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Fear Free Success Story: Hanover Veterinary Hospital

Sandra ToneyHanover Veterinary Hospital in Cedar Lake, Indiana, has the distinction of being the first veterinary hospital in the Northwest Indiana region to become Fear Free Practice certified.

Lindsay Pollard, FFCP (Veterinary), the hospital’s practice manager, says they began trying out some Fear Free methods after hearing about the concept. “A few of our staff members obtained individual certifications,” Pollard says. “After learning more and attending a few conferences where Fear Free was highlighted, we decided to go all the way.” Hanover Veterinary Hospital completed the program to become Fear Free certified in December 2018.

When deciding to become a Fear Free Practice, the biggest difference has been in the way he interacts with the animals after certification, says owner Jeremiah Bieszczak, DVM. “The biggest change has been reading body language and emotional state/stress level and addressing that instead of pushing through it. We are better able to read pets and have more tools and knowledge to deal with these situations.”

Many long-term clients are delighted with the constructive visits they’ve had with Fear Free, and new clients are thrilled with the difference between them and their previous veterinarian, says Pollard. Oftentimes they mention the care and compassion used when handling their pets. Pollard feels they’ve made much progress with many of the patients since becoming Fear Free certified.

Fear Free helps all pets, but scared pets often need Fear Free much more to turn their lives around. Pollard has one patient in particular whom she’ll always remember and says Fear Free methods changed everything for this dog.

The pet was a 14-year-old female shepherd mix. Sally, who has since passed away, desperately needed help. “Prior to our Fear Free certification, both Sally and her owner, Sara Zilz, dreaded coming to the vet. She also had some fear aggression and anxiety issues at home. She had a very high FAS and was fearful to the point of aggression,” says Pollard. “Our exams with her were very limited at best and it took several staff members to accomplish anything with her at all.”

Sally had been adopted by Zilz from the humane society when she was 9 weeks old. She didn’t notice any problems with Sally until she took her for training and Sally became spooked by large signs in the store hanging over her head. Then she began showing other fearful behaviors. Zilz says Sally disliked smoke from the grill and even hated when someone blew out a candle. She started having food-guarding issues and was even afraid of shadows on walks.

Zilz says she never thought about potential problems at the veterinarian’s office. “I had her boarded at Hanover. Dr. Bieszczak came out when I picked her up and nicely said something along the lines of ‘She needs to be medicated before we will take her for another boarding.’ This broke my heart. I did not realize she was that bad.”

A veterinary technician named Bobbi became Sally’s best friend when she was boarded. Bobbi would sit in her kennel with her and try to get her to come out. She wouldn’t even go outside to potty.  Bobbi called Zilz several times and asked if she could do some things to help her. After that, Bobbi became Sally’s veterinary technician of choice.

After they became Fear Free certified, Bieszczak started Sally on fluoxetine, an anti-depressant. This medication was a game-changer for her. Pollard says they also started doing happy visits with Sally, using treats with her during exams and treatment, and including calming pheromone products during her happy visits and exams/treatment.  They also tried to keep the same staff member working with her all the time, and kept detailed notes on her likes and triggers, constantly adapting their plan and approach to better suit Sally individually.

“She made more progress with each happy visit and regular visit until eventually she was happy to see several staff members,” Pollard says, “and she was happy coming into the building. Sally would readily accept most treatment from us with the help of some treat distractors and enforcers.”

“At one point, I felt everyone wanted to give up on Sally. Once I saw the Hanover Veterinary Hospital staff was not giving up on her, I knew things would be okay,” says Zilz.

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.
 
 

How Scent Affects Patients and Clients in the Clinic

Susan M. Ewing

Both dogs and cats rely heavily on scent to interpret their surroundings while humans rely more on sight. Blindfold a human just before a visit to a doctor or emergency room, and the stress level would be higher than if the person could see, but most people would at least be able to hear and understand what was happening in the way of treatment. We can’t explain to our pets what is happening, or why they are in a hospital. Take away their sense of smell and you’ve taken away their ability to interpret their world, adding more stress to an already stressful situation. By understanding the effects of scents, you can help them stay calm.

Ban Bleach

No one intentionally stops a dog or cat from smelling, but disinfectants can do just that. Bleach and other disinfectants with a harsh odor can make a pet “nose blind,” creating stress when they try, and fail, to learn about their environment. In one study, “Minimising Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can be Done About It” (published online in Veterinary Sciences, April 13, 2017), lead author Janice K.F. Lloyd cites Karen L. Overall, VMD, in the Manual of Behavioral Medicine for Dogs and Cats: “A solution of bleach, even as low as 1 percent, can destroy olfactory neurones, resulting in a loss of information and heightening anxiety.”

While disinfecting is essential, using one that doesn’t have a harsh odor may help to lessen the negative effect on a pet’s nose. At Applebrook Animal Hospital in Ooltewah, Tennessee, Kathryn Primm, DVM, uses Rescue disinfectant, a hydrogen peroxide product with little odor, which also dries quickly.

Scents From Other Animals

When pets are able to smell, identifying stress in other animals can increase their own level of stress. Secondarily, humans may also experience some stress when smelling clinic odors. Most pets are quick to respond to their owners’ emotions, and if that emotion is stress, it’s going to affect the pet.

“When we have bad odors suddenly, like anal glands,” says Dr. Primm, “it is critical that they be cleaned and deodorized completely, or they will cause fear in all the pets that perceive them.” For those kinds of odors, Primm uses K.O.E. (Kennel Odor Eliminator) by Thornell, a product that quickly eliminates odors and comes in a concentrate, a spray, and individual wipes.

Sometimes, when possible, opening a window can help. Many pets will become distracted from their environment as they process scents from outdoors. Synthetic pheromones may also help to calm a dog or cat. Plug-in pheromone diffusers may reduce stress in a waiting room, and doctors or technicians can spray their clothes with the pheromones. Use diffusers or sprays with caution around birds and fish.

Many people appreciate the calming effects of lavender and chamomile, and both of these scents seem to calm pets, too. Be careful how you use them, though. Certain diffused essential oils can cause some respiratory distress in cats so use them with caution, and alert clients to the risks of active diffusers in the home to pets.

With so many pets depending on their noses for information, it makes sense to pay attention to scents.

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

Ways to Minimize Stress Diarrhea In Patients

By Deb M. Eldredge, DVMWe have all been there. The embarrassed client who pokes her head in the door and asks if we have a hose to clean her dog off. The carrier with the yowling cat and the fetid odor with an owner who is embarrassed and says her cat “might need a little cleaning and could the carrier be cleaned too?”

Plan Ahead

Even before you work on the stress aspects, think about how to physically minimize chances of stress diarrhea. Ideally these pets are scheduled early in the day for their office appointments. That way the owners can skip the pet’s morning meal – and maybe even the evening meal of the night before if need be. Less in means less out. Obviously doing this depends on the health of the pet and how the owner manages feedings but it might be a solution.
There may be dietary changes that help with a specific pet. Think plain canned pumpkin for fiber to help keep stools firm. Advise owners to avoid any special or extra treats for a day or two before the appointment.

Travel Trauma

A careful history can enlighten you about the cause. Is it the car travel? Some pets just don’t handle car rides well. Or is it only when the pet actually senses and anticipates a veterinary visit? Sometimes it is both factors. The important thing to realize is that Fear Free procedures must be instituted ahead of the veterinary visit to help these animals.

If it is the car travel, consider dispensing anti-nausea medications ahead of the visit (yes, vomiting often accompanies stress diarrhea). Look at calming combos that help with travel anxiety such as Travel Calm, an essential oil combo for dogs who get carsick. Send clients home with canine or feline pheromone products—wipes or sprays—that the owner can use in the carrier and car to and from the clinic. For patients who have a history of travel-related diarrhea, offer to prescribe PVPs—pre-visit pharmaceuticals—such as gabapentin or trazodone to help them relax.

Encourage families to give the nervous dog an extra-long walk and possibly some playtime early on the morning of the appointment to try and stimulate bowel emptying before the dog gets in the car or enters the clinic. Playtime at home for a cat might help as well.

Counterconditioning

Long term, especially if the diarrhea is specifically associated with arriving at the veterinary clinic, you can try some counterconditioning techniques to help put a stop to loose stools. Encourage owners to take their pet for short trips ending up in the parking lot of the veterinary clinic. Then dogs can get out and get some special treats or, even better, some playtime with a favorite toy such as a tug. Cats can get favorite treats. Then happily turn around and take them home. Pets will come to associate trips, even trips that end up at the dreaded vet clinic, with some good things.

As pets deal with a clinic utilizing Fear Free practices, the fear and panic they previously showed when traveling to or arriving at the clinic should subside. As fear and anxiety decrease, so should episodes of stress diarrhea. Everyone will be happier!

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

Nutraceuticals for Fear, Anxiety, and Stress? What to Consider

By Linda LombardiDo you have clients asking about using nutraceuticals for their pets’ behavior issues? Here’s a primer on what they can—and can’t—do.

The term “nutraceutical” is a mashup of “nutrition” and “pharmaceutical.” Beyond that, because they’re unregulated, there’s no legal definition, and every journal article you read will likely start by spending several paragraphs grappling with this fact. For practical purposes, nutraceuticals are food-derived substances that are claimed to have an effect on health. For example, alpha-casozepine, derived from milk protein, affects neurotransmitters in a similar way to benzodiazepines and may help reduce anxiety.

Looking at a list of these products, their claimed effects, and how they’re sold, it can be a little difficult to see how they are different from drugs–after all, some drugs are derived from nature, too. Lisa Radosta, DVM, DACVB, of Florida Veterinary Behavior Service in West Palm Beach, says, “They are really in my mind not that much different from drugs, except they’re unregulated, but in the mind of the consumer they are different because they are ‘natural,’ and that is something that a lot of people are looking for.”

The desire for something “natural” can be based on misconceptions both about nature and about drugs. “Natural” doesn’t necessarily equal “safe”: the natural world is chock-full of poisonous substances. In some cases, clients may simply need some reassurance about the drug options.

“When clients are thinking of behavior meds, they’re thinking of sedatives that will ‘turn their animals into zombies’ and change their personalities,’ says Jill Orlando, DVM, DACVB, of Carolina Veterinary Behavior Clinic in Raleigh, North Carolina. “When they think of a supplement, they don’t think it’s going to affect their animals as strongly as what they perceive a behavioral drug does.” She also notes that people may unconsciously project the stigma of human mental illness–and the associated medications–onto their pets.

But there can be reasons to consider these products beyond client psychology, if only because there are so few approved medications for fear, anxiety, and stress in animals. The trick is to sift through the research to figure out the safe and effective choices.

Dr. Radosta prefers to use the term “supplement” to also include products derived from herbs– essentially all the products clients may find on the internet or at high-end pet stores and bring in to her with questions–and they all require the same careful consideration, first, for safety.

“A lot of these supplements haven’t been given to a group of dogs to see what they do to the liver, to the kidneys; nobody knows,” she says. “So that’s kind of scary. On the other hand, we shouldn’t throw the baby out with the bathwater. The research does show that some of them can offer benefits for fear, anxiety, and stress in animals. We don’t want to throw things away just because they aren’t a drug, but we also don’t want to assume they’re safe.”

Consider the source of a product. “What I tell my clients and veterinarians is, we try to use supplements from companies that we trust–as much as you can trust a company. We try to use supplements made by pharmaceutical companies. It’s not that I love pharmaceutical companies, but it’s that I can hold someone responsible.”

Whatever the source, read the research and evaluate the evidence yourself. Given the lack of regulation, you first need to know if a product has been properly tested for safety in dogs and cats. “For me, that’s key. Did someone give this to a bunch of animals? What is the LD50? Do we know? We shouldn’t be playing around with an animal’s life.”

Regarding evidence for effectiveness, methods of studies can vary widely. One thing to consider, says Orlando: “Is the research done on the actual product, or is it done on the functional ingredient in that products? That’s not to say that that information isn’t useful, but it doesn’t necessarily prove that product is effective.” Other factors include but are not limited to the following:

  • Species used in the study: was the research done on dogs and cats or only on rats and mice?
  • What condition was studied? If a study was narrowly focused on, say, separation anxiety, the substance may not work for other types of anxiety.
  • What was evaluated? Actual behavior or physical measurements such as stress hormones? Both types of studies have strengths and weaknesses.

If you’re still not sure, Dr. Radosta says, consult a veterinary behaviorist—that’s why they’re there!

Once you’ve decided on a product, Dr. Radosta says, make sure clients have reasonable expectations about efficacy. The common expectation that “natural” means “won’t affect the animal as strongly” is correct; it means it’s not going to have as strong a beneficial effect as a drug. Where you might get a 50 percent effect on a behavior from a drug, you can expect about half that from a supplement. “That in my practice is considered a positive outcome, and the day the client takes the supplement home I make that very clear,” she says. “If you say your dog is 25 percent changed, that’s a success.”

Because effectiveness is reduced, more than one supplement may be needed. One of Dr. Radosta’s clients whose dog has an extreme storm phobia now administers 11 capsules a day, a regimen that might add more stress for some owners and pets. These products also tend to be more expensive than their pharmaceutical counterparts, a cost that can add up quickly.

Finally, with either supplements or medications, the ideal solution relies on more than just pills; it should also involve behavioral modification. Realistically, though, this isn’t always going to be possible. Not everyone can afford a skilled trainer, and sometimes life is just too overwhelming to add another burden on clients’ time. “I meet a lot of people here in south Florida who are taking care of elderly parents and I do discuss that with them, but I have empathy,” Dr. Radosta says. “I say straight up: your life looks really stressful to me, how are you feeling, can you do this?”

But nearly everyone can handle some simple changes such as crating a fearful or aggressive dog in another room when company comes to avoid exposing a pet to triggers.

“Behavior modification can’t always happen,” Dr. Radosta says, so sometimes we do what we call medication and management: supplements or medication–something that changes neurochemistry–and managing the environment so the behavior can’t occur.”

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