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Kim Campbell Thornton
Blood draws, chemo, happy vet visits, even training veterinary students: Fear Free makes things work. Here are this month’s success stories.

Chemo for Indy

Indy was a middle-aged mixed-breed dog who developed Stage 3a lymphoma requiring weekly treatment under a CHOP chemo protocol. Only one problem: he was an FAS 4-5 patient who did not like to be touched, let alone restrained. How were we going to treat weekly with IV catheter-administered chemotherapy? Spent a lot of time in the early days fine-tuning a PVP protocol that allowed us to work on touch gradient approach so we could eventually hold his paw and use a regular or butterfly catheter to administer therapy. We always had myself and one specific technician available to work on desensitization with gentle restraint and forelimb holding. Lots of treats. For longer IV treatments, we preemptively sedated Indy. By the end of his treatment cycles, he would walk into the chemo room, sit or lie on a padded mat, and let us treat without incidents. Amazing! It works!

Jeffrey D. Palmer, DVM, Elite Fear Free Certified Professional, Burr Ridge Veterinary Clinic, Darien, Illinois

 

PVP, Tuna Lead to Successful Cat Exam

A new feline patient with a high level of fear, anxiety, and stress went home with gabapentin as a pre-visit pharmaceutical. The exam we performed two days later was great. He was readily eating tuna and happy to be petted. He did well for a complete exam, including radiographs and blood draw. The Feliway-infused towel was also a great help.

Matthew Hudson, DVM, Elite Fear Free Certified Professional, VCA Blum Animal Hospital, Chicago, Illinois

Cat Can Do

We have seen so many success stories with numerous patients, but the best for me is my personal cat. He is an uncontrolled diabetic, and the first year I owned him he had a lot of blood draws and vet visits. He was a wonderful-tempered cat at home, but at the clinic, while he never bit or scratched, he hissed and struggled every time he came out of the cage and became a difficult patient to handle. He is very food-motivated and after we started Fear Free practices and he got squirt cheese and baby food every time he was handled, he now purrs and rubs on everyone when he comes for treatments and is so much happier and easier to handle. I am overall so much more aware of a patient’s anxiety level the moment they walk in the door now, and it gives us a chance to start finding ways to alleviate their stress before it escalates.

Cheri Crane, Elite Fear Free Certified Professional, Customer Service Representative, Healing Paws Veterinary Clinic, Springfield, Missouri

Culture Change

For most of my practice career, I have been involved in student training. Some students embraced the things I taught them about the importance of minimizing fear, anxiety, and stress in patients, while others felt I was “too soft,” “only cared about giving the animals treats,” or “was crazy or misguided in my efforts.” Fellow faculty members sometimes shared these sentiments and even accused me of not being able to “get the job done” when I would elect to postpone or re-plan a procedure for an animal. The revolution of awareness that Fear Free has helped to create in our profession has changed the way I am viewed by students and colleagues. No longer the “crazy Dr. Griffin,” I am the one they ask to teach them about low-stress handling and Fear Free techniques. The art and science of Fear Free have become valued: this is truly a gift for all of us, our patients, and their owners. I look forward to the day when Fear Free is taught in all veterinary colleges and is fully embraced as an indispensable standard of care in veterinary practice.

Brenda Griffin, DVM, DACVIM, Elite Fear Free Certified Professional, Adjunct Clinical Associate Professor of Shelter Medicine, Maddie’s Shelter Medicine Program, University of Florida College of Veterinary Medicine, Gainesville, Florida

Happy Puppy, Happy Vet Visit

I took a client’s puppy to our veterinary office for a happy visit after the previous appointment did not go well for them. We played on the floor, showed off some of their tricks, ate some really yummy food. I was able to ask for a nose target to get up on the scale all on his own! We were able to leave with a calm, happy puppy and his next vet visit went much better.

Jenn Hauta, Elite Fear Free Certified Professional, Fairy Dogmother Training & Pet Care, Nanaimo, British Columbia, Canada

 

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

Kim Campbell Thornton is content manager for Fear Free Pets and is a Level 3 Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985.
Heather E. LewisThe way people interpret color is tied strongly to human culture and language. For example, feeling blue means feeling sad, and seeing red means feeling angry, at least in Western, English-speaking cultures.  But how do animals see and respond to color? The answers are few, as there is little research in this field of study. We can say that dogs and cats see a narrower range of colors than we do. This is because they have traded color vision, biologically speaking, for superior vision at night. Indeed, dogs and cats see much better at night than people do.

Cats have trichromatic vision, just like humans, but they do not see the red end of the human visible spectrum. Dogs have dichromatic vision, which means they do not see anything in the orange and red range in the human visible spectrum. Both species see slightly into the ultraviolet range. This is fascinating as it means that any material that has phosphorous in it, or a whitening or brightening agent derived from phosphorous, will fluoresce slightly under their vision. For example, a piece of paper is a glowing white object to a cat.

Fear Free color palettes have three objectives relating to the little we do know about animal preferences for color and stress reduction for people and animals alike.

  • To avoid anything bright white that may fluoresce. This is the reason behind abandoning a white doctor coat. People often react with stress to laboratory coats, and this is called “white coat syndrome.” If we are trying to create a low-stress medical experience for animals, it is likely best to dress veterinary doctors in colors that do not stand out. Thus, Fear Free practitioners prefer softer colors for coats and scrubs. Architects should also check the building materials we are using in hospital spaces and avoid materials that fluoresce. You can test for this by using a Woods Lamp (a black light used in the veterinary and human healthcare industries for detecting ringworm), in a space with the lights turned off. The lamp will identify materials that fluoresce.
  • To use colors that animals can see well, particularly in low-light conditions. If you were to paint a dog or cat medical ward dark red, and have dim lighting in that space, the space would appear dark grey and shadowy to the animals. A lighter space, painted in hues and tones that are brighter and more toward the blue end of the spectrum, will be more visually understandable to the animals. There is very little research on this idea, but one example is a study in mice, who see similarly to dogs and cats. The study indicated that mice “showed clear and consistent individual preferences for cages when offered a choice between white, black, green and red cages. Overall, most mice preferred white cages, then black or green, and red was the least preferred.”[i]
  • To use colors that are relaxing to people. Think of a spa, and the colors that are used in a spa, which are often toward the bluer end of the spectrum, or they are nature based. Spa color palettes tend to be relaxing to people and remind them to slow down and move carefully and gently. The research of color on human behavior is well understood; fast food restaurants use reds and oranges because they are NOT relaxing, and they motivate you to move along and finish your food quickly, so the booth may be occupied by the next customer. We want to encourage the opposite behavior.

Do not worry about hard and fast rules about color, as they don’t exist. Quite simply, use color as a reminder to yourself to be more considerate of how our animal friends see, and to support a gentler way of being around dogs and cats, and all the animals you care for.

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

Heather E. Lewis, AIA, NCARB, is a principal of Animal Arts, an architectural firm that has exclusively designed animal care facilities, including veterinary hospitals and animal shelters, for more than three decades.  She has worked on dozens of projects across the country, both large and small in her 19 years with the firm.  Heather is a member of the Fear Free℠ Advisory Board and assisted in creating the Fear Free facility standards for veterinary hospitals.  Heather is a regular contributor to various veterinary industry magazines.  She has spoken on the design of facilities for the care of animals at dozens of national and regional conferences including Fetch Hospital Design Conferences, the UC Davis Low Stress Animal Handling Conference, and the Humane Society of the United States Animal Care Expo.
Rachel Lees, RVT, KPA CTP, VTS (Behavior)Teaching cued behaviors, working through desensitization and classical counterconditioning, and clicker training are the glamorous gowns of training plans or behavioral treatment plans. They’re rewarding because this is where owners and veterinary behavior team members can begin to see improvements in the patient.

But preventing and managing undesirable or unwanted behaviors are the foundation garments beneath the fancy dress of behavior modification. Prevention, safety, and management aren’t glamorous, but they are an important part of the plan. If the patient continues to engage in unwanted behaviors, the behaviors will continue to be reinforced (negatively or positively). To avoid this dynamic, the veterinary behavior team must coach clients as much as possible to set the patient up for success and manage any panic, stress, or anxiety present.

Avoiding Triggers and Controlling the Environment

Learning occurs with every interaction. This can work to our advantage when we can strengthen behaviors we like by adding positive outcomes. The goal with prevention is to control the environment and regulate the patient so we can prevent the patient from learning undesirable behaviors during non-training times. An example might be use of crates and playpens to eliminate urine accidents in the home.

Prevention includes setting each animal up for success and manipulating the environment to promote and reinforce desired behaviors. This can be as general as setting a puppy up for success using crate training for assist with elimination training or working with a puppy or kitten during the socialization period to promote positive experiences for lifelong learning.

Prevention can also be as detailed as using white noise to create a sound buffer for a storm-phobic patient or placing an opaque window treatment on front windows to eliminate displays at passersby. Below is a chart with some common behavioral diagnoses and types of prevention that can be recommended for these conditions until appropriate training and behavior modification have been taught and implemented. Some prevention techniques might be temporary, and others might be long-term.

Behavioral Concern Types of Prevention
Aggression during Grooming and Husbandry Behaviors (Familiar and Unfamiliar People) Discontinue all forms of grooming and medical care. If medical or grooming care must be performed (in an emergency) the veterinary team should use sedation to prevent increasing fear, stress, and anxiety during these situations
Inter-Dog Aggression Keep all patients 100% separated to eliminate practice of aggression in any or all potential situations.
Redirected Aggression to a Canine Housemate Eliminate and manage all triggers that may create arousal, aggression, and frustration.  This may include opaque window treatments to eliminate the display at passersby or may include full separation between patients if triggers are unclear.
Fear-Based Aggression to Unfamiliar People Discontinue walks and keep the patient away during all guest visits. This may include using a crate in a place where the patient cannot see visitors. This will help keep the patient as safe and comfortable as possible while the guest is in the home.
Coprophagia Pick up stool immediately after elimination to prevent the patient from ingesting the stool later.

Management: Outlets to Minimize FAS While Practicing Prevention

Providing healthy forms of behavioral management can be helpful in creating a calmer and more confident pet. Providing mental, physical, and environmental enrichment can improve any domesticated animal’s overall wellbeing. Providing enrichment can help pets find appropriate outlets for innate behaviors and physical activity. Enrichment can also help to alleviate tension or any fear, stress, or anxiety the pet may be feeling. Enrichment may be used to eliminate unwanted behaviors such as chewing and destruction by young puppies or to decrease or eliminate barking in the crate during guests’ visits. Below is a short list of different forms of enrichment that can be used together or separately as needed:

  • Puzzle Toys: Puzzle toys that dispense treats or kibble provide human-approved outlets of stimulation, can double as meal opportunities, and can manage and prevent unwanted behaviors such as barking and other attention-seeking behaviors. This type of enrichment can be more mentally stimulating than a 5-mile walk. Advise clients to give these to patients ideally in anticipation of unwanted behavior or after unwanted behaviors have been interrupted. This can set patients up for success, so they do not continue to perform the undesirable behavior.
  • Sound Enrichment: Whether clients are away from home or looking to create a sound buffer to help prevent unwanted behaviors, their pets can be enriched through sound in a variety of ways. “Through a Dog’s Ear” CDs or iCalm units provide patients with biorhythmic classical music. Studies have shown that classical music can help to reduce respiration and blood pressure. DOGTV is another form of enrichment that can give dogs visual stimulation while also providing different forms of classical and calming sounds. White noise machines can be another buffer to eliminate sounds happening outside the pet’s home environment.
  • Enrichment Walks: These walks are an outlet to burn off energy while also allowing the dog to sniff and learn about the environment. In the text “From Fearful to Fear Free,” this type of sniffing is described as a form of social media for your pet. Think “Nosebook” and “Pee Mail.” This same type of enrichment can be used for cats who have learned to walk comfortably in a harness and leash. For patients who have been diagnosed with fear-based aggression issues on walks, enrichment walks can be performed in a space with limited human and dog contact such as industrial parkways.

There are many different forms of prevention and management. This article discusses only a few of the options for some diagnosable behavioral issues. This is something that can be recommended by any veterinary team member if a client and patient are waiting to be seen by a veterinary behaviorist. Suggestions such as using baby gates at doorways to prevent dog fights or keeping a patient leashed to a person can be lifesaving recommendations. Stating some of these more obvious recommendations is essential because not every client or dog trainer understands the importance of management and prevention.

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

Rachel Lees, an Elite Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and lead veterinary behavior technician at The Behavior Clinic in Olmsted Falls, Ohio. She loves helping people create and maintain a strong human-animal bond.
A sick dog is lying on the carpet. Treatment of dogs at home
Mary Ann Vande Linde, DVM, Vande Linde & Associates, Brunswick, GeorgiaOsteoarthritis is the most common joint disease diagnosed in humans and pets. What does this mean to a veterinary team? It means that a high percentage of pets and their owners have some familiarity with the discomfort and pain of joint disease. I’m sure we have all had clients tell us they have noticed a change in their pet’s activity, but they usually pass it off as normal for his/her age or suggest their pet is just “slowing down.” This belief does not mean that they don’t care; they just do not understand that what they are seeing may be due to pain. There are some simple communication tools your team can utilize to add value and increase a client’s understanding and acceptance that osteoarthritis (OA) is not normal, and their pet has options.

One of my mentors once told me “never tell a client what you can show them.” A client may see their pet hiding or not playing, and they will need assistance determining if their pet is painful or fearful. Using the Fear Free Strategies of Considerate Approach (CA) and Gentle Control (GC) allows the pet to be comfortable enough to exhibit OA signs in the client’s presence. With CA, a relaxing atmosphere can be created where the pet can have room to move and be observed. Adding pheromones to help keep them calm and non-slip surfaces both on and off the exam room table enables them to safely explore. In addition, with GC, veterinarians can examine the pet where he or she prefers and is most comfortable. Make sure to plan ahead by having materials easily accessible, and have assistance available in the room so the veterinarian can keep a gentle reassuring hand on the pet. Later during the physical exam, the doctor can communicate how their assessment relates to what the client sees their pet experiencing.

To be efficient and consistent communicators, teams need tools that open clients’ minds to possibilities.  The Zoetis Canine and Feline OA Screening Checklists can be a discussion starting point. These checklists have “cartoons” of cats and dogs doing common activities around the home that have been identified through research as top behaviors that can indicate OA pain.1,2

This visual checklist allows the client to see their pet’s behavior changes through the animations.  They can see how a healthy cat moves compared to a cat who has unhealthy changes from OA pain. With a checklist a client can tell the veterinarian what they see in comparison to the pictures, or they can review a video of what their pet is doing compared to the cartoon. By reviewing the checklist with a trained technician or veterinarian, the client can offer insight into how they view their pet’s mobility, behavior, and daily comfort. This checklist can be used prior to any exam with an email electric copy, or completed in the room by computer, phone, or as a printed hard copy. This could be a valuable addition to any biannual or annual checkup.

Age is not a disease. And we have tools, strategies and skills that make client discussion interactive, efficient and fun. Clients love to learn about their pets, they want a plan, and they want to feel confident they have made good decisions. Combining the tools of an interactive team checklist, Fear Free strategies of CA and GC and using open questions with active listening create productive discussions, save time, and produce healthier teams and pets. Go ahead talk about OA with these tools: it’s painless.

References

  1. Enomoto, M. (2020). Development of a checklist for the detection of degenerative joint disease-associated pain in cats. Journal of Feline Medicine And Surgery
  2. Wright, A. (2019). PVM1 Diagnosis and treatment rates of OA in dogs using a Health Risk Assessment (HRA) or Health Questionnaire for OA in general veterinary practice Value In Health22, S387
  3. Adams, C., & Kurtz, S. (2017). Skills for communicating in veterinary medicine. Oxford: Otmoor Publishing.

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

Sponsored by our friends at Zoetis Petcare. NA-02335

Tony Johnson, DVM, DACVECC
Let’s just get this right out of the way first: animals feel pain.

They have different pain tolerances, just like people do (if I step on my pit bull Gwen’s toe, she never notices, but if I accidentally do the same to my Pomeranian, Turley, she’ll scream, run and hide, and not speak to me for days) but sensing pain comes hand-in-hand with having a complex neurosystem and a big brain.

The challenge for us as veterinarians is how we detect and react to their pain.

To address the complexities of animal pain and its management, the International Veterinary Academy of Pain Management (IVAPM) has declared September to be Animal Pain Awareness Month. (https://ivapm.org/animal-pain-awareness-month/) It’s also Pain Awareness Month for another group of big-brained animals – people.

Treating animal pain will always involve some guesswork until someone develops a way for dogs and cats (and horses and iguanas, etc.) to point to their anatomy and say “It hurts right here, doc.” Until that beautiful day, we have to tease out the sometimes-subtle signals of discomfort and adopt a trial-and-error approach, backed up by science whenever possible.

As an ER clinician, acute pain is what I deal with most. I do see animals with chronic pain, and try to help whenever I can, but for those patients I encourage pet owners to seek the counsel of their family veterinarian, since chronic pain will take a solid partnership spanning weeks or months – things that are impossible in the rushed setting of the ER.

With that as preamble, I’ll share some tips from 25 years of ER pain management.

  1. If a condition is known to be painful, treat for pain. Blocked cats are painful. Pancreatitis is painful. Pyelonephritis hurts. Some diseases have pain baked in, and treating pain should always be part of the initial management plan, yet I very often see pets with diseases such as pancreatitis and urethral obstruction go without pain medication. Until the disease has calmed down, assume pain is present and treat for it.
  1. Recognize the signs of pain. Is that cat sitting at the back of the cage hissing because he is afraid, or is it pain? Is the usually sweet and slap-happy Golden now snapping at the kids because his ears hurt? Recognizing an animal in pain is an important first step in managing pain. A trial of pain medication (perhaps even combined with appropriate sedation) can help tease out the complex web of animal pain responses and decrease the fear, anxiety, and stress of painful conditions and hospitalization. Using a validated pain scale (available at https://ivapm.org/, and many other places) can also help to quantify and track pain during treatment.

AAHA, in 2015, developed guidelines for small-animal practitioners that clearly outline ways to monitor and manage pain: https://ivapm.org/wp-content/uploads/2017/03/2015_aaha_aafp_pain_management_guidelines_for_dogs_and_cats-03.10.17.pdf

  1. Use the right class of medication for the disease. Let’s look again at blocked cats and patients with pancreatitis. A blocked cat who is non-azotemic and going home might benefit from an NSAID used cautiously. A blocked cat with a K+ of 8 and a creatinine of 4? The medical board will be knocking at your door if you give an NSAID.

Same holds true for a dog with raging pancreatitis. If he’s vomiting every time the wind blows, an NSAID will only make matters (way) worse. Opioids have minimal GI effects beyond constipation (which I have not seen as a major problem), and we use tons of opioids in the ER and ICU to manage pain. Our brains (and those of our patients) are hard-wired to receive opioids – it’s a gift from evolution and nature. Use it.

Why do brains have receptors for chemicals produced by a poppy largely grown in the Middle East? I have no idea, but for the sake of my patients I am thrilled that they do, and I make use of it every day I am on the clinic floor.

The opioid crisis has certainly made giving opioids a challenge, with increased regulation and paperwork and changes in the supply chain making some drugs unavailable. Try to keep abreast of what’s on and off the market and do your best to make sure you always have a few options for good pain control on hand. I think every hospital needs to have a full mu agonist such as fentanyl, morphine, or hydromorphone on hand for treating severe pain. Butorphanol is great as an adjunct for sedation for minor procedures like lacerations, but it’s just not potent enough for cases of moderate to severe pain.

  1. Sometime more is more. Treating pain with multiple different approaches can result in better pain control and lower doses of any individual medication. Using a lidocaine sacrococcygeal block to help unblock a cat, combined with a full mu agonist like fentanyl, or an opioid agonist/antagonist like buprenorphine, can treat pain from different angles, as well as make unblocking easier.

Look for creative ways to address pain, using different techniques such as local blocks, epidurals, and topical lidocaine patches. Combining classes of drugs such as NSAIDs and opioids, in carefully selected patients, can achieve results that higher doses of either drug can’t achieve.

I have found that learning new techniques can be a great way to fend off burnout and makes me feel as if I am growing as a clinician. Learning new pain management skills aids me in fulfilling my obligation to alleviate animal suffering. Enrolling in CE classes, attending online seminars, and even brainstorming with colleagues can open new worlds to the clinician who wants to learn and grow. It can also make great financial sense to a practice, as owners now accept and even expect advanced pain-control modalities.

The IVAPM offers consultations in pain management and pathways to become IVAPM-certified as a pain management practitioner. (More info at https://ivapm.org/).

We all want our patients to live long, pain-free lives. Learning about pain and learning new ways to manage pain and recognize it will serve our patients better and help us grow as doctors and people.

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

Dr. Tony Johnson, DVM, DACVECC, is a 1996 Washington State University grad and obtained board certification in emergency medicine and critical care in 2003. He is currently Minister of Happiness for VIN, the Veterinary Information Network, an online community of 75,000 worldwide veterinarians, and is a former clinical assistant professor at Purdue University School of Veterinary Medicine in Indiana. He has lectured for several international veterinary conferences (winning the small animal speaker of the year award for the Western Veterinary Conference in 2010) and is an active blogger and writer.
 
 

Course Overview

Pain is not just physically unpleasant for animals. Beyond physiological symptoms such as GI dysfunction, immunosuppression and delayed wound healing, pain also affects animals emotionally and increases FAS. If not controlled, acute pain can lead to central sensitization, chronic pain states, increased morbidity and increased mortality.

If left untreated for too long, pain can become maladaptive and lead to a vicious cycle of reduced activity, weaker muscles, even less exercise, and even more pain. This course will show the importance of treating pain early and why doing so can lessen its overall impact on patients.

This course, approved for 1 RACE CE hour, was written by Ralph Harvey, DVM, MS, DACVA, UTCVM.

This course consists of 6 lessons. 

  • Lesson 1: Defining and Classifying Pain
  • Lesson 2: Surgical and Post-Operative Pain
  • Lesson 3: Chronic Pain
  • Lesson 4: Pain from Cancer
  • Lesson 5: Impact on the Human-Animal Bond
  • Lesson 6: Modern Analgesic Therapies

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Stand-Up Comedy with Dr. Kevin Fitzgerald

We invite you to join us for the second installation of our Fun Webinar series to break up your stressful weeks with something to look forward to! These webinars are for our human clients and intended to give you a mental break, learn something new and fun, or cater to your own emotional and mental wellbeing.

We’ve been told laughter is the best medicine, so we’ve asked comedian Dr. Kevin Fitzgerald to fill our prescriptions. Best known for his 11 seasons on the popular Animal Planet television series “Emergency Vets”, Dr. Kevin Fitzgerald practices small animal medicine at VCA Alameda East Veterinary Hospital in Denver, continues to do research, has authored over a hundred peer-reviewed scientific articles, and is on multiple boards for different Denver-area veterinary and zoo associations. In addition to his veterinary career, Dr. Fitzgerald has been performing stand-up comedy since 1986, opening for and working with performers such as Joan Rivers, Bob Hope, Kevin Nealon, Brian Regan, and Norm McDonald.

Dr. Julie Reck, Owner, Veterinary Medical Center of Fort Mill, Fort Mill, South CarolinaMore than ever, pet owners have a strong bond with their pets. That means they are expecting their pet’s experience at the clinic to be enjoyable. Fear Free provides that excellent “customer” experience for both the pet and the pet owner. However, a client’s first Fear Free experience will likely be different from previous veterinary visits and could seem strange. It is important to ensure that each client fully understands that Fear Free considers both the medical and emotional well-being of their pet and realizes the significance of taking both aspects of the pet’s care into consideration.

Three Key Messages for Our Practice

  1. We believe in the power of positive reinforcement. Patients will be treated kindly and receive lots of treats and verbal encouragement.
  2. Fear Free is reinventing the definition of a successful veterinary visit. It is no longer acceptable to “just get it done.” We take into consideration where the patient is emotionally and proceed appropriately, which may mean that some things will not get done during a visit. For example, toenail clipping may have to be done another day if the patient elevates to moderate signs of fear, anxiety, and stress (Level 3 FAS).
  3. Our hospital has a consistent approach to handling and treating our patients: Everyone is practicing Fear Free techniques with every patient.

Below are tips for successfully communicating the benefits of Fear Free to your clients.

Maximize Your Social Media Presence

Currently I have owners seeking out my clinic specifically for the Fear Free experience, but in the beginning this was not the case. It became obvious to me that the benefits of the Fear Free visit needed to be stated clearly in all my communications.

For the pet owner, the Fear Free journey begins before they get to the clinic. I want my clients to be educated consumers, so they “know before they go,” or, in other words, they know what to expect when they arrive at my clinic. My website and my clinic’s Facebook page fully communicate this to pet owners. We take a proactive approach to prepare the client for a positive experience. This includes stating our philosophy on what a good veterinary experience looks like for the pet and the pet owner using videos, testimonials, news feeds, or stories to keep pet owners informed and prepared for that great Fear Free experience.

The Customer Service Representative (CSR) Prepares the Client and Pet for the Visit

Our CSRs are the next line of communication. They are trained to answer any questions about Fear Free and are critical in making sure that the pet arrives safely and prepared for the visit.

Safety includes recommending that the pet is either in a carrier or harnessed/seat belted while in the car, and that they have a collar and leash if walked into the clinic or stay in the carrier until in the exam room. The carrier can provide the pet a sense of comfort.

Being “prepared” for the visit means making sure the pet arrives hungry and that we have their favorite treat ready for them when they arrive. A day or two before the visit, we send the owner a reminder email and/or text with these same instructions.

Continuing to Communicate During the Examination

The examination provides an opportunity to have a conversation with the pet owner, allowing them to feel more involved with the entire process. I will explain what I am doing, such as standing behind the patient instead of examining their head and face first. I will also describe the patient’s emotional status based on the patient’s body language and my physical findings. This prepares the owner for any diagnostic and/or treatment recommendations that I make, and they are more likely to be compliant with my plan.

Additionally, if the patient’s level of FAS does not allow the completion of the exam or planned procedures, such as nail clipping, the client will be more likely to understand because of the ongoing conversation about the patient’s behavior and emotional status.

It is also important that the pet owner understands their pet’s level of fear, anxiety, and stress will change, based on the situation. A dog who typically loves coming to the clinic may behave differently when coming in for examination and treatment of a painful ear infection. Where we may have never needed to sedate in the past, it is necessary now to ensure that the patient had the best possible experience because the dog’s pain has exacerbated his level of fear.

For patients with a history of severe veterinary visit FAS who we are seeing for the first time, we will inform the pet owner that the first visit will be a consultation. We take the patient’s history, perform a visual examination, but forgo the physical examination to keep the FAS level as low as possible. We may prescribe PVPs and/or schedule a series of “Happy Visits” where the patient arrives, receives treats, then leaves before we ever get to the hands-on physical exam.

What About the Client Who Fails to See the Benefits of Fear Free?

For clients who are more interested in “just getting it done,” I will inform them that the goal is to consider the long-term emotional wellbeing of their pet rather than the short-term approach of “just getting it done.” Some clients will understand and comply. For those who do not, we will agree to disagree and part ways.

It is important that the clinic owner and staff back this decision and uphold the values the Fear Free team has agreed upon. This is especially true if the pet owner is loud and unpleasant. Professional affirmation for the decision and support from colleagues can reinforce that one negative encounter with a client cannot undermine all the positive feedback and improved patient outcomes that comes with being Fear Free.

I have found that it is the small consistent changes that accumulate over time that get you to Fear Free. You might start with pheromones and see a subtle difference, then add in Considerate Approach and Gentle Restraint with liberal use of treats and see more of a change. As you continue to master the techniques and communicate the benefits of Fear Free, you will find that you and your staff are emotionally enriched, your clients have a renewed feeling of trust and bonding to you, and your clinic and your patients are actually happy to see you!

Sponsored by our friends at Zoetis Petcare. NA-02292

Heather E. LewisNoise is a notorious problem in shelters. When we reduce noise in shelters, we also moderate factors that cause fear, anxiety, and stress. Controlling noise is both an art and a science. Here are some helpful tips:

  • Create a calm environment and reduce mental stress. Because dogs cause the noise, it is important to ease dogs’ mental stress, so they feel less prone to barking. Regular exercise, outside time, supervised play groups, and walks help them to use their energy in positive ways. Creating feeding, cleaning, and bedtime routines in the shelter whenever possible so dogs know what to expect can also reduce their stress. Limit unpleasant stimulation as much as you can given your means. For example, for some dogs with barrier anxiety, it can be helpful to place a partial barrier on the fronts of their runs, so they have a choice of retreating from visual stimulation. And although it is sound, specially composed calming music may help to relax dogs and promote less barking. When played at low volume, it is meant to create calm rather than to mask noise.
  • Reduce the reverberation. Once you have done everything you can to lower stress through behavioral means, this is when building materials become more effective. Your best place for noise reduction is the ceiling! Choose a ceiling material with a high Noise Reduction Coefficient (NRC). The material should also be cleanable and antimicrobial. This is not impossible, as ceiling materials have improved. We like the Rockfon Medical Plus ceiling panel. This product achieves an NRC of .9, which means that 90 percent of reverberant noise within a tested frequency range is absorbed by the material.
  • Absorb the sound. In addition to the ceiling, you can place sound-absorbing panels high on the wall to reduce noise in the space. Please note that these sound panels are not enough on their own; they must be paired with the ceiling. Choose a panel with a high NRC and choose the thickest product offered as this one will absorb noise in a broader frequency range. Sound-absorbing panels do not need to be ugly! We use products that can be printed with a photo or image for a custom look.
  • Contain the noise. Beyond absorbing noise, it is also important to prevent it from affecting other shelter occupants, especially cats. We do this by ensuring that rooms containing dogs also contain the noise. The best way to do this is to build a wall with heavy mass (concrete block, etc.) around the dog housing. You can achieve the same result by layering materials. For example, a stud wall with sound insulation and two layers of drywall on each side will be much better than a stud wall without those materials. Keep in mind that a sound wall is only as good as its weakest point. To design an effective sound wall, do the following:
    • Build the wall up to the structure, so no sound “flanks” over the top of the wall.
    • Seal penetrations through the wall, such as duct and conduit penetrations.
    • Install gasketing around doors into the room, and a sweep on the bottom of the door.
    • If there are windows into the room, provide double glazing in the windows.
  • Separate dogs from other spaces. Despite doing the above, dogs are still loud. We recommend having more than one wall between dogs and cat spaces, or dogs and other quiet spaces such as offices. If the cats are right next to the dogs in your shelter, consider moving them to another room in the building, if possible.
  • Mask the noise. As a last resort, you can use masking noise to make your shelter feel more pleasant. An example of masking noise is soft white noise. While these sounds can be effective, we put this at the bottom of the list to encourage you to truly solve your noise problems first.

Your shelter does not have to be noisy! With a multifaceted and rigorous approach that begins with reduction of mental stress for dogs, you can create a much more peaceful, Fear Free place for animals and people.

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

Heather E. Lewis, AIA, NCARB, is a principal of Animal Arts, an architectural firm that has exclusively designed animal care facilities, including veterinary hospitals and animal shelters, for more than three decades.  She has worked on dozens of projects across the country, both large and small in her 19 years with the firm.  Heather is a member of the Fear Free℠ Advisory Board and assisted in creating the Fear Free facility standards for veterinary hospitals.  Heather is a regular contributor to various veterinary industry magazines.  She has spoken on the design of facilities for the care of animals at dozens of national and regional conferences including Fetch Hospital Design Conferences, the UC Davis Low Stress Animal Handling Conference, and the Humane Society of the United States Animal Care Expo.
Rachel Lees, RVT, KPA CTP, VTS (Behavior)We’ve all seen the many animal-training programs on cable TV and streaming networks. Some of the concepts depicted in these programs are appropriate for veterinary behavior cases and some are questionable. This article will discuss the learning theories and training philosophies demonstrated in these programs and review why veterinary behavior professionals are using alternative protocols.

Whether you are a veterinary team member working in general practice or interested in behavior, it is important to recommend up-to-date Fear Free information for patients and clients. Giving outdated information can potentially damage the human-animal bond and potentially end with the patient being rehomed or even euthanized.

The first part of this blog post looked at punishment. Punishment is not recommended in treatment as it can slow learning and cognition, suppress behavior, increase fear and fear-based aggression, create damaging and unintended associations with owners and other environmental stimuli, and damage the human-animal bond.

This blog post discusses “dominance” theory,  a commonly used training philosophy recommended by many traditional trainers. We will dive into the origins of this concept and discuss current recommendations.

Do You Really Need to Be Alpha?

The word “dominance” is one of the most misunderstood terms in veterinary behavior. The dictionary defines dominance as “the predominance of one or more species in an animal community.” The word predominance is defined as “possession or exertion of control.” When reviewing these definitions, it is hard to imagine that some trainers use them to describe how to train domestic animals. When an owner shows “exertion of control” over a pet, it increases the likelihood of behavior suppression, increased fear and anxiety, and can make owners and their actions conflicting to the pet.  This can damage the human-animal bond and even increase owner-related aggression.

Here is the question veterinary professionals and owners have asked for years: If this training is so aversive, why did we start using it in the first place? In 1947, a Swiss scientist, Rudolph Schenkel, published a paper suggesting parallels between domestic dog behavior and that of wolves. In 1970, wildlife biologist L. David Mech built on that notion in his book “The Wolf: The Ecology and Behavior of an Endangered Species,” reinforcing the “alpha wolf” idea Schenkel had promoted (a concept Mech recanted later in his career after studying wolves in the wild). The adapted theory had gone as far as to assume that the human family makes up the dog’s pack, and if behavior problems are present, it is because dogs are working to raise their social rank in the “pack.” But as science has advanced, so has our understanding of canine behavior.  Schenkel’s and Mech’s research had significant flaws, including the following:

  • Their original research was based on captive wolves. These captive social groups show little resemblance to the normal behavior of free-living wolves. Free-living wolves are all related to each other, which is quite different from artificial colonies of captive wolves.
  • Dogs and wolves may be from the same “genus” but are not the same. When these theories were published, they did not take into account the 15,000 years of domestication that separate modern dogs and wolves. These theories were generalized to the human-dog relationship and resulted in increased human-related aggression and behavioral problems. Comparing a dog to a wolf is like comparing a human to an ape. We are similar but not the same.
  • The original ritualistic body language displays were misinterpreted as forcible dominance displays. For example, it was reported that the “dominant” wolf will place the subordinate onto the ground. In reality, the subordinate or more fearful wolf will voluntarily assume this position to avoid conflict in a ritualistic appeasement behavior, which is the opposite of the original findings.

Meghan Herron, DVM, DACVB, at Ohio State University, published research concluding that use of forceful techniques can increase the likelihood of aggression toward owners. Unfortunately, the conflict inherent in the alpha-dog theory makes for appealing television, so the idea has been widely disseminated. Veterinary behavior professionals are now working to teach updated concepts that will enhance the bond between humans and dogs instead of putting a barrier between them.

As veterinary professionals it is important that we ask questions about training recommendations and behavioral concerns at each physical exam to confirm that clients are getting the most up-to-date behavior and training information. Clients value your opinion and recommendations and your advice can be lifesaving. Observe training classes you may recommend to ensure that they use Fear Free techniques.

Recommended Reading for Owners or Veterinary Professionals 

  • From Fearful to Fear Free
    • Author(s): Marty Becker, Lisa Radosta, Wailani Sung, and Mikkel Becker
  • Decoding Your Dog
    • Author(s): The American College of Veterinary Behavior
  • Dog Sense
    • Author: John Bradshaw

Other Resources 

Herron, Meghan E. Shofer, Frances. Reisner, Illana R.  2009. Survey of the use and outcome of confrontational and non-confrontational training methods in client-owned dogs showing undesired

Shaw, Julie K.  Martin, Debbie. Canine and Feline Behavior for Veterinary Technicians and Nurses.  John Wiley & Sons, Inc. 2015.

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

Rachel Lees, an Elite Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and lead veterinary behavior technician at The Behavior Clinic in Olmsted Falls, Ohio. She loves helping people create and maintain a strong human-animal bond.