When the owners were allowed to be present with their dogs, they did have more reduced fear levels: reduced vocalizations and reduced temperature, and we also saw some female dogs had lower heart rates when they were with their owners,” says coauthor Anastasia C. Stellato. “So our results show that, if possible and if it’s appropriate for that client, to allow owners to be in the exam room could have a beneficial impact.”

Owner presence didn’t eliminate fear: more extreme responses, such as attempting to escape, were the same in both groups, despite the superficial nature of the exam. “It’s important to keep in mind that the exam we conducted was very passive,” says Stellato. “It was on the ground, they had a traction mat, we didn’t even use rectal temperature, and yet we still saw those fearful responses.”

So while those reactions indicated that the dogs would have preferred to avoid the exam, owner presence apparently allowed them to tolerate it somewhat better.

The study found an age difference in that older dogs lip-licked less than younger dogs when their owner was present. It’s possible that this was the result of a stronger bond developed over the years, but since length of ownership was not recorded, this remains a hypothesis for further investigation.

One finding that was surprising to the researchers was that owner-present dogs yawned more. Yawning is a complex behavior in dogs, so this result is difficult to interpret. “It was contrary to our expectation, so it requires further investigation,” says Stellato.

On the whole, the results suggest that when possible, allowing the owner to be present can be a simple way to reduce stress.

Veterinary behaviorist Karen van Haaften, senior manager of behaviour and welfare at British Columbia SPCA, says: “I think it’s a nicely designed study. It’s randomized and controlled, which is nice to see in a clinical study. I personally am not surprised by the results of this paper, but I think it’s really useful information for both veterinarians and pet owners to know, and I think it’s a timely one to consider, because during COVID, most vets are not allowing pet owners into the hospital.”

Even after the pandemic is over, pets will still need to be separated from their owners sometimes, so ways to mitigate the stress of this experience need to be considered. Van Haaften says: “When I read this, I’m asking myself, why are we seeing this response? Is it the social support — the bond that the pet has with the owner — that is reassuring to them? Or is the lack of familiarity? They don’t see anything in this clinic environment that feels familiar to them. Probably it’s both, but if the second, we can work on that.”

When pets do need to be separated from their owner, she says, consider how to include things familiar to the pet in the experience.

“We can interact with them in the way that we see that the owner does – use cues the owner uses, use training that they already know, walk them in on equipment that’s familiar, maybe bring something familiar from the owner into the room with them.”

Post-pandemic, we can return to the idea that familiarizing pets with the clinic in advance; for instance, dropping in simply to get some treats and meet friendly people. “If you do that a couple times a week they’re going to love going into the clinic — now it’s a familiar place where good things happen to them.”

And in some cases, a very little bit of familiarization right before an exam can make a big difference. “For some dogs, it doesn’t take that long to bond with a person,” van Haaften says. “If a technician or someone spends five minutes feeding cookies, performing trained cues with a dog, suddenly, now they’re good friends, and the dog has a familiar person they can go into the clinic with.”

Some clinics are doing exams outdoors for pets who are stressed inside the clinic, which can allow the owner to be nearby and this might be worth continuing for some pets as well. In general, van Haaften recommends flexibility and attention to individual differences.

“Behavior during vet exams is really complicated, and different techniques are going to work with different animals,” she says. “Be creative, be willing to be flexible about how you do exams to give your patients the best experience.”

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, coauthored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.

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Fear Free Principles in an Orthopedic Exam (Full Video)

Kristin Kirkby Shaw, DVM, MS, PhD, DACVS-SA, demonstrates the use of Fear Fear principles in an orthopedic exam.

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Linda LombardiThe veterinary clinic or hospital can be a stressful place for cats, full of strangers and strange noises and sights. A recent study suggests a simple and inexpensive way to reduce this stress by use of plexiglass sheets hung over the front of the cage.

In the study, thirty pet cats were placed in one side of two connected cages (the starting side, left or right, varied randomly) for 70 minutes. There were three conditions: open cage vs a cage-front covered by clear plexiglass; open cage vs opaque plexiglass; and clear vs opaque plexiglass. Observers calculated stress scores from the cat’s behavior during the first and last 15 minutes and recorded how much time was spent in each cage.

The cats who were most stressed in the first 15 minutes spent significantly more time in the cage that blocked the most incoming stimuli: they preferred either type of plexiglass to the open cage, and preferred opaque plexiglass to clear.

Coauthor Kyle G. Mathews, DVM, MS, DACVS of North Carolina State University says the idea behind the study was to find an affordable way to make clinics less stressful, while still allowing a full view of the patient. The opaque plexiglass is “like looking at the cat through a pair of sunglassses,” he says, which is much better than other inexpensive possibilities. “When you put a towel over the cage, or you give them a hiding box, you can’t see the animals.” When staff need to open the door to look at the hidden cats, that adds stress; if there’s a problem, staff might not notice in a timely fashion.  “They may have IV lines, and that makes giving them a hide box difficult, because they could get their lines tangled up,” he adds.

Other possibilities are more expensive. For example, louvered windows, such as those used for privacy in conference rooms, would probably work. “You’re looking down at an angle and can see the cat, but the cat looking straight out can’t see the room,” he says. “But these are very expensive and have to be custom made.” In comparison, inexpensive plexiglass cut to order can be bought fairly cheaply and all that’s needed is to attach hook and loop fastener strips to hang it from cages.

If you’re wondering why not a one-way mirror, they ruled that out immediately for good reasons. “A one-way mirror only works if there’s light on one side, and dark on the other. So the person in the dark room can see the person in the light room, but the person in the light room can’t see the person in the dark room,” he says. “So we’d need the light in the cage with the cat and the room would need to be dark.”

While they may be a start, barriers won’t solve all the problems that stress cats. In particular, while plexiglass sheets block light (a 74.4 percent reduction for opaque and 13.9 percent for clear), they do little to block noise (only a 4.5 percent reduction). Although no one has specifically studied the effect of noise on cats, it’s almost surely a problem, especially in an echoing stainless steel cage.

“Eventually, if people don’t want to rebuild a room for cats, we may need to design a cage that has insulation around the outside of it, but still stainless inside that you can clean,” he says. “But noise reduction is going to be a more expensive alteration. So this was our first attempt at looking at, is there something relatively cheap that a practitioner could use to retrofit their clinic that would make it feline friendly.”

Further research also needs to be done in a real hospital setting: this study was done in a special room, with video of the sights and sounds of a veterinary inpatient ward projected onto a screen. But in the meantime, the results suggest that it’s worth trying and doesn’t appear to have any downsides. “The indication is that it probably is helpful, especially in the most stressed-out cats,” he says. “It’s not going to hurt them – they’re not going to move away from it, there was no indication that was the case.”

Board-certified veterinary behaviorist Margaret E. Gruen, Assistant Professor of Behavioral Medicine at North Carolina State University and a Fear Free Certified Professional, agrees that this is worth trying, noting that odors, separation from owners, lack of hiding places, and sounds of people talking and monitors beeping are all stressors for cats, making hospitalization and recovery more difficult for them as well as increasing morbidity. They may refuse to eat or be hesitant to use the litter box. And anxiety is often difficult to differentiate from pain in cats. Looking at ways to mitigate these stressors while still being able to easily observe feline patients, especially when they are ill or recovering from procedures, benefits both veterinary teams and the cats themselves.

“The cats, and their people, will appreciate it,” she says. “And having happier cats in the hospital is a win for everyone.”

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, co-authored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.
Linda LombardiFor some animal behavior issues, the need for a medical workup is clear. While a cat who stops using the litter box certainly may be under stress or have social problems in the household, the first step is to rule out bladder or kidney issues.

But there are also medical issues where a potential connection to a behavior problem may be less obvious. One that can be tricky to diagnose and that affects behavior in a wide range of ways is pain.

A recent article published in the journal Animals reviewed records of 100 dogs seen by the 13 coauthors and found that conservatively, a third of them involved some form of pain, and in some cases possibly up to 80 percent.

Coauthor and board-certified veterinary behaviorist Margaret E. Gruen, DVM, Ph.D., of North Carolina State University says, “We want to raise the consciousness that there are a lot of things where pain can be a contributor.” When clients come in with behavior issues, she says, “we want to be really specifically looking for discomfort, even if it’s behavior where we’re not immediately thinking, oh, that could be pain.”

It can be tricky, because pain in animals is not always obvious. “Unless you are really well versed in pain, it can be hard to pick up a painful animal in the exam room,” says Mike Petty, DVM, CVPM. “They put on a show about how well they feel. We will see dogs limp across the parking lot and then quit limping when they hit the front door.”

This means that knowing how to look for it is critical. “Primary care providers must keep an open mind that absolutely any change in their patients’ behavior that the client reports can be related in some way to pain. That means doing a good pain palpation as a part of every examination,” says Robin Downing, DVM, DACVSMR. “Only by including a pain palpation in every examination will a practitioner become proficient in identifying even subtle pain in patients.”

It’s also important to be aware of the many demonstrated connections. An increasing number of behavioral effects of pain and discomfort are being found in research. As more of these are studied, what’s “obvious” changes. “Compulsive licking in cats is a fantastic example,” says Dr. Gruen. While this was once commonly assumed to be a result of stress, after research revealed that approximately three-quarters of cats with compulsive licking actually had an underlying dermatological issue, such cats are now more likely to be treated correctly.

A less well-known example involves compulsive behaviors such as stargazing, fly-snapping, and pica. Research has shown that these can result from gastrointestinal problems in dogs.

And while inappropriate elimination as possible evidence of pain is well known in cats, it’s perhaps less frequently considered that pain can also be connected to housesoiling in dogs. “Oftentimes it’s too much effort for the dog to go and find their owner, or they dread going down the three steps into the backyard,” says Dr. Petty. “So they will sometimes go to the door and urinate or defecate there, or sometimes won’t even go to the door and just do it wherever they are.”

Problems of Aging

It’s often not easy to tell the difference between pain and cognitive decline, both of which can happen as pets age — and the two can interact as well.

“If a dog is acting weird, it might not be simple cognitive decline; it might be cognitive decline driven by pain,” says Petty. “Sometimes animals are in so much pain they can’t even think straight, so they’re much more likely to have behavioral issues.”

A sign such as apparent disorientation could be due to physical issues: a dog who seems to be stuck standing on a rug might be reluctant to cross a slippery floor because walking on it hurts. An apparent decrease in sociability could also be due to undiagnosed pain: “If you’re getting up and moving around the house, they’re less likely to follow you from room to room,” says Petty. “I always say to these clients, let’s make sure there isn’t a pain issue that pushing your dog over the edge, while we look at this cognitive issue.”

Petty thinks that teasing apart these potential causes is especially important because they often push people toward the decision to euthanize, since the dog doesn’t seem to be enjoying life and the pet-owner bond can be affected. Treating pain can help, as well as encouraging owners to modify their expectations for an aging pet. It may not be that the dog doesn’t enjoy his favorite activities anymore so much as they need to be modified: say, rolling the ball a short way instead of throwing it across the yard. He tells clients, “Think of what the dog used to like to do and tone it down.”

Looking for Changes

Because pain isn’t always obvious on examination, listening to the owner’s observations is crucial — but these may also need to be guided.

“When I speak with my clients about the possibility of pain in their pets, I alert them that any changes in behavior must lead us to at least consider pain as the culprit,” says Dr. Downing. “So, this means changes in eating and drinking, changes in getting onto furniture/beds, reluctance to ascend or descend stairs, decreased grooming (cats), restlessness at night (or the converse – – sleeping excessively), decreased interaction with human or animal family members, “grouchiness,” any changes in housetraining or litter pan use, objections to petting/brushing, decreased stamina on walks, or any other changes they may witness.”

But even for owners, these changes can also creep up so slowly that they almost don’t notice them. “It’s very common with chronic pain issues that once they’re treated, the owner says, ‘I just realized it’s been two years since he jumped on a couch,” Petty says. He strongly recommends using a questionnaire such as the Canine Brief Pain Inventory starting when pets are six or seven years old. “If you give this to every dog owner that walks in for their annual exam and have them answer these questions, you’ll be amazed at the red flags that come up.”

Lack of change where it can reasonably be expected can also be a hint, where behavior modification isn’t working. “If we have a patient who is working with someone, and they’re doing lots of appropriate things and not making progress, that’s when you want to think, let’s look even closer,” says Gruen. “Are we seeing anything that could be pain?”

Treating Both

Finally, it’s also important to remember that even when an underlying medical issue is identified, both medical and behavioral treatment may be needed.

“We need to know what the medical conditions are but that doesn’t necessarily mean treating that will solve the behavior problem,” says Gruen. “A good example is noise phobia.” In a dog who has some pain along with some fear of fireworks, for example, tensing up at the frightening noise may also cause physical discomfort. “That gets associated with the noise, so worsens the behavior problem.”

Similarly, when cats have urinary tract issues or pain that causes them to start avoiding the litter box, simply solving the medical problem may not be enough. “You can treat the infection, but the aversion is set up and persists,” she says.

Likewise, simply treating the behavior isn’t going to work if an underlying medical issue has been missed. “Making changes in those other pillars of the treatment plan is important and will be helpful, but it’s an uphill battle if you have an untreated medical concern,” says Gruen. “Particularly if it’s pain and discomfort, because that affect so many things.”

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

Linda Lombardi writes about the animals that share our planet and our homes for magazines including The Bark, websites including National Geographic and Mongabay.com, and for the Associated Press. Her most recent book, co-authored with Deirdre Franklin, is The Pit Bull Life: A Dog Lover’s Companion.

Course Overview

Bath time is scary for many animalswhether it’s the sound of the water, the feel of it on their skin, being restrained, or the tub itself. This one-hour module will teach you how to break down the bathing process into individual components that can be worked on separately to allow for calmer, safer bathing experiences. We will provide step-by-step desensitization and counterconditioning plans for every componentintroducing the shampoo bottle, entering the tub, introducing water, and introducing the sound and feel of the dryer. You’ll also learn what you can do to modify the bathing environment to make it more inviting and less stressful for animals.

There are three lessons in this course:

Lesson 1: Overview of Fear Free Bathing and Positive Reinforcement
Lesson 2: Introduction to the Tub
Lesson 3: Modifying the Environment for Success

This one-hour course was designed for Fear Free groomers but is also open to our veterinary professional and trainer members. It was written by Terrie Hayward, M.Ed., KPA Faculty Member, CPDT-KA, CSAT, co-author of the book Grooming Without Stress, and is approved for one hour of RACE CE.