Showcase Your Practice: How to market your Fear Free Certified Practice
Has your team recently achieved the Fear Free Practice Certification? Congratulations! You’ve worked hard to implement the Fear Free standards through culture change, facility modifications, patient and client care, and more! Now what? How do you get the word out to maximize your return on investment? This webinar is for any Fear Free Certified Practice members that are looking for ideas on how to market your achievement. Natalie Gruchow, CVPM, Elite FFCP, was a practice manager for nine years and led her team to become the first Fear Free Certified Practice in the Dakotas. In this webinar, you will learn: Marketing strategies for your Fear Free Certified Practice How to ensure consistent messaging throughout your hospital with mindful brand cohesion Real world examples from the first Fear Free Certified Practice in the Dakotas How to locate community resources to market your brand Communication tips to overcome resistance and adversity
You must be a Fear Free Certified Practice member and logged in to view this webinar.
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
When Cookies Can’t Compete: Fear Free Solutions for Non-Food Motivated Pets
Not all pets find treats irresistible, and for pet owners and pet professionals, this can pose unique challenges. Many pet professionals automatically reach for a tasty treat when rewarding, building a bond with, or reassuring the pet they’re working with, but what do we do when treats fail? Join us as we delve into innovative and Fear Free solutions for working with animals that may not be food-motivated. In this webinar, you will learn: – Effective, positive reinforcement methods that prioritize the emotional well-being of animals, fostering trust and cooperation – Methods to identify alternative motivators when traditional treats fail – How to tailor your approach to suit the unique personalities and preferences of non-food-motivated pets.
Our friends at Latah Creek Animal Hospital displaying their certifications at their clinic.
So, you’ve completed your Fear Free® Certification or Fear Free®Veterinary Practice Certification. First and foremost, congratulations, and thank you! You have taken a huge step in alleviating fear, anxiety, and stress for your clients, their pets, and even your team. Now it’s time to start spreading the word!
As you move through your Fear Free marketing journey, keep in mind that like all of us, pet owners are busy, and their attention is demanded by many other businesses as well as personal obligations. However, as their trusted Fear Free Certified Professional, the messages you share are often held in their highest regard. To get the most out of this benefit, always ensure that you are crafting your content and messaging in a way that addresses how your Fear Free Certification benefits your clients and their pets as quickly as possible. Align your goals with theirs and you’ll end up with happier, healthier, more relaxed pets and, in turn, happier pet parents.
Whether you have achieved your individual Fear Free Certification, or your clinic has achieved Fear Free®Veterinary Practice Certification, we recommend starting by choosing a few goals, defining specifically what success looks like to you, and then outlining and deploying your marketing plan.
As you work on developing your goals and success measures, here are some tips for getting started:
Marketing Your Individual Fear Free Certification
Your individual Fear Free Certification is a powerful tool that can be used to market not only your personal brand, but also elevate the work you do.
Display Your Fear Free Certified Professional Badge. We recommend adding your certified professional badge to your team member bio on your company’s website and updating it to include more about Fear Free, your certification, and the difference it brings for the pets in your care.Additionally, add a homepage spotlight on your company’s website highlighting the presence of Fear Free Certified Professionals on your team. We encourage you to take that a step further and link the spotlight to another page where you explain what Fear Free is, how having Fear Free Certified Professionals on your team benefits your clients and their pets, and links to where they can learn more (here’s a great page to send them to).
Educate Clients Directly. Weave Fear Free principles into your touch points when preparing clients for appointments, during their visit, and in follow-up communications. Let clients know you are a Fear Free Certified Professional and what that means for their pet by walking them through what to expect and following up with them on that education throughout their Fear Free visit. If they have a pet who experiences fear, anxiety, or stress in the veterinary, grooming, training, or boarding & daycare environment, discuss how their Fear Free visit will be a different and a more positive experience for their pet and themselves than what they may have experienced in the past. Discuss how your team will allow their pet to tell them if they’ve had enough and stop the treatment or appointment if their FAS level becomes too high. Continuing that education from your marketing messaging through to their in-person visit can have a significant impact.
Shine a Spotlight on Your Certification. Ask your company’s marketing team to create a team member spotlight about your Fear Free certification. This can be shared on social media or even in an email newsletter. Have someone snap a photo of you in action practicing Fear Free techniques and pair it with a brief write-up about you, your certification, what it means for pets in your care, and where clients can find more information.
Be a Fear Free Champion in Your Professional Community. Odds are, you are one of many Fear Free Certified Professionals in your community. Use the Fear Free Online Directory to find other Fear Free Certified Professionals in your area. Reach out to them, build relationships, and discuss how you can promote and refer clients to each other to strengthen the Fear Free ecosystem in your community.
Grow Your Professional Brand. Are you working on amplifying your professional brand on social media? Map out your goals for your brand and utilize your certification to support them. We recommend developing a campaign across all the social media channels you use with a few different posts highlighting Fear Free, what it means to be Fear Free Certified, and how that certification can benefit your audience. Use photos of you in action, share success stories, and include calls to action for your audience to take on each post. Our Fear Free Marketing Toolkit, which can be found on the left side panel of your member homepage on our website, includes several social media posts and cover photos to help you get started spreading the word.
Achieve Your Career Goals. Are you looking to move to the next level in your career, find a new role, or build your network? Share regular posts on LinkedIn about the work you put in to become certified, how it is helping you in your everyday practice, and the difference it makes for the pets in your care. Add your certification to your resume and utilize the Fear Free network to find a company that aligns with your professional goals. Find and connect with like-minded Fear Free Certified Professionals through our private member community on Facebook to further work toward your professional goals.
Marketing Your Fear Free Veterinary Practice Certification
Fear Free Veterinary Practice Certification allows you to not only bring a higher level of Fear Free care to your patients but also opens the door to many new opportunities for marketing Fear Free to your clients and community.
Define Your Differentiators. One of the first steps in your clinic’s marketing strategy should be developing and advertising your clinic’s differentiators. If you haven’t already, gather your team and brainstorm 3 to 5 things that make your clinic unique from others nearby. Fear Free Veterinary Practice Certification is a built-in differentiator and a great place to start. Once you define some additional differentiators, highlight them on your website’s homepage, on social media, and in client communication. Tell the story of not just what you do differently, but how you do it differently. Looking for a great example of highlighting Fear Free as a differentiator within a Fear Free Certified Veterinary Practice group? Check out PetVet365’s homepage and Fear Free Experience page.
Display Your Certified Practice Badge. Add your certified practice badge to your clinic’s website homepage with a brief write-up on what it means to be certified and what it means for your clients. Couple your homepage highlight with an additional page on your website that dives deeper into your Fear Free Certified Veterinary Practice designation, the hard work your team completed to get there, and how it will positively affect your clients’ experience with your clinic. Need some inspiration? Check out how Family Pet Health in Murfreesboro, Tennessee, showcases their veterinary practice’s certification on their homepage and an additional Fear Free page.Additionally, your team’s professional certification badges should be included on their website biographies. Spotlight them on social media or in your clinic’s newsletter to continue spreading awareness. Our Fear Free Marketing Resources page, which can be found on your member homepage on our website, also includes social media graphics and client-facing videos you can share to spread the word.
Walk the Walk, Don’t Just Talk the Talk. Marketing can fall flat when it isn’t backed up by your clients’ experiences. Make sure clients and their pets can recognize your differentiators, especially your Fear Free Veterinary Practice Certification, in every interaction, from their search online to the preparation for their appointment, from their time inside your clinic to the follow-up after their visit. Don’t let the initial marketing of your certification be the end; keep reminding, educating, and impressing your clients with the Fear Free principles your team practices every single day.Also, remember that word of mouth is one of the most powerful marketing tools you have at your disposal, so arm your clients with the education they need to shout your clinic’s name from the rooftops to their families and friends!
Attract and Retain Qualified Team Members. We all know that attracting strong candidates and retaining them is a pain point many practices are experiencing right now. Recruitment marketing is just as important as client marketing and can make a big difference in the types of applications you receive for open positions. Being a Fear Free Certified Veterinary Practice is a powerful recruiting tool that you should use to elevate your practice above the rest. Include that you are a Fear Free Certified Veterinary Practice in your job ads, the careers page on your website, and on your clinic’s LinkedIn page, explaining how that designation improves your team’s experience, safety, and medical standards, as well as delighting your clients.
Network, Refer, and Cross Promote Within Your Fear Free Ecosystem. There are likely many other Fear Free Certified Professionals in your community who are looking to ensure that their clients have a Fear Free experience everywhere they go. Use the Fear Free Online Directory to find certified groomers, boarding and daycare facilities, trainers, and pet sitters in your area. Connect with them, build relationships, and develop strategies for referring clients and cross promoting each other. This could look like a postcard or flyer you each give out to new clients that includes a special gift or discount, highlighting each other on social media or on your websites, and referring clients who are looking for a new professional service to a fellow Fear Free Certified Professional.
As with any new marketing endeavor, failing to ensure that you have the resources you need can result in missing goalposts. The great news is that our Fear Free team is here to support you and provide those tools you need to achieve your goals and alleviate fear, anxiety, and stress for not just pets, but people too.
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Since 2016, Fear Free has helped to change the way pets receive care from both veterinary and pet professionals. By closely listening to the needs of pet care professionals, Fear Free has built a robust catalog of certification programs and courses that focus on emotional wellbeing, enrichment, and reduction of fear, anxiety, and stress in pets. Over 100,000 Fear Free Certified Professionals are working to change the standard of animal care across the world. We thank you for being an important part of this initiative.
To learn more about Fear Free, register for a new membership, renew your membership, or learn more about Fear Free Veterinary Practice Certification, visit www.fearfreepets.com.
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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Parrots can make wonderful companions but we need to make sure we’re meeting their needs and giving them the opportunity to express their natural behaviors. Animal Trainer and Behavior Consultant Cassie Malina joins Steve Dale to discuss her lengthy career working with birds and her top tips for keeping parrots engaged, fulfilled, and Fear Free.
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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Avian patients present a multitude of challenges and requirements that typical companion animals don’t have. This doesn’t mean they deserve any less of a Fear Free experience than our other pets. Barbara Heidenreich and Dr. Alicia McLaughlin, co-authors of the Fear Free Avian Certification Program, join Steve Dale to talk about the course and how Fear Free avian practice works.
When she was 12 years old, Karina Salvo, DVM, CTPEP, CVFT, CVMMP, volunteered to work for a one-doctor practice. Cleaning cages, doing laundry, and walking dogs led to watching her first surgeries. From that point, she knew that her career path would lead to veterinary school.
But one thing she and the veterinarians she grew up working for—and later, with—didn’t learn was how to make exams easier on pets. When she became aware of Fear Free®, though, it made sense to her that veterinary visits should be less frightening and more fun for patients.—not to mention for veterinarians and technicians themselves.
“The one thing that I noticed in each and every practice was the frequency in using force to hold a patient,” says Salvo, now an Elite Fear Free Certified® DVM who also has certifications as a palliative and end-of-life practitioner (CTPEP) and in branches of Traditional Chinese Medicine (CVFT and CVMMP). “Some of the staff wrestled what I thought were highly aggressive dogs down to the ground in order to give a single vaccine or draw blood. The end result was someone got hurt, scratched, urine and feces everywhere, and a dog that was left splayed out and panting on the floor in exhaustion or cowering in the corner. This was the ambience of the veterinary field I grew up in.”
As she learned more from Fear Free, she found that in-clinic exams became easier.
Now she owns her own practice, AcuVetDoc Veterinary Reproduction & Animal Care Wellness Clinic, in Royal Palm Beach, Florida, where she treats not only pets but also wildlife. That allows her to see only one patient at a time.
“I can practice 100 percent the way I choose to. I intentionally do not have a receptionist or a technician,” Salvo says. “Patients are scheduled on the hour instead of every 15 minutes. This allows me to work one on one with the patient and the owner. My ‘team’ in my practice is the owner, myself, and the patient. By working together, all of us can better understand the patient and the medicine. Practicing this way has allowed me to build trust in my patients as well as owners because both are comfortable.”
Salvo greets clients and patients at the door so she can watch how the animal walks into the building. If owners have given permission beforehand, treats are on the carpeted floor as they enter.
Animals who have previously had poor experiences at veterinary clinics may be directed into an exam room that resembles a living room—with carpet, a bookcase, leather sofa, chair, and hidden treats. While Salvo sits on the floor, pockets filled with treats, and talks to the owner, patients can explore, approaching when they’re comfortable. If they need more time, Salvo may simply hand out treats during the visit, holding off on an exam. She discusses this possibility with clients beforehand so that they’re aware the first interaction may be a “meet-and-greet,” with the exam portion on a subsequent visit.
Many of her patients enjoy “playtime,” a rewarding exam in which Salvo uses tasty treats to get patients to move on their own but in a fashion that allows her to examine them. For instance, she might get them to sit or turn their head so she can look inside ears or examine the mouth.
One patient who stands out in her memory was a 12-week-old Cockapoo puppy whose first experience at a veterinary clinic had involved being held on an exam table while he screamed, attempted to bite, and urinated and defecated. The veterinarian told the owners that their puppy had mental health issues and should be returned to the breeder. This time they were hoping for a better experience.
Salvo met the owners outdoors, where she had set up chairs and some treats. They sat down, talked about how the puppy was doing at home, and handed out treats to the puppy. Salvo assigned homework: to find tasty, high-value treats that could be dropped on the floor any time visitors came to the home and to be used as rewards during training. She suggested walking the puppy in areas far enough away from people that strangers wouldn’t want to pet the dog but close enough that he could see people, other dogs, and vehicles such as carts. Offering high-value treats during these walks would contribute to forming a positive association with the experience and a connection with the owners.
At the second visit a few days later, Salvo again met the owners outside and had tasty treats already on the ground for her new friend to gobble up. Eventually, the puppy approached her and she was able to perform an exam and give an oral vaccine as the puppy sat next to the clients and received treats.
“On subsequent visits, we sat next to each other outside, and he came and laid on my lap and became more interactive with me and less afraid of the environment,” says Salvo. “With a cheese and Cheerio trail to lead him inside, we made it to the scale and an exam room!”
Three months after that first visit, the puppy frequents farm fairs, Home Depot, and PetSmart, and comes running into the clinic to greet Salvo.
“This is an amazing story with very patient owners who were willing to take their time to understand and provide their dog with what he specifically needed when he needed it, redirection to something positive, protection from being thrown into the middle of a chaotic situation, and to slow introduction to the world around him,” she says.
Fear Free continues to make a difference in her practice. “The best feeling is when the owners are ready to leave and the patient stays behind and makes eye contact with me waiting for another fun treat,” Salvo says, “or when they return and they are pulling their owner into the building.”
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Sandra Toney has been writing about cats for over 25 years and is an award-winning member of Cat Writers Association and Dog Writers Association of America. She has written for many print and online magazines about cat health and behavior as well as authoring eight books. She lives in northern Indiana with her cat, Angel.
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Michael Petty, DVM, CVPP, CVMA, CCRT, CAAPM/strong>The approach to a pain exam in a cat barely resembles what you might do with a dog, who you can take outside on a leash and trot around, and who are usually more accepting of a physical exam for pain. Instead, I am going to describe the team approach to diagnosing pain in cats.
Owners often report that their cat has become grouchy or will even growl and strike out while being petted or picked up. The underlying cause could be that the cat is in pain and doesn’t want to be touched out of fear of causing more pain. It’s much the same as a person with a painful wrist or shoulder; they understand how to move that arm without causing undue pain, but a well-meaning handshake from another person can cause excruciating pain as the person with the painful arm loses control of the movement.
This leads us to the beginning of the pain exam: discussing with the owner behavioral changes they have either observed but dismissed (often as “old age” or some new quirk) or behavioral changes such as elimination outside the litter box. Indeed, a 2020 study published by Daniel Mills et al. in the journal Animals called Pain and Problem Behavior in Cats and Dogs found that it is estimated that almost 80 percent of behavioral issues can be related to various painful conditions; not only musculoskeletal, which is the focus of this discussion, but also other sources such as gastrointestinal pain. Hence it is crucial that every member of the veterinary staff plus the owner be involved in order to properly diagnose, treat, and evaluate the progress of any therapy. Otherwise, the mental snapshot of the animal in pain might be as jumbled as a jigsaw puzzle dumped out of its box.
The pain exam starts with your customer service representative, maybe the most important person in the diagnostic team. They are going to hear the owner say things that an educated customer service representative might recognize as a sign of pain, such as not using the litter box, suddenly fighting with other animals in the house, or hiding in another room. The receptionist then has the ability to ask the owner to video the cat walking across the floor, using a step, or jumping to a favorite spot. The receptionist can also ask them to visit websites, for example www.catredflags.com, to set the stage for a pain discussion once in the clinic.
The pain exam continues with the technician who, clued in by the receptionist that there might be a pain problem, can ask about videos. If the client did not visit any of the suggested websites, the technician can have them do so on a clinic tablet or laptop.
At this point, it is important to ask about behavioral changes: has the cat’s world become less vertical and more horizontal? Does the cat hesitate to jump or jump up in stages using a chair, for example, to reach a windowsill? Does the cat socialize less with humans or other animals in the household? There are more examples on the website mentioned in the previous paragraph. All of these inquiries help to “soften up” the client for the message that their pet may be living in a constant state of pain and has been telling them all along through their actions.
The pain exam concludes with the veterinarian, whose success in diagnosing pain depends heavily on the events and education preceding the examination. Without them, the owner might not see the cat through the eyes of someone trained to recognize pain in cats.
I always start my pain exam by letting the cat wander the room, keeping an eye on how they move and jump. Cats should move like a tiger gracefully moving through the jungle, with a fluidity of movement. Of course, some cats do nothing but hide under a chair during the visit, so this is the importance of asking the owner to take videos: This is my number-one diagnostic tool to know that “somethin’ ain’t right” with the cat’s musculoskeletal system. Pointing out what we see to the owner brings them a new sense of enlightenment regarding the cat’s condition.
Once I know something is wrong, I finally put my hands on the cat to locate the problem. The physical starts with stroking the cat from head to tail, in a gentle pattern. For many cats in pain, this will relax them and build a trust that will allow you to do slightly more potentially painful manipulations. You can also look for areas of sensitivity at this gentler touching. When these painful spots are found, there is no longer any need to revisit them; what more can you ascertain or achieve, besides increased stress in the cat?
The next step is to focus the exam on suspect areas. By this time, you may have an idea as to the general body area where the pain is located. If so, depending on the cat’s FAS score, I may examine only those joints, as the exam is over when the cat says it is over, and further manipulation may result in a heightening of their FAS score, indistinguishable from a response to pain. I find it easier to manipulate the cat’s joints when they are in lateral recumbency.
Manipulation of the elbow in a recumbent position. Please note, this is my daughter’s cat Alvin who is very compliant. This cat is not being scruffed; his head is only being held in place.
However, some cats will not allow that to happen. The exam can also be done with the cat in a standing position.
Examination of the lumbosacral joint in a standing position.
Each joint needs to be gently extended and flexed to look for resistance, but not to the point of causing undue pain. Again, if you are trying to persuade yourself or the owner that there is an issue, this is not the way to do it. For videos on how to do a complete pain exam on a cat, visit https://www.zoetisus.com/oa-pain/feline-exam-videos.aspx to see Dr. Duncan Lascelles demonstrate.
This brings us to radiographs. Some cats have either a demeanor or pain level so high that a physical exam should not be performed. If we are convinced that the issue is pain, it is now become less important to know the exact location, thanks to the approval of frunevetmab, an anti-NGF monoclonal antibody that is distributed to all of the OA joints in the body.
However, if we are not convinced, or we hope to do directed therapy such as acupuncture or rehabilitation therapy, then radiographs are a must. These should always be performed with something to reduce the cat’s anxiety and pain during the radiographic study. I prefer butorphanol as it gives 15 minutes of mild to moderate pain control as well as an additional few hours of somnolence, which can help ease the cat’s anxiety while waiting to go home. Just remember, the pain control lasts only about 15 minutes or so after injection; don’t confuse any sleepiness on the cat’s part past 15 minutes as pain control. And a final word on radiographs. Many cats with OA actually form areas of calcification distant from the joint. If you haven’t brushed up on diagnosing OA on radiographs in cats, you may want to explore that further.
Notice the distribution of calcification in this cat with knee OA. There is a typical lesion on the left knee but both knees have areas of calcification proximal to the joint. Sometimes they will even be seen floating in an adjacent muscle. Another reason to consider that cats might actually be aliens.
Utilizing the team approach and minimal hands-on interaction can greatly diminish the FAS in our painful feline patients who are going to be resistant to touch. Now that we have examined that cat with input from the entire veterinary staff, along with the owner and the cat itself, we no longer have a jigsaw puzzle, and can move forward with the therapeutic phase of their OA treatment.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Michael Petty, DVM, a certified veterinary pain management expert and veterinary acupuncturist, is author of Dr. Petty’s Pain Relief for Dogs: The Complete Medical and Integrative Guide to Treating Pain (Countryman Press, February 2016). He owns Arbor Pointe Veterinary Hospital and the Animal Pain Center in Canton, Michigan, and is past president of the International Veterinary Academy of Pain Management.
The pain exam starts with your customer service representative, maybe the most important person in the diagnostic team. They are going to hear the owner say things that an educated customer service representative might recognize as a sign of pain, such as not using the litter box, suddenly fighting with other animals in the house, or hiding in another room. The receptionist then has the ability to ask the owner to video the cat walking across the floor, using a step, or jumping to a favorite spot. The receptionist can also ask them to visit websites, for example 
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.