stress Archives - Fear Free

Recover DogCover

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.

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Brought to you by our friends at ReCover.

Managing Patients with High Fear, Anxiety, and Stress: When Clients Refuse Your Recommendations

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 One, Part Two & Part Three of this series.

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Managing Patients with High Fear, Anxiety, and Stress: Communicating with Owners

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 One, Part Two & Part Four of this series.

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Managing Patients with High Fear, Anxiety, and Stress: Navigating Roadblocks

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 One, Part Three & Part Four of this series.

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Managing Patients with High Fear, Anxiety, and Stress: A Guide to Effective Handling

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 resources^{10, 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 Two, Part Three & Part Four of this series.

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Have Our Voices Gone ‘Horse’?

By Dr. Marty BeckerI’m sure that many of you, like me, can become numb, inured to human violence, whether it’s the war in Ukraine or the Israeli/Palestinian conflict. But when those of us who love or care for God’s creatures see instances of animals suffering, harmed, or killed, we are always ready to speak up or take action. What did you think when you heard that four horses died ahead of the 149th Kentucky Derby in May of this year?

Caring for animals is important. It has certainly been the bedrock of my life. But I care, too, about my fellow humans and the world we create for ourselves and all the rest of God’s creation. As members of the human family, we need to animate and activate our discussions, disgust, directives, and donations for all forms of suffering and injustic.

I’m sure the vast majority of people spoke out in support of the “Me Too” movement following the repulsive actions of Harvey Weinstein and Jeffrey Epstein. When George Floyd was killed, we were horrified by the actions of those police officers, and many marched. When white supremacists descended on Charlottesville, Virginia, for the “Unite The Right” rally spouting hateful rhetoric such as, “Jews will not replace us,” “You will not replace us,” and “Blood and soil” (a phrase evoking Nazi philosophy on ethnic identity), we were shocked and sickened; I know there were many kitchen table discussions asking, “How can this kind of hatred still exist against a people vilified for most of modern history?”

Here we are, almost eight decades after the end of World War II, and anti-Semitism, yet again, has grown in breadth, intensity, and violence. And yet again, too few speak out to confront the rot we see exposed on the street, on campuses, in churches, and on the media.

I have made it a point over the past month to repeatedly call my Jewish colleagues and friends to see how they’re doing. My shoulders fell as I heard stories of their rabbi killed, of their children being bullied at school and no longer feeling comfortable wearing their Star of David, of them seeing anti-Semitic graffiti in their neighborhood. It’s bad enough to see global anti-Semitism on TV or your mobile phone, but it hits harder when you see it on a wall as you drop your kids off at school or pick them up from soccer practice.

I know in the Becker family, we talk about injustice and try to live up to the words in our constitution: “We the people,” or those in the Pledge of Allegiance, “One nation, under God, indivisible.” What also ping pongs between my heart and head is the congregational prayer I’ve heard and recited since childhood that includes the words, “All God’s children.”

This is not just a message of support for the Jewish population. There’s room in our hearts and wallets to support races that are discriminated against, ethnic groups like the Palestinians, the cruel crackdown on Rohingya Muslims in Myanmar, violence upon the LGBTQ+ community, and of course, any animal abuse.

Let’s make it a growing chorus of people who speak out against discrimination, violence, and abuse, and speak up for human rights, diversity, and equal opportunity.

Grow hoarse from making your voice heard.

Dr. Marty Becker, “America’s Veterinarian,” is the founder of Fear Free, which works to prevent and alleviate fear, anxiety, and stress in pets by inspiring and educating the people who care for them. This includes veterinary and other pet professionals as well as pet parents through FearFreeHappyHomes.com and animal shelter and rescue group staff and volunteers through FearFreeShelters.com.

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Taking Cats to the Back: What the Science Says

Christie Keith
Are pets calmer and less stressed without their owners present during veterinary exams? A recent study partially funded by Fear Free sheds some light on this often-controversial subject.

There’s a lot of disagreement among veterinary professionals on how to interpret the emotional cues displayed by pets when removed from their owners. Many pet parents also object to having their pets taken away to a treatment area. While this practice was extremely common during the COVID pandemic, it was a normal part of many veterinary visits before lockdown became a household word and continues to be today as well.

The reason many veterinary team members offer for the practice is that pets seem calmer and easier to handle when separated from their owners. Others say this isn’t because their fear, anxiety, and stress (FAS) are reduced but because the pet is shutting down out of fear and/or in a state of learned helplessness. What exactly is the effect of separation from owners and transport to a different room during a veterinary visit on a pet’s FAS?

In a study published in the Journal of Feline Medicine and Surgery, researchers conducted a prospective non-blinded randomized two-period two-treatment crossover trial with 21 healthy adult cats. Each cat received an initial examination with their owner present to establish a baseline, and then they were divided into two groups. The cats were chosen from patients of a university veterinary teaching hospital’s wellness and dental care service and had previously been seen without any history of needing “undue restraint,” sedation, or anxiolytics to be examined.

The first group of cats received an examination in a treatment area without their owner, and the second received an examination in an exam room with their owner present. The actual order of the exam itself was randomized, and handling techniques described as “low-stress” were utilized. All veterinary team members had completed Fear Free certification to standardize handling and assessment.

The examining veterinarians recorded heart rate (HR) as measured by auscultation and also established a FAS score for each cat. The baseline HR for cats in the study averaged 176 beats per minute (BPM). For cats examined in the treatment area without their owners, mean HR was 226 bpm and 195 when measured in the exam room with owners present.

The most frequent values when measuring FAS scores were 3 at baseline (moderate stress), 4 in the exam room with owner present, and 5 in the treatment area without owner.

The authors wrote, “Results from this study indicate that minimizing transfer between examination areas and including the owner during wellness examinations can reduce some of the more overt signs of stress in cats during clinic visits. The data also suggest more proactive owner education measures may be of benefit, such as methods of owner habituation of their pet for transport and handling ahead of scheduled clinic visits.”

Note: This study was partially funded by Fear Free, which had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Christie Keith is a journalist, editor, and communications consultant with an exclusive
focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate
and Elite Fear Free Certified professional.

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Stress and Mental Health Challenges: How Schools Are Helping Veterinary Students Cope

Audrey Pavia
For many young people who love animals, becoming a veterinarian is a life-long aspiration that starts in high school and culminates in acceptance to a veterinary college. Reaching that goal takes an incredible amount of work and dedication and can take a toll on a student’s mental health.

Veterinary schools around the country have come to recognize the emotional challenges veterinary students face as they work to complete their degrees and have stepped forward to provide them with help. Right now, every Association of American College of Veterinary Medicine (AACVA) member school offers some kind of program design to help students maintain mental health.

How It Started

Kathleen Ruby, PhD, a psychologist based in Neskowin, Oregon, helped create the first mental health program for vet students, at Washington State University College of Veterinary Medicine.

“I was hired as one of the first counselors/mental health practitioners in the country for a college of veterinary medicine in 1998,” she says. “At the time, the position was quite ill-defined. It had been set up at the request of several faculty who found themselves counseling struggling students not just academically, but regarding personal issues and mental health problems.”

Dr. Ruby had been informed of two suicides of students in the college within a decade, and between these tragedies, and some faculty feeling uneasy about the one-on-one care many students seemed to require, the administration was persuaded to hire a professional to aid and support students.

“As a PhD mental health therapist with 12 years of experience running a private practice, as well as having helped a medical social worker work with students in my husband’s medical residency, I was seen as a good candidate,” she says.

At first, Ruby’s position was viewed as similar to an in-house university counseling center, where students made counseling appointments when they felt they were needed, and the counselor served as an in-house therapist.

“The program continued this way for a couple of years, and I found myself inundated with anxious, depressed, and overwhelmed students,” Ruby says. “The levels of anxiety, anxiety disorders, and mild to moderate depression were much higher than I was used to seeing in my private practice.”

Ruby notes that most vet students are young adults, which is the prime age for some mental illnesses to appear.

“I found myself dealing with several bipolar breaks,” she says. “Acutely, there were students who were victims of sexual assault, rape, and domestic violence, as well as divorce. More chronically, we had several students who had a great deal of childhood trauma, which they’d been able to cope with until put within the pressure cooker of an extremely difficult curriculum challenge.”

Ruby found–and other counselors in CVMs agreed–that the academic intensity; the closed nature of programs in which classes are small, with approximately 100 students who remain together all four years; the financial challenge of paying for medical school; the young-adult life stage; relationship challenges; and personal challenges inherent in medical training all contributed to making veterinary medical training a challenge to student mental health and well-being.

“Once this was ‘diagnosed,’ we began to craft programs to address some of the major stress points in the environment of training itself,” she says.

Helping Students

Fast forward to 2022, and students at vet schools in the U.S., as well as some in Australia and New Zealand, have access to mental health programs designed specifically for them. In addition, the AAVMC now offers an Accepted Student Wellbeing course for new vet school students, and is partnering with several organizations, including the Veterinary Mental Health Initiative, to create tailored resources on specific topics for students, staff, and faculty.

At University of California at Davis, the school of veterinary medicine student mental health program is designed to be multifaceted to meet student needs through the entirety of their professional school experience, according to A. Zachary Ward, Ph.D., coordinator of mental health and wellness programs.

“We start by interfacing with our first-year students in their first weeks of the program,” he says. “We work to overtly promote the focus on mental health and wellness at our school, and reduce the perceived stigma associated with reaching out for help when needed. We provide multiple presentations on mental health topics over the years and serve as mentors to the Health and Wellness Club, a student-run organization on our campus.”

The program also provides consultation to students, faculty, and staff on mental health-related topics, with particular focus on consultation around how someone can help a student when concerned about their mental wellbeing.

“We also explore methods for promoting mental wellbeing within the systems of our campus,” says Ward. “However, the bulk of what we do is provide direct clinical services to our students through individual psychotherapy, crisis intervention, group counseling, and couples therapy.”

It Works

These efforts to help vet students navigate life is paying off at UC Davis, according to Ward.

“Results can be measured in several ways, using metrics that we use to show psychotherapy works, via students’ responses to mental health symptom surveys and client satisfaction surveys,” he says. “However, to me, it’s the qualitative feedback that we receive from students that really tells me that our program is making a significant impact in their lives.”

Ruby believes the best gauge of success is how far and wide the understanding of mental health issues and the importance of personal well-being has spread throughout all echelons of the veterinary profession in the past two decades.

“Leadership at veterinary colleges and throughout the profession have gone from being somewhat apprehensive about the need for such care and training to becoming enthusiastic supporters and advocates,” she says. “Almost all the colleges now have at least one mental health professional, and some more than one. Most have well-integrated and sustainable wellbeing programs that are woven throughout the curriculum.”

Veterinary mental health and its challenges have been recognized, studied, and reported on throughout academic journals and popular media, Ruby says. She finds that this proliferation of knowledge, resources, training, and awareness-building has been a positive and helpful force within the profession.

“Perhaps the most exciting trend for me is that many of the speakers at educational conferences, and some of the current counselors, authors, and researchers are now DVMs who have recognized the need within their profession and have gone on to get additional certification in mental health and well-being fields to work within and improve the health of their own profession,” she says. “I can think of no greater validation than that!”

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

Audrey Pavia is a freelance writer and author of Horses For Dummies and Horseback Riding for Dummies. She lives in Norco, California, with her two Spanish Mustangs, Milagro and Rio.

What to Know About Recognizing Signs of FAS in Avian Patients

Fear Free

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

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

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

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

Another aspect of body language to watch for is overexcitement.

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

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

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

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

Challenges of Animal Pain: 4 Management Tips

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

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

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

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

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

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

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

If a condition is known to be painful, treat for pain. Blocked cats are painful. Pancreatitis is painful. Pyelonephritis hurts. Some diseases have pain baked in, and treating pain should always be part of the initial management plan, yet I very often see pets with diseases such as pancreatitis and urethral obstruction go without pain medication. Until the disease has calmed down, assume pain is present and treat for it.

Recognize the signs of pain. Is that cat sitting at the back of the cage hissing because he is afraid, or is it pain? Is the usually sweet and slap-happy Golden now snapping at the kids because his ears hurt? Recognizing an animal in pain is an important first step in managing pain. A trial of pain medication (perhaps even combined with appropriate sedation) can help tease out the complex web of animal pain responses and decrease the fear, anxiety, and stress of painful conditions and hospitalization. Using a validated pain scale (available at https://ivapm.org/, and many other places) can also help to quantify and track pain during treatment.

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

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

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

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

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

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

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

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

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

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

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

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

Christie Keith is a journalist, editor, and communications consultant with an exclusive focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate and Elite Fear Free Certified professional.

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How It Started

Helping Students

It Works

Audrey Pavia is a freelance writer and author of Horses For Dummies and Horseback Riding for Dummies. She lives in Norco, California, with her two Spanish Mustangs, Milagro and Rio.

Christie Keith is a journalist, editor, and communications consultant with an exclusive
focus on animal welfare and veterinary medicine. She is a Fear Free Shelters graduate
and Elite Fear Free Certified professional.