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Endocannabinoid System in Dogs & Cats: A Complete Overview

Have you ever wondered how pets stay healthy or what manages their sleep, stress, or pain? Much of it has to do with something called the endocannabinoid system in dogs and cats. Pets have this internal network in their bodies, just like us humans. This system is intimately involved in everything from mood to appetite to immune function and more.

Understanding the endocannabinoid system, or ECS, in dogs and cats is cool because it opens new ways to help them stay happy and healthy. Scientists and vets are learning more about this system and finding better ways to help our furry friends. It’s a big deal in pet care and veterinary medicine, making a huge difference in the lives of many animals and their owners.

Introduction to the Endocannabinoid System (ECS)

The endocannabinoid system is crucial to how our bodies—and those of dogs and cats—maintain balance. It’s the body’s natural way of ensuring that mood, appetite, and health are all held in check.

This system relies on a network of cannabinoid receptors found throughout the body. The cannabinoid receptors react to natural substances in the body called endogenous cannabinoids. What’s even more interesting is that these receptors also react to plant-based cannabinoids found in the hemp plant.

Endogenous cannabinoids help the body balance itself by influencing how cells work. This includes helping manage different physiological processes, such as mood, pain response, metabolism, and immune function.

Then, special enzymes break down the cannabinoids. These enzymes stop the action and keep everything in balance. The whole cycle keeps the body’s systems working well, helping with overall health.

Understanding the ECS in Pets

Diving deeper into how the endocannabinoid system works in pets, we find it’s all about balance or homeostasis. Think of it as the body’s natural way of keeping everything in perfect harmony. When something’s off, like if your client’s pet is feeling stressed or in discomfort, the ECS steps in to address the issue.

This system is about more than just responding to problems, though. It’s always active, helping to regulate things like mood, sleep, and appetite. Whether it’s a dog chasing a toy or a cat lounging in the sun, the endocannabinoid system is working behind the scenes.

In addition, scientists think this system might be similar in all mammalian species. This includes horses, rabbits, monkeys, dolphins, elephants, and even sea urchins, to name a few. So, studying canine and feline patients could help us find new ways to utilize the endocannabinoid system in veterinary medicine.

The Role of the ECS in Maintaining Homeostasis

As we’ve already mentioned, the endocannabinoid system plays a huge role in maintaining homeostasis or balance. Homeostatic balance is all about keeping things in the body steady and stable, no matter what’s happening outside. For pets, this means their mood, body temperature, and energy levels stay just right no matter the situation.

The endocannabinoid system uses its network of cannabinoid receptors and natural chemicals to communicate with different parts of the body. This helps manage many functions of the body, ensuring that important physiological processes carry on without a hitch. Research is also ongoing into how the endocannabinoid system influences hindbrain structures in pets, which point to basic life functions like breathing and heart rate.

Essentially, the endocannabinoid system helps pets adjust to different situations by telling the body what it needs to stay balanced. If a pet is too hot, stressed, or even really hungry, the endocannabinoid system kicks into gear. It sends out signals to help adjust the body’s responses, whether that’s cooling down, calming down, or regulating hunger.

Cannabinoid Receptors and Their Functions

Now, let’s zoom in on a chief part of the endocannabinoid system: cannabinoid receptors. These receptors are like tiny sensors found all over the body, in both pets and people. They are present in the brain and spinal cord areas, immune cells, blood vessels, and other organ systems.

There are two main types of cannabinoid receptors: the CB1 receptor and the CB2 receptor. Differentiating between cannabinoid receptor type 1 and cannabinoid receptor type 2 is essential for understanding their roles in the body.

CB1 receptors mostly hang out in the brain and central nervous system. They are key in neurotransmitter release, affecting mood, memory, motor activities, and pain response. CB2 receptors are more abundant in the peripheral immune system and help manage inflammation and immune response.

These receptors wait for signals from cannabinoids. Among the cannabinoids, 2-arachidonoylglycerol (2-AG) and anandamide (AEA) are notable for their ability to bind to CB1 receptors. 2-AG also binds to CB2 receptors.

Furthermore, cannabinoid receptors can engage with plant-derived cannabinoids like Cannabidiol (CBD) and Tetrahydrocannabinol (THC). THC binds directly to CB1 receptors and is not typically recommended for pets as it’s mainly utilized for its “euphoric” effects on humans.

In comparison, CBD indirectly influences both CB1 and CB2 receptors. While THC is beneficial for humans, offering potential therapeutic effects, CBD is particularly suitable for pets and humans alike, providing therapeutic benefits without affecting cognition!

CB1 Cannabinoid Receptors: Locations and Functions

CB1 receptors are mainly found in the brain and nervous system. They act as the body’s mood and sensation managers, helping control emotions, appetite, and pain response.

In the brain, they are densely concentrated in areas such as the cerebral cortex (for higher thought processes), the hippocampus (for memory and learning), the basal ganglia and cerebellum (for movement and coordination), and the amygdala (for emotion processing).

CB1 receptors also extend throughout the spinal cord and the central nervous system. Their presence in the peripheral nervous system is less pronounced but still significant. In these areas, they help manage pain signals and sensations. This can help pets experiencing chronic pain or acute discomfort feel relief.

These receptors can also be found in some other organ systems. These include the gastrointestinal tract, which helps modulate metabolism and appetite and ease symptoms of gastrointestinal disorders. CB1 receptors are also found in the liver and fat tissue, where they help control how the body uses and stores energy.

Fatty acid amide hydrolase (FAAH) enzymes break down the cannabinoids bound to the CB1 receptors after they’ve done their job. This ensures that the body’s responses are appropriately regulated and temporary.

CB2 Cannabinoid Receptors: Roles in Immune Response

CB2 receptors have their main posts in the immune system. This includes areas like the spleen, tonsils, and white blood cells. But that’s not all. They’re also hanging out in the bones and skin, ready to jump into action if an injury or something else needs healing.

These receptors are key in helping manage inflammation and promote healing. When the body is injured, CB2 receptors work to calm down the response by helping reduce swelling and pain. They also aid in cell migration, which is crucial for healing. This response benefits pets with skin problems, joint pain, or any issue related to inflammation.

CB2 receptors also help strengthen pets’ immune systems, making it easier for their bodies to ward off infections. They help make immune cells more efficient at attacking germs and regulate the production of these cells. This ensures that the body defends itself without triggering an excessive immune reaction.

Enzymes are important for how CB2 receptors work, too. For instance, an enzyme called monoacylglycerol lipase (MAGL) helps break down 2-AG after they’ve worked with CB2 receptors. This makes sure the body’s immune response doesn’t go on too long or too strong.

The Impact of Cannabinoid Receptors on Pet Health

Endocannabinoid receptors play a crucial role in maintaining pet health. Each type of cannabinoid receptor works like a health manager to help maintain a happy and healthy balance in the different organ systems.

CB1 receptors help manage how pets feel and react to different situations. They play a key role in reducing discomfort and stress, making sure pets can relax and not feel too much pain. In addition, CB1 receptors can positively influence appetite, memory, and neurological health.

On the flip side, CB2 receptors are more focused on the immune system and help in reducing inflammation. Inflammation is the body’s response to injury or infection. By managing it, CB2 receptors help pets heal faster and feel less discomfort from conditions like arthritis, allergies, or autoimmune disorders.

Together, CB1 and CB2 receptors work to keep pets’ health in check, from their brain to their paws. By understanding endocannabinoid receptors, we can utilize them for pets’ overall health.

Endogenous vs. Exogenous Cannabinoids

There are two key types of cannabinoids: endogenous cannabinoids and exogenous cannabinoids. Endogenous cannabinoids, also called endogenous ligands, are produced naturally by the body. Exogenous cannabinoids, on the other hand, come from external sources, such as hemp plants.

Endogenous ligands work within the endocannabinoid system to maintain balance. Meanwhile, exogenous cannabinoids, like CBD, offer the ECS support from outward sources. They can mimic the effects of their endogenous counterparts and support the same benefits.

Understanding the interaction between these two types of cannabinoids is important for optimizing pet health. Whether the body’s cannabinoids maintain homeostatic balance or plant-based cannabinoids offer extra support, both may contribute significantly to a pet’s wellbeing.

The Effects of CBD on the Pet’s ECS

CBD has gained a lot of attention for its potential health benefits. Research suggests, in many cases, that dogs and cats experience the same benefits from cannabinoids as humans. Unlike THC, CBD doesn’t affect a pet’s cognition. Instead, it interacts with their endocannabinoid system in ways that may positively contribute to their health. That’s why, at Holistapet, we focus on crafting the best natural CBD options for pets!

When CBD enters a pet’s body, it can bind to both CB1 and CB2 receptors. This may help regulate and support various functions like mood, appetite, and discomfort. For example, nervous or scared pets might find a sense of calm, and those with physical discomfort may experience relief with CBD.

One of the most exciting things about CBD is its potential to help with various issues without causing serious side effects. It’s like giving the endocannabinoid system a helping hand, supporting the body’s natural efforts to keep everything in balance.

THC-free CBD Products: Safety and Efficacy

One big concern for pet owners regarding CBD for their dogs and cats is safety. That’s where THC-free CBD products come in. These products offer the benefits of CBD without the risk of THC’s effects. Keep in mind that THC can be toxic to pets, even in small amounts.

THC-free options aim to provide the benefits of cannabinoids while ensuring pets don’t experience any unwanted effects. This means pets can enjoy CBD’s calming and relieving benefits without worries.

Research and anecdotal evidence suggest that THC-free CBD products can effectively manage a variety of pet issues, from nervousness and stress to discomfort and appetite issues. The key is choosing high-quality, tested products, like the ones we offer, to ensure they are truly THC-free and safe for pet use.

Exploring CBD Products for Pets

CBD comes in different forms to address pet’s various needs and preferences. We’ll soon go over them in detail, but first, let’s have a quick look at the variety of CBD products available for pets:

Tincture (CBD Oil): This is a liquid form of CBD that you can measure and mix into food or give directly.
Edible Treats: These perfectly dosed CBD-infused snacks are loved by pets. They are simple to give, just like regular treats.
Topical Creams: CBD-infused creams can be applied directly to the skin to help relieve itchiness or support joint health.
CBD Capsules: Flavorless capsules filled with CBD and other ingredients, usually powder, can be split open and mixed with wet food or given whole. Capsules also work great with pill pockets or wraps.

CBD Tinctures for Dogs and Cats

CBD tinctures are convenient liquid drops designed for a pet’s wellbeing. They’re easy to use, allowing pet owners to measure out any size dose and administer it directly into their pet’s food or mouth. This method is particularly beneficial for picky eaters or pets requiring immediate relief from issues like anxiety or discomfort.

What makes tinctures remarkable is their rapid onset of action, especially when administered orally. They provide swift results, often taking effect within 30 minutes of application.

When selecting a good CBD tincture, make sure to choose a high-quality CBD product formulated specifically for pets, like HolistaPet’s CBD oils. Holistapet’s CBD pet tinctures are crafted with pure Broad Spectrum CBD Oil and Hemp Seed Oil, creating a potent concentration that offers numerous benefits for the pet. Plus, we only use 100% natural, non-GMO ingredients, guaranteeing a pristine final item.

You’ll also want to find tinctures with clear dosage instructions based on a pet’s size. Additionally, opt for products like ours that undergo third-party testing to ensure safety and efficacy. It’s wise to start with a small dose and monitor the pet’s response. You’re on the right track if they seem happier and more comfortable.

Edible CBD Treats: Benefits and Considerations

CBD dog treats and CBD cat treats are powerful snacks that contain the perfect dose in each piece. They come in flavors that dogs and cats love, making it super easy for pet owners to administer.

One of the best things about CBD treats is that they’re simple to use. Each snack contains a specific amount of CBD, so you know exactly how much the pet is getting. This is handy for making sure pets get the right amount every time. In addition to CBD, some treats may include other helpful active ingredients.

For instance, the Holistapet CBD dog treats are enhanced with targeted ingredients like L-theanine and Chamomile to promote calmness or Turmeric Root and Boswellia to support joint health. These beneficial herbs are combined with Hemp Seed Powder, which is a superfood, to ensure the pet maintains optimal health, comfort, and mood.

Choose CBD treats, like Holistapet, made with high-quality, natural ingredients without artificial additives or preservatives. If a pet owner is trying CBD treats for the first time with their pet, encourage them to start with a little and see how their pet does. You’ve found a good thing if they seem happier and more comfortable.

Topical CBD Applications for Skin, Coat, and Joint Health

Topical CBD products, like creams and balms, are great for dogs and cats with skin or joint issues. Rub these products directly onto the skin, targeting the area that needs help. CBD is absorbed locally when applied to the skin and can usher relief without entering the pet’s internal system.

CBD topicals can make moving around easier for pets with sore joints, especially older ones. Rubbing these creams on their joints can help reduce discomfort, prolonging an active lifestyle. For skin problems, CBD topicals may help soothe irritation and promote healing.

When picking a CBD topical for pets, always check that the product is pet-friendly. Some products made for humans might have ingredients that aren’t safe for pets. The product must be free from fragrances, essential oils, or other additives that might irritate the pet’s skin or be harmful if licked.

Dosing Guidelines for CBD in Pets

CBD dosing is all about starting slow and paying attention to how the pet reacts. Whether it’s for already healthy dogs, cats with joint health concerns, or pets needing support for their immune system, getting the dosage right ensures they experience all the health benefits without any issues. Encourage your clients to approach CBD dosing for pets in this way:

Start Small. Begin with a tiny dose, especially if the pet has never had CBD before. For example, you might want to start below the suggested amount and monitor the pet before you up the dosage.
Watch. Observe the pet closely to see how they respond. Do they seem more relaxed? Are they moving around easier if they were sore before?
Wait. It is advisable to keep the initial dose for at least a week, as CBD can take time to show effects in some pets.
Adjust as Needed. Trying a slightly higher dose might be okay if you don’t notice any changes after some time. Like people, pets react differently to CBD.
Talk to the Vet. As their trusted veterinarian, you can give advice based on the pet’s specific health and needs before starting the pet on CBD.

Remember, every pet is different, so what works for one might not work for another. For more guidance on CBD dosage for pets, you can check out Holistapet’s CBD Dosing Guide. For additional pet CBD-related information you can trust, check out more through https://www.holistapet.com/.

The Significance of the ECS in Dogs

The endocannabinoid system is important in canine species because it helps them stay healthy and feel good. This system is all about keeping things balanced for dogs, the same as for humans. It’s like a system working quietly inside pets, looking after how they handle pain, emotions, and illnesses.

Cannabinoid receptors are found throughout a dog’s body, which means the system can affect many different parts of its health. The ECS also helps keep a dog’s immune system strong, which is important for keeping them well, especially as they age.

How the ECS Contributes to Dogs’ Health

The endocannabinoid system plays a huge role in keeping dogs healthy. It acts like an internal support system that manages different body processes.

It’s especially important for helping dogs deal with discomfort. When dogs are in pain, maybe from running around too much or because of joint issues, the endocannabinoid system steps in to soothe their soreness.

The endocannabinoid system also helps dogs regulate their emotions, making stressful situations easier to handle. Dogs that feel anxious or stressed, whether from loud noises or being alone, can gain relief through the endocannabinoid system.

This system also plays a role in the digestive system, making sure dogs can digest their food properly without issues. Plus, it supports immune function to fight off sickness.

In short, the endocannabinoid system is critical for maintaining a dog’s health in various ways. By understanding and supporting this system, perhaps through the safe and targeted use of CBD products, we can greatly enhance dogs’ quality of life.

Research Insights: ECS and Canine Conditions

Studies in veterinary medicine are finding out how the endocannabinoid system can be a game-changer in addressing health conditions in canine species. Research points to the endocannabinoid system as a possible therapeutic target in dogs.

Studies have shown that activating the endocannabinoid system can help soothe arthritis symptoms in dogs. This is big news for canine patients who suffer from chronic conditions, as it offers a potential new way to help improve their quality of life.

Moreover, the endocannabinoid system is being looked at for how it can help with issues in the nervous and immune systems. Keeping everything balanced with the endocannabinoid system might be the key to addressing all sorts of conditions, from stress behaviors to illnesses where the body attacks itself.

The ECS in Cats: Insights and Research

Research in veterinary medicine regarding the endocannabinoid system in cats is still growing, but what we know so far is pretty exciting. It shows that the endocannabinoid system can help cats in many of the same ways it helps dogs.

For example, it can help ease their pain, help them stay calm, and aid their immunity. In addition, the endocannabinoid system helps keep endothelial cells healthy, which is good for cats’ heart health. All these show how the ECS affects many parts of a cat’s health.

Further studying the molecular characterization of cannabinoid interactions within the endocannabinoid system can help us find better health solutions for pets. Using the endocannabinoid system as a guide, we can potentially uncover more ways to keep our feline friends healthy and happy.

Unique Aspects of the Feline ECS

Using CBD for cats can be a good way to help them cope with stressors, deal with discomfort, or simply stay healthy. But since cats are different from dogs and people, we must be careful about how we use CBD with them.

First, it’s important to pick the right CBD product for cats. This means choosing something, like Holistapet’s CBD cat treats, that’s made especially for felines and doesn’t have any THC. Even small amounts of THC can be toxic to cats. Next, you’ll want to work with your clients to choose an option with healthy ingredients and a flavor that their cat prefers. This is important because cats can be selective with what they eat, and you want to provide a healthy option they’ll enjoy.

Holistapet CBD cat treats are felines’ favorite, featuring a delightful salmon or chicken flavor they love. Their grain-free treats are crafted with natural ingredients and are free from gluten, dairy, artificial colors, and preservatives. They contain no wheat, animal by-product meal, corn, artificial flavors, or colors. We believe that a healthy cat is a happy cat.

Last but certainly not least, the amount of CBD we give to cats matters a lot. That’s why Holistapet’s cat treats contain exactly 2mg of broad-spectrum CBD, ensuring the perfect increment for dose management. The best approach is to start with a very small dose and watch how the cat reacts. If they seem to feel better, that’s great! If not, work with your client to advise on the best dose and even suggest specific CBD products that are safe for cats.

Final Thoughts – Endocannabinoid System in Dogs & Cats: A Complete Overview

Understanding the endocannabinoid systems in dogs and cats is essential to ensuring their optimal health and happiness. From assisting with stress and discomfort to supporting their overall wellbeing, the endocannabinoid system is key.

Using CBD carefully, with attention to the right products and doses, may support this system. To get started, you can visit Holistapet’s shop to see their line of quality CBD products for pets. Always remember to start small and watch how the pet reacts. By learning more about the endocannabinoid system and how to support it, we can help our furry friends lead happier, healthier lives.

Original post

Brought to you by our friends at Holistapet.

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

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Positive social connections are known to improve human health, so might this be true for dogs as well? Like us, dogs experience the same surge of stress-reducing oxytocin during canine-human interactions.

The desire to lavish sick or injured canine companions with love and support, without compromising the recovery process, is what led to the creation of ReCover DogCover—a disposable stress-free garment that protects healing areas while allowing dogs to maintain their mobility, confidence, and independence.

What is the ReCover DogCover?

When Duke II, a happy and playful dog owned and loved by ReCover’s founder, was diagnosed with cancer, his life changed. The skin beneath Duke II’s once luxurious coat developed painful sores, creating a heartbreaking barrier between him and the gentle snuggles and loving caresses that once punctuated his daily life. Despite trying every commercially available product as well as DIY options for dressing Duke II, there was simply no way to simultaneously keep him clean and comfortable while maintaining his physical freedom and ability to enjoy an affectionate touch.

Duke II’s owner noticed a dip in Duke’s spirits, as well as her own. Then, in a conversation with her dog’s veterinary oncologist, inspiration struck—and the ReCover DogCover was born.

A different breed of healing: DogCover benefits

Unlike other pet bodysuits, the ReCover DogCover is a completely disposable step-in garment designed to protect healing areas from bites, scratches, and other physical irritants. The DogCover’s material is entirely breathable, creating positive airflow to the pet’s skin and supporting natural thermoregulation to keep pets comfortable. Additional benefits to the DogCover include the following:

  • Step-in, suit-up design — No tugging, pulling, or pinching! The DogCover can be placed with the dog in a standing position—simply put their paws in the leg holes and prepare to suit up.
  • Custom fit — The full-stretch tear-away fabric ensures a completely personalized fit for every dog, including a tearable perforation along the underside so males can freely urinate without soiling the fabric.
  • All day and night wearability — The DogCover’s customizable fit ensures you won’t have to remove the suit for bathroom breaks. The dog stays clean and dry.
  • Flexible, full-stretch material — Whether a dog is on post-surgical crate rest or is allowed to run and play, the DogCover’s soft, stretchy material ensures full-body comfort and coverage.
  • Antibacterial surfaces — Bacteria-resistant inner layers protect wounds and incisions from irritation and secondary infections.
  • Water-repellent outer layer, internal absorbency — The DogCover protects the pup from the elements (e.g., rain, puddles), while the moisture-wicking interior draws natural fluids away from the pet’s wound or incision—ensuring a clean and dry environment.
  • UV-resistant, flame-retardant material — All DogCover materials are thoughtfully selected to ensure the dog’s safety.
  • Disposable and biodegradable — Don’t worry about disinfecting the DogCover. To ensure the desired hygiene level, each garment is designed for a single use. And because we’re equally passionate about environmental responsibility, the DogCover is 35 percent biodegradable.

In addition to its at-home applications, the DogCover’s convenient, stress-free design and consistent benefits have made it an asset in veterinary clinical settings, including the highly-regarded Animal Medical Center in New York City, where it is being used with great success.

Dressed for success: Reducing post-surgical stress with the DogCover

In addition to protecting your patients physically, the ReCover DogCover enhances their emotional wellbeing by reducing stressors typically associated with the recovery process, allowing them to live a more normal life. Some positive impacts:

  • Enhanced comfort  — DogCover’s soft, flexible fabric and personalized fit are non-irritating, ensuring the pet can enjoy restful sleep—a critical aspect of healing.
  • Fewer changes to the dog’s daily routine — Dogs thrive on consistency and the ability to predict what happens next. By minimizing potentially stressful changes (e.g., putting on and removing a bandage, wrap, or other recovery device, and limiting specific physical activities or interactions), dogs feel more relaxed and confident.
  • Inclusion in household activities — Dogs can perform all their normal behaviors while wearing the DogCover, including elimination, eating, drinking, sleeping, going for walks, playing with toys, and simply being part of the family.
  • Optimal healing and recovery — Recovery complications can delay your patient’s healing and their return to normal, resulting in additional pain, medications, confinement, and stress. The 24/7 protection provided by the DogCover increases the likelihood of a smooth and timely recovery.
  • Uninterrupted affection — When you don’t have to worry about disrupting your patient’s healing or contaminating their incision, you can feel free to spoil them with affection. These positive interactions provide powerful reassurance and can help your patient feel at ease—even when everything else seems out of sorts.

With the ReCover DogCover premium post-surgical recovery suit for dogs, your patients can experience an enhanced recovery journey with less fear, anxiety, and stress, while you can feel confident and empowered to appropriately manage their care.

 

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

Jaime Bast RVT, CCRP, KPA-CTP, FFCP is a copywriter and registered veterinary technician from St. Louis, Missouri. In her free time, Jaime loves learning about canine nutrition, behavior, and training and competing with her American cocker spaniels in a variety of dog sports.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Brought to you by our friends at ReCover.

By Marc Bordelon, DVM, MBAThe contemporary use of ultrasound in veterinary medicine has evolved from its inception solely as a referral tool for use by specialty veterinarians to a practical and useful diagnostic tool in general practice and emergency medicine. Veterinarians and staff should be prepared to explain the purpose and procedures involved in point of care ultrasound (POCUS) as well as possible pros and cons to pet parents. Despite being a non-invasive procedure that is virtually painless and quick to perform, there may be concern around logistics, outcomes, and cost. The vet team should be prepared with information to make ultrasound examinations comfortable and pleasant for patients and clients alike.

Client conversations will include questions regarding how ultrasonography and POCUS is used in veterinary practice. Consider the indication for the ultrasound recommendation: is it routine, preventive, diagnostic, or emergency? Routine and preventive medicine ultrasounds are becoming more common. Practices create bundle packages with their wellness exams that are customizable depending on the pet’s age and physical exam findings. It is feasible to say that by looking early and often, a baseline for normal will be established for each patient, and evolution to disease states may be diagnosed sooner, rather than waiting for clinical changes to prompt an ultrasound investigation. Early diagnosis has an immediate impact on patient health and well-being and client experience. Providing routine ultrasounds at an affordable price is simply smart medicine.

Today, routine ultrasonography doesn’t require expensive equipment purchases. Affordable, hand-held ultrasound tools, like the Butterfly iQ+ Vet, are extremely durable, easily connected to a cell phone or tablet, and carried in the clinician’s or technician’s pocket. This model dramatically increases access to ultrasound for every veterinary hospital. Additionally, handheld ultrasound can be utilized in any exam room, with the educated client actively witnessing and perhaps even participating in the process, never having to leave the side of their fur baby.

POCUS examinations are indicated in both routine and emergency care. POCUS is performed using protocols to scan known areas of interest in the thoracic cavity, including heart and lungs, and four quadrants of the abdominal cavity. Abnormalities such as free fluid or air can be quickly identified and may help determine patient stability in the emergency setting, often in 10 minutes or less. This allows the veterinary team to determine the appropriate next steps and monitor patient progress. Questions to consider during the emergency POCUS exam may include the following:

  • Do these findings explain the pet’s clinical disease state?
  • What are the next steps in this treatment plan?
  • Is there an abnormality that requires further exploration?
  • Should this patient be referred to a specialist?

Utilizing POCUS examinations in practice is a valuable and effective diagnostic tool. Scanning sick patients on the first presentation offers an important baseline for each case. Embedding the ultrasound cost into the exam and making it affordable ensures better compliance. This approach helps forge a strong veterinary-client-patient relationship and may add the satisfaction of an early and accurate diagnosis for the veterinarian.

Multiple studies have proven that early implementation of procedures like POCUS can lead to better case outcomes, quicker workups, increased client satisfaction, and the ability to get a diagnosis early on in the disease state.

Getting Patients Comfortable

Now let’s look at patient protocols. Depending on the type of ultrasound exam needed and the reason for presentation (routine, sick, or emergency) there are several ways to make the ultrasound procedure more comfortable for both patients and clients.

Diagnostic imaging presents a unique challenge because it is important for the animal to remain quiet, comfortable, and still. The use of a sedative, and in some cases anesthesia, will be necessary to collect the desired images for some patients. Use of the following practices can decrease stress for patients and help them remain calm and still during an ultrasound examination in the Fear Free environment:

  • Introduction and positive conditioning to ultrasound probes and POCUS for kittens and puppies
  • Non-slip comfortable surface
  • Warmed ultrasound gel
  • Calming scents such as lavender and canine or feline pheromones
  • Relaxing background music or white noise.
  • Low traffic area with limited distractions
  • Minimal noise pollution (other animals, people talking, equipment alarms, intercoms)

Positioning is also important in ultrasound examinations. Patients should feel safe and secure during preparation and procedure. Evaluation of fear, anxiety and stress (FAS) should be monitored throughout. Here are several ways to position a pet while helping them to remain comfortable, while first considering physical limitations.

  1. Determine if the procedure can be performed with the patient in a non-traditional position such as standing or laying comfortably on their side.
  2. Determine if the pet can get into position on cue; for instance, rolling onto their side.
  3. If the pet does not know such a cue, use a lure to help guide the pet into position.
  4. If luring doesn’t work, the pet can be physically guided into position, but this is the most stressful option. It is imperative that the pet feels supported and stable when being guided into position.

When the above positioning options aren’t possible, Dr. Caroline Conn of Sweetwater Veterinary Clinic in Santa Clarita, California, an Elite Fear Free Certified Professional, routinely uses the following techniques in her ultrasound exams:

  • Sedation (after approval from owner, mainly for emergencies and diagnostic abdominal scans)
  • Performs ultrasound in client presence when possible (increased value for client)
  • *Cooperative Care technique: This technique takes time for both the veterinarian to teach and client to practice. Absolute buy-in is a must before using this for pre-scheduled appointments. The Cooperative Care technique utilizes the client teaching their pet how to get in lateral recumbency and/or dorsal recumbency on their own at home beforehand, to simulate the positioning of an ultrasound exam.
  • When the pet is properly positioned, the owner places cool water or non-scented hand sanitizer on the area to be ultrasounded to stand in for ultrasound gel, and uses an object like a remote to simulate use of an ultrasound wand. (Advise clients to wipe off hand gel after use as it can be toxic if ingested.)
  • Patients remain in position for a few minutes to start, gradually building up to 10 minutes. During this time, the owner gives treats to their pet, which act as a distraction and reinforcement for remaining in position to create a positive experience.
  • However, it is done, safe handling is a must for both pets and the veterinary team. Utilizing the core Fear Free concepts, such as Gentle Control, Touch Gradient, Considerate Approach, FAS evaluation, and communication, ensure the physical and emotional wellbeing of all involved.

Pain and Fear Reduction

In an emergency situation, medications for pain and fear are often needed. Analgesia and anxiolytics not only help the pet physiologically and emotionally, they also help to reduce the client’s stress when they see that their pet is comfortable.

Reducing pain and fear also has an emotional and physiological advantage because the pet is now more approachable and feels safe being examined or undergoing blood draws or other emergency procedures. This also translates to a safer environment for staff.

Keeping Clients Comfortable

Keeping the client comfortable and informed is almost as important as keeping the pet comfortable. A comfortable patient makes for a happier, satisfied client. In addition to the benefits of hand-held ultrasound devices, here are some additional ways to increase client comfort and decrease their stress:

  • Have a veterinary technician/nurse or veterinarian greet the client at the door. This lets them know right away that their pet will not have to wait for treatment.
  • Have their animal’s medical records accessible. If possible, in an emergency situation, speak to their regular veterinarian for background information on the pet.
  • Take time to connect by greeting the client and the pet, and sharing what information you have about the pet’s condition.
  • Remember that honesty is the best policy. Be upfront with clients about possible wait times, cost, and the severity of their pet’s emergency.
  • Reduce pain, fear, anxiety, and stress ASAP. Get approval from the client to administer medications as soon as you have enough information on the case and can determine which medications are appropriate.
  • Over communicate. If you must take the pet away from the owner for treatment, provide updates every 10 minutes on how the pet is doing. As the case progresses, you can customize the frequency of updates depending on how critical the pet’s situation is.

Summary of Fear Free POCUS

Hand held ultrasound has made the use of POCUS more feasible in all areas of veterinary medicine. As its use and acceptance grow, Fear Free techniques will be incorporated into these procedures. Clients should be educated on the benefits offered by POCUS in routine, sick and emergent cases. Patient comfort must be considered and addressed in all cases (FAS) as the patient is positioned and the scan is performed. Client participation is optimal if it is safe and quiets the pet. If the pet parent cannot be with their fur baby, frequent communication is imperative.

Consider the following guidelines for POCUS procedures, in addition to established Fear Free protocols:

  • Early introduction and positive conditioning to ultrasound probes for kittens and puppies
  • Non-slip comfortable surfaces are safest and create less anxiety
  • Warmed ultrasound gel
  • Use calming scents such as lavender, or canine or feline pheromones
  • Relaxing background music or white noise
  • Utilize low traffic area with limited distractions
  • Minimal noise pollution (other animals, people talking, equipment alarms, intercoms)

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

Marc Bordelon, DVM, MBA, is veterinary clinical senior manager for Butterfly Network. Dr. Bordelon regularly lectures at several veterinary colleges and participates in wet labs and with other professionals in conference settings. Dr. Bordelon formerly owned multiple veterinary practices including a 24/7 hospital and specialty practice, and has routinely performed over 2,000 ultrasounds a year. To contact Dr. Bordelon, you can email him at MarcBordelon@butterflynetwork.com.  To contact the Butterfly Veterinary Team please email vetsupport@butterflynetwork.com

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Brought to you by our friends at Butterfly.

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Four of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

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

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

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

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

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

Summary

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

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

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

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

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.      

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Three of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

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

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

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

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

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

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

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

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for fear free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Continue learning about managing patients with high FAS through Part OnePart Two & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.    

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part Two of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

You see a historically high FAS dog on your schedule for planned sedation and feel confident in your plan. The client has done a great job with positive basket muzzle training and administering PVPs as directed, and while the PVPs don’t really seem to have had much of an effect, surely the sedation you just gave will help her feel calmer. So, you wait. And wait. No effect. Did you miscalculate your doses?

Unfortunately, despite all your careful planning, you will encounter some hurdles when managing high FAS patients, particularly during procedures that are more painful or aversive. Here are some tips on circumventing roadblocks during Fear Free care:

  • Re-evaluate wants vs. needs. It’s easy to lose sight of this Fear Free fundamental when you’re in the middle of handling a pet, especially since vet professionals tend to be very goal-oriented. When a patient’s FAS escalates, take a mental step back and ask yourself whether your current task is truly medically necessary for that pet at that moment. With a Fear Free approach, much of what we do in general practice is considered a want, not a need. Making the ethical call to stop before you cause further emotional damage to that pet can be difficult, but it’s amazing how much further you get when non-urgent concerns are deferred for a follow-up visit.
  • Reassess your analgesia and decide if sedation or anesthesia is more appropriate. Sometimes we underestimate the level of pain caused by procedures we want to accomplish. When a high FAS pet escalates from pain, upgrading to stronger analgesics such as a full mu opioid or engaging multimodal pain relief can help bring FAS back down. However, in some pets this will be inadequate, and stepping up to sedation or even general anesthesia may be needed. One high FAS dog I saw would take treats readily during the initial visit, but would try to bite whenever I tried to examine the area of matted hair on his rear leg. He was rescheduled to come back the next day, but PVPs, analgesics, initial sedation attempts, and adding on more sedation medications didn’t touch him. He finally ended up needing general anesthesia, and what I thought was a matted hotspot was actually a several cm region of semi-necrotic tissue that was much more painful and inflamed than I ever could have guessed.
  • Teamwork makes the dream work! When interacting with a high FAS pet, think of your team outside of the vet clinic as well, particularly if you encounter a roadblock. I’m eternally grateful for the veterinary behaviorists, in-home providers, positive trainers, behavior consultants, groomers, and pet sitters in my area. Establishing a referral network of ethically aligned pet and vet professionals will help that pet receive the care they deserve throughout their life, while also making your job easier. For example, since most vet clinics don’t have trainers on staff, I routinely refer to reward-based trainers to help with skills that can reduce FAS during vet visits such as reducing arousal around other dogs: desensitization and counterconditioning to restraint, basket muzzles, nail trims, injections, Elizabethan collars, going into carriers; and training for veterinary cooperative care. And if you aren’t lucky enough to have veterinary behaviorists in your area for direct patient referral, many provide virtual behavior consulting with other vets to help manage challenging patients.

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

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for fear free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Continue learning about managing patients with high FAS through Part OnePart Three & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.              

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.This is Part One of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

At least once a day, I see a high FAS patient. While I don’t always know their detailed backstory, the alerts on their patient files are like a roadmap to how they got there, as a “wiggly” puppy transforms into an adolescent that “may urinate” to a 3-year-old who’s a “CAUTION, WILL BITE!!!” Some days it seems like every pet has an FAS score of 4 or 5, and for Fear Free Certified Professionals, those days can be both emotionally and physically exhausting. It’s even more disheartening when we encounter ethical quandaries such as a pet parent who’s not on board with our Fear Free plan for their highly stressed pet. These situations are common, and according to psychotherapist and compassion fatigue expert Dr. Elizabeth Strand, moral stress is the number-one contributor to compassion fatigue in vet med1.

So what do we do with these high FAS patients? How do we care for their emotional and physical wellness, while also caring for our own wellbeing and balancing the needs of the pet parent? Flexibility, communication, and supporting the Fear Free team culture are key to approaching these challenging cases.

After becoming Fear Free certified, I started realizing that a patient would be a lot less stressed if I approached the interaction like jazz–with a general sense of where it might go, but incorporating improvisation and responding to what the pet was communicating at that moment. This may mean giving the pet a brief break during handling to allow de-escalation, or even backing off completely on what I was originally trying to accomplish. Fear Free handling is a dialogue, not a monologue. When handling a patient with high FAS, a few other guiding principles can help:

  • Location, location, location. When handling any pet, try to choose the area where the pet prefers to be and is most comfortable. There are multiple places where a pet can be handled other than an exam table, such as the floor, on a lap, on the bench, or in the bottom of their cat carrier. In general, many pets with high FAS also do better with the owner present.
  • Give every pet a sense of choice and control where possible. Encourage voluntary movement by calling the pet using a happy voice, asking the owner to call them over, or luring them to move of their own free will with a treat or toy. Many dogs also know cues for sit and down, so instead of pushing a dog’s rear end down and pulling their legs out to get them sternal, ask or lure the dog to a sit and down. Respect the cat’s choice to stay in the carrier and access them by removing the top of the carrier and covering them with a towel to facilitate hiding. When restraining a pet, especially a high FAS pet, allowing them to stay in the position they prefer goes miles toward keeping them calm, whether it’s allowing a dog to stand instead of sit for a jugular draw or allowing a cat’s front end to remain sternal instead of forcing them into full lateral to reach the medial saphenous.
  • Less is more. Use the minimum number of people needed and the least amount of restraint needed while staying safe. The more hands on a pet and the more people crowded around them, the more likely they are to become stressed.
  • Prevent and treat for pain. Pain contributes to FAS and vice versa, and as mentioned in a 2022 Fear Free roundtable3, pain and fear are “two sides of the same coin.” Dull needles also hurt more, so try to make it common practice during sample collection to not reuse needles. During unsuccessful blood draws, I often see people pulling the needle out of a pet’s skin, re-palpating the vein, and then pushing that same, microscopically shredded needle back into that pet’s skin for a second or third attempt as the pet gets more and more stressed.
  • Sedate early, not as a last resort. With many high FAS pets, you will often reach a limit for what PVPs can accomplish. Injectable sedation may be the best way to help minimize FAS. Sedating earlier when the patient is calmer will be safer for the pet and likely allow you to use lower doses of anesthetic drugs. Familiarizing yourself with Fear Free in-clinic sedation protocols, lowering the charge for sedation to get client buy-in ($70 is more palatable than $140), and getting staff members comfortable with sedation/monitoring will also prove invaluable. Another way to approach stressful procedures for high FAS pets is to tack them onto an already-scheduled procedure involving general anesthesia. Depending on the patient’s needs, these could include shaving a matted cat, microchipping, trimming or dremeling nails, performing a cystocentesis, aspirating a growth in a sensitive location, expressing anal glands, or performing an orthopedic exam/radiographs. For more info on Fear Free in-clinic sedation, check out Fear Free Level 1 module 7b8, Fear Free Level 3 module 19, and these other Fear Free resources10, 11, 12, 13.

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

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for fear free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Continue learning about managing patients with high FAS through Part TwoPart Three & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
By Dr. Natalie Marks, DVM, CVJ, Elite FFCPAs a practicing veterinarian and previous practice owner for more than two decades, I’ve witnessed quite a bit of evolution within our industry. There continue to be advances in diagnostic technologies, telemedicine, novel therapeutics for dermatology and osteoarthritis, and a dramatic shift from independent practice ownership to corporatization. However, one of the most important discoveries and initiatives has been the concept of Fear Free, the initiative dedicated to the physical and emotional health of our patients and clients through the reduction of fear, anxiety, and stress.

However, Fear Free is, and can be, more. It is a lifestyle and guide on how to practice and manage and educate. Client trust and compliance is key to a successful veterinary-client-patient relationship, and that’s difficult to achieve when fear, anxiety, and stress surround exam room interactions and associated communications. This is never more evident than when trying to manage wound care. The aftercare associated with an incision, a laceration repair, a skin lesion, or a superficial burn can be extensive and complicated, often with multiple medications, bandage care, an Elizabethan collar, and an incredibly stressed patient and pet parent. This negatively affects patient care and the veterinary team as frustrated pet parents call and email frequently, taking veterinary professionals away from patient care in hospital.

There’s now a single solution for improved wound healing for patients, reduction of the home care burden for pet parents, and preservation of emotional health for patient, pet parent, and the veterinary health care team. KeraVet® Gel is a first-of-its-kind wound care product.  As a scientist, safety and efficacy of any new product is top of mind.  I’ve been impressed with the initial studies with this product, which has a keratin-based patent-protected technology to promote a moist wound environment and barrier to the environment as well as a bitterant to deter licking behavior, enabling us to send a patient home without that collar that so often leads to increased stress for both the patient and our client. That said, it is important to note that there can be a risk to the human-animal bond when we frequently apply something to our pets that tastes unpleasant, and for some pets that can be more stressful than protective clothing, bandages, or an Elizabethan collar. Each animal is an individual and their needs should be taken into account when deciding on the best solution for wound healing.

In the right circumstances, though, this product can be a game changer. One of the tenets I lived by as a practice owner was “best medicine leads to best business.” Our clients want to see the value in the care they are investing in, that it’s convenient and safe, and that it addresses their family member’s physical and emotional health. When we choose to use KeraVet® gel, we give our clients a single effective solution addressing both of their needs, thus building trust and compliance, and strengthening the human-animal bond. These are the clients who return and refer and stay lifelong members of our hospitals.

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

Natalie Marks is a veterinarian, consultant, educator, media expert, an advisor for KeraVet Bio, on the Executive Committee of VANE (Veterinary Angel Network), and an Elite Fear Free Certified Professional. She is passionate about working with colleagues and mentees and moving the needle forward with innovation with companies like KeraVet Bio. Learn more about Dr. Marks at marksdvmconsulting.com and KeraVet Bio at https://keravetbio.com/

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By Shepherd Veterinary Software

Fear, anxiety, and stress (FAS) are not exclusive to our veterinary patients. For some practice owners, the mere thought of switching to a cloud-based software triggers a similar negative spiral. Fear of change can prevent them from appreciating how a serverless system could optimize their workflow and support future practice growth.

Like any fear, apprehension about changing software is best conquered with knowledge. Let Shepherd Veterinary Software address the most common fears and stressors. Learn about the comfort and peace of mind that comes with being in the cloud.

Fear: Data migration will be an enormous hassle

This is perhaps the biggest concern among veterinary practice owners and managers—for good reason. In the past, transferring inventory and patient records was painstakingly inefficient, not only because of data loss during the transfer, but also due to the financial loss from closing the practice during the process.

Reality: Modern cloud-based veterinary practice management systems (PIMS) such as Shepherd Veterinary Software provide step-by-step assistance that streamlines the data migration process. Shepherd’s experienced team understands the implications of switching from server to cloud-based software and provides a wealth of resources and advice to ease the transition and help you anticipate and minimize potential challenges.

Anxiety: My team will struggle to learn the new system and be less productive

No matter how inefficient or frustrating your current PIMS, most team members will find switching to a new, entirely unfamiliar software daunting.

 Reality: Modern software options have intuitive, user-friendly designs that reduce errors and increase productivity for all skill levels. With the help of self-paced training modules, ongoing software support, and skill-building resources, most veterinary staff can feel confident using a new PIMS like Shepherd in as little as a few hours. And, if the team hits a snag during the learning process,  Shepherd’s support team is only a call or click away.

Stress: My practice data will not be secure stored in the cloud

When it comes to practice data, on-site servers can provide practice owners with false peace of mind. A physical unit in your clinic or hospital may feel well protected, but server-based PIMS are often more vulnerable to cyber attacks and malware, not to mention physical threats such as fire and water damage.

Reality: Remote cloud-based storage safeguards your practice’s data through expert monitoring that will identify and address any threat. Automatic security updates and patches keep the system one step ahead of hackers and cyber threats, and automatic syncing ensures access to the latest patient and practice information. There’s also no costly downtime waiting for IT or the release of a system-wide update.

Fear: The benefits won’t be worth the effort

Cloud-based veterinary software is a significant investment of a practice’s finances and resources. It’s only natural to question its proposed benefits and value.

Reality: As veterinary teams quickly discover, serverless software delivers powerful, game-changing advantages that extend beyond practice management to elevate patient care, enhance the client experience, and shape future growth.

  • Improved accuracy — Automated charge capture ensures consistency across all documents, including the patient chart, estimate, and invoice.
  • Increased revenue — Smooth workflows and quick-fill SOAPs mean you can fit in more appointments and care for more patients without staying late.
  • Easier oversight and case management — Remote access allows you to view the practice dashboard, inventory, and patient records from any location with an internet connection.
  • More time to spend with patients and clients — Automated features and powerful integrations eliminate the need for time-consuming repetitive tasks so you can focus on patient care.
  • Stronger client relationships — Enhanced communication tools, such as messaging and pet portals, help develop the veterinarian-client-patient bond.
  • Better job satisfaction — Increased efficiency and smooth workflow put the joy back in veterinary medicine, resulting in a healthier practice culture.

Anxiety: Team members fear that remote access will blur the work-home boundary

Many professionals have discovered that working remotely has an unexpected downside—an “always available” mentality that erodes the work-home life boundary. As a result, some practice owners and veterinary team members may hesitate to embrace remotely accessible cloud-based PIMS. They fear that because of the flexible software, they will be pressured to always be available.

Reality: Remote access can re-envision rather than add to the workload. It allows veterinarians and practice leaders to check in on daily operations, review the schedule, answer questions about a specific case, and take much-needed breaks without losing touch—or control—of the practice.

Stress: Clients won’t understand the change, especially if service is disrupted

Successful software transitions rely on careful planning. It’s important to notify clients as early as possible about anticipated schedule changes or closures. Instead of explaining that your practice is “changing software,” talk in terms of client benefits (e.g., better communication, reduced wait times, simplified check-in).

Reality: This change can build excitement! Upgrading your software demonstrates your practice’s commitment to exceptional client and patient service. With the right approach, you can help anxious clients understand that the temporary inconvenience will result in long-term gain.

Change is never easy, but the transition to cloud-based software is nothing to fear. Discover how veterinarian-designed Shepherd Veterinary Software can elevate your practice’s performance, increase efficiency, and help you rediscover the joy of veterinary medicine. Contact the Shepherd team to schedule a personalized demo and let your software-switching fears float away in the cloud.

Linda LombardiFor some animal behavior issues, the need for a medical workup is clear. While a cat who stops using the litter box certainly may be under stress or have social problems in the household, the first step is to rule out bladder or kidney issues.

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

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

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

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

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

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

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

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

Problems of Aging

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

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

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

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

Looking for Changes

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

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

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

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

Treating Both

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

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

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

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

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

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