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Pheromone Use in Veterinary Clinics: A Fear Free Approach

Pheromone Use in Veterinary Clinics: A Fear Free Approach
In the world of veterinary care, creating a stress-free environment is not just a goal; it’s a necessity for the health and wellbeing of our furry patients. The integration of pheromones into veterinary practices has revolutionized the way we approach animal stress, aligning perfectly with the Fear Free initiative’s mission to prevent and alleviate fear, anxiety, and stress in pets. bSerene™ is at the forefront of this movement, offering science-based pheromone products specifically designed for dogs and cats.The Power of Pheromones in Creating Calm
Pheromones are chemical communicators that play a crucial role in animal behavior and emotional regulation. These odorless signals are key to social bonding, territorial marking, and many other aspects of animal life. bSerene™ harnesses the power of these natural communicators to create a sense of security and calm in stressful environments such as veterinary clinics.

How Calming Pheromones Enhance Veterinary Care

Immediate Detection and Response: Animals detect calming pheromones through the vomeronasal organ, leading to an immediate calming response processed by the brain. This natural mechanism is why pheromone-based products are so effective in reducing stress in clinical settings.
Evidence-Based Success: Research supports the efficacy of pheromone use in veterinary practices. Studies show that feline facial pheromones can increase comfort and wellbeing, evidenced by behaviors like increased food intake and grooming. Similarly, canine pheromones have been shown to reduce stress during examinations, making the veterinary visit smoother for both pets and practitioners.

The Power of Pheromones in Creating Calm
bSerene’s partnership with the Fear Free program underscores its commitment to improving the veterinary health care experience. Here’s how you can integrate bSerene™ pheromone products into your practice to support this mission:

Pheromone Diffusers in High-Stress Areas

Exam Rooms: Create a calming atmosphere that facilitates smoother assessments.
Waiting Rooms: Reduce the anticipation stress often experienced by pets.
Kennel Areas: Promote a sense of calm for pets staying for extended periods.

Pheromone Sprays for Direct Contact

On Scrubs: Help staff soothe pets through their touch.
In Travel Carriers: Ease the stress of transportation.
On Towels in Kennels: Provide a comforting chemical message for resting pets.

Pheromone Collars and Valerian Spot-On Treatments
Sending pets home with bSerene™ collars can extend the calming effect beyond the clinic visit. Additionally, advising pet owners to use bSerene™ Valerian spot-on treatments before visits can make a significant difference in managing veterinary visit stress.

A Comprehensive Approach to Stress Management
It’s crucial to remember that stress management in veterinary care requires a holistic approach. bSerene’s innovative use of pheromones, combined with their Fear Free partnership, offers a scientifically backed strategy to enhance the wellbeing of pets. By adopting these practices, veterinary clinics can foster a tranquil environment that benefits pets, pet owners, and clinic staff alike.

Implementing bSerene™ pheromone products in your practice is a step toward a more compassionate and effective approach to veterinary care, ensuring that every visit is as stress-free as possible.

The Dual Benefit: Calmer Pets, Happier Owners
When pets are calm, the entire veterinary experience is transformed. Less stress for pets means:

Quicker, More Efficient Visits: Calm pets are easier to examine and treat, leading to shorter and more productive appointments.
Reduced Owner Anxiety: Seeing their pets calm can significantly ease owners’ stress, making them more cooperative and receptive during visits.
Improved Safety: Stress can lead to aggression. By reducing stress with pheromones, the risk of bites or scratches is minimized, protecting staff, pets, and owners.
Enhanced Clinic Reputation: Satisfied clients are more likely to return and recommend your clinic to others, thanks to the positive experiences facilitated by pheromone use.

Clinic Checklist for Implementing Pheromone Solutions
Incorporating pheromone-based solutions into your veterinary practice is a strategic move toward a Fear Free environment. This checklist is designed to guide clinics through the process of integrating bSerene™ pheromone products effectively, ensuring a calm and stress-reduced setting for all pets.

Initial Setup

Evaluate Your Clinic Space: Identify areas where pets commonly show signs of stress, such as the waiting room, exam rooms, and kennel areas.
Choose Appropriate Pheromone Products: Select bSerene™ diffusers, sprays, and collars based on the specific needs of your clinic’s layout and the common stressors for pets in your care.

Pheromone Diffuser Placement

Install Diffusers in High-Stress Areas: Strategically place diffusers in the waiting area, exam rooms, and kennel or holding areas.
Check Diffuser Functionality Regularly: Schedule weekly checks to ensure that diffusers are working correctly and refill them as needed.

Pheromone Spray Usage

Integrate Sprays into Daily Routines: Use bSerene™ sprays on items that come into direct contact with pets, such as scrubs, towels, carriers, and examination tables.
Educate Staff on Proper Spray Application: Provide training on how and when to apply pheromone sprays to maximize their effectiveness. For instance, allow alcohol-based sprays to dry for a minimum of 15 minutes before a patient comes in contact with sprayed items.

Pheromone Collar and Valerian Spot-On Implementation

Stock Pheromone Collars for Post-Visit Stress Management: Offer bSerene™ collars to pet owners as a take-home solution to help pets recover from the stress after a procedure.
Recommend Valerian Spot-On Treatments: Advise pet owners to apply bSerene™ Valerian spot-on treatments before visits or in other stressful situations.

Staff Training and Education

Conduct Fear Free Training: Ensure that all staff members are familiar with Fear Free principles and how to use pheromone products as part of this approach.
Create a Protocol for Pheromone Product Use: Develop clear guidelines for when and how to use each pheromone product in your clinic.

Monitoring and Adjusting

Observe Pet Behavior: Pay close attention to how pets respond to the pheromone products and adjust their use as needed to achieve the best results.
Gather Feedback from Pet Owners: Regularly ask clients about their pets’ behavior and stress levels following visits to assess the effectiveness of Fear Free interventions, including pheromone use.

Maintenance and Restocking

Maintain an Adequate Inventory: Keep a regular inventory of all bSerene™ pheromone products to ensure you never run out.
Review Product Usage and Effectiveness: Every few months, evaluate the effectiveness of the pheromone products and consider any necessary adjustments or additions.

Community and Client Education

Inform Pet Owners About Pheromone Benefits: Use newsletters, social media, and in-clinic displays to educate pet owners about the benefits of calming pheromones and how they’re being used in your practice.
Offer Guidance for At-Home Pheromone Use: Provide instructions and recommendations for pet owners interested in using bSerene™ products at home to extend the stress-reducing benefits.

By following this checklist, your clinic can successfully implement bSerene™ pheromone solutions, creating a more peaceful environment for pets, improving their overall experience, and aligning with the Fear Free initiative’s goals.

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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Brought to you by our friends at bSerene.

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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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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5 Steps to Heartworm Disease Awareness

By Jennifer Merlo, DVM, CVBMC, Fear Free Director of Veterinary AffairsWe mention heartworm prevention to pet parents during almost every veterinary visit. So how is it that more than 1 million pets in the United States have heartworm disease¹? American Heartworm Society (AHS) study data collected in 2022 shows that rates of heartworm disease continue to trend upward in both recognized “hot spots” and in locations where heartworm disease was once rare.²

Due to the increased incidence of travel and remote work career options, the United States is experiencing spread of heartworm prevalence throughout the country. Despite our best intentions, our pet parents are still unclear on the severity of the disease and the importance of maintaining proper heartworm prevention.

Here are five ways to help increase your client compliance and decrease the incidence of heartworm disease in your area:

Discuss heartworm prevention at every visit for every pet.

Veterinarians and veterinary staff recognize the importance of discussing heartworm prevention at puppy appointments. However, often we forego discussing it during adult and senior canine patient visits. The AHS reports that only 37 percent of the U. S. canine population is on heartworm prevention!³ This is a staggering number, and it is our job to educate our clients on the importance of prevention for every pet, year-round. We must make it a point to have this discussion with them at every visit and reinforce the importance of prevention rather than treatment.

Cats get heartworms, too!

Too often we neglect to have this important conversation with our feline pet parents. Fewer than 5 percent of cats are on heartworm prevention³. Most feline pet parents do not think about their cat being at risk, since most of them are indoor-only pets. It is important to have open discussions with cat owners about the spread of heartworms. Educating them that even “indoor” cats are still at risk for mosquito bites and heartworm disease can help reduce the incidence within our feline population. Pet owners may not be aware that there are multiple options for adequate heartworm prevention in cats that do not include giving an oral medication; something we know that causes lower compliance rates in cat owners.

Heartworms travel and so do our pets.

The last few years have seen an increase in the number of remote workers, as well positions that require travel across state lines. Our pet owner population now looks at their dog companions as part of the family who often travel with them. As veterinary professionals, we can no longer rely on heartworm incidence maps as they relate to our direct location since our patients are traveling on a regular basis. Heartworm disease has now been diagnosed in all 50 states and without proper education our pet parents may not be aware that they are unintentionally putting their pets at risk. Be sure to ask questions about travel, including vacations as well as work travel, and be sure that pet owners understand that all pets, in all states, are at risk for contracting heartworms.

Ensure that pet parents are regularly giving heartworm prevention.

When I was in practice, I was always in awe of the fact that most pet owners had an ample supply of heartworm prevention at home, yet our records indicated they should need to buy more. This is often because most pet owners only give their pet’s heartworm prevention one-third of the time. With the numerous options available on the market today, there is an option available for every pet parent to become compliant with their pet’s prevention routine. Discuss different prevention options and gauge what your client feels they can be most consistent with. By opening the conversation and talking through what works best for them, you increase your veterinary-client bond while simultaneously reinforcing the human-animal bond.

Recommend heartworm testing annually.

Despite everyone’s best intentions, sometimes doses of prevention get missed, and it’s our job to help our pet parents provide the best medical care for their pets. Recommend yearly heartworm testing to ensure that their pet is free of heartworm disease. Make obtaining the blood sample a Fear Free experience by using a Considerate Approach through positive rewards such as delicious treats or petting and using small-gauge needles to minimize discomfort. My staff was great at using insulin syringes to obtain the minimal amount of blood necessary to perform this annual test while the pet parent offered the patient treats. Most of our patients did not even realize venipuncture had occurred! Remind owners that unless we test, we won’t know, and that it’s just as important to monitor for heartworms as it is to prevent them.

It only takes one bite from an infected mosquito to transfer heartworms to a cat or dog. Let’s join with our pet parents to ensure that all our canine and feline patients are well protected.

Resources

American Heartworm Society, 2023; https://www.heartwormsociety.org/
American Heartworm Society Incidence Map, April 11, 2023
The Truth About Cats and Dogs, American Heartworm Society

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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How Clients Can Train Their Birds for Transport and Reduce Travel Stress

Barbara HeidenreichBefore you can care for avian patients, clients must first get them to your clinic. Often, that’s easier said than done. Most companion birds are not used to leaving their home or riding in cars, and it can be frightening for them.

Reducing or eliminating distress for the avian companion starts before the patient arrives at the veterinary clinic. This is because transportation to the clinic can be a critical part of the process. Most avian companions rarely travel outside of the home. This means travel may have the potential to be challenging. Training birds for transportation in advance can give clients peace of mind and make it more likely that avian patients will receive regular annual examinations and necessary medical attention in a timely manner.

Transport Container Selection

Training for transport first requires finding an appropriate container. Some manufacturers have designed small travel cages, crates, and backpacks specifically for companion birds. However, other products such as plastic kennels or wire crates designed for dogs and cats can be adapted to work well for birds. Buyers should examine these products closely to ensure that the materials are safe and suitably indestructible, depending on the species identified for training.

An ideal container is comfortable, inviting, and easy to train the bird to use. This may require that the client add and position perching of the appropriate size for the species in training. Birds with long tails, like macaws, may require perching to be placed closer to one end to allow them to sit comfortably in the crate or cage. The container should have enough space for the bird to easily turn around.

Some containers provide more than one door, large doors, or unobstructed openings that make it easier for birds to enter voluntarily. This can facilitate training the bird to willingly enter a container for transport.

While it is tempting to put many toys inside a travel container, be careful to avoid hanging toys that can swing into the bird during car movement. This can create an unpleasant experience. Alternative options to consider include small foot toys that can be placed on the bottom of the crate or items that can be secured to the sides that won’t move.

Training to Enter the Transport Container

Training the bird to enter the travel container involves a series of steps. The first step is to give the bird time to habituate to the new crate or portable cage. This involves giving the bird time to see the travel container without any requirement to engage with it. This can be done by placing the crate or cage within viewing distance, while making sure the bird is calm and relaxed in its presence.

The next steps are to encourage interaction with the travel container. The initial interaction can be started by luring. Luring involves placing preferred items in a trail from outside that leads to inside the travel container. This can include food items and toys. For some birds, providing attention can also work.

If the bird knows how to orient their beak toward an object, like a ball on a stick or the tip of a chopstick to earn desired outcomes (also known as targeting), this behavior can also be used to guide the bird into the crate.

Subsequent steps include reinforcing for allowing the door to be closed for short increments of time. This is followed by reinforcing for allowing the container to be picked up with the bird in it. Over time, the container, with the bird inside, is moved for short distances.

Another important step in the shaping plan is to practice driving the bird in the container in the car. It is recommended to start with short trips around the block. Placement of the container may be important to prevent motion sickness for some individuals. Being able to see where they are going can help. If possible, advise clients to place the carrier in the front seat, raised so that the bird can see out the window. They shouldn’t cover the carrier or place it on the floor or in the back of the vehicle.

If clients report regurgitation, advise them on options to prevent motion sickness. Additionally, driving prior to feeding a meal can help reduce nausea.

Addressing Fear Responses

If the avian companion shows a fear response to transport containers due to prior experiences, another strategy is to use distance as a reinforcer for calm behavior in the presence of the travel container. This is done by starting far enough away from the container that the bird’s behavior is relaxed and calm.

Rather than getting closer and closer to the container, the client should approach the container only to a point at which the bird remains relaxed and comfortable, and then retreat from the container. This teaches the bird that calm body language at that distance results in moving away from the container. This is repeated and the distance between the bird and the container is decreased with each approximation.

Eventually the bird is very close to the container, showing relaxed behavior, and the procedure is switched to the steps utilizing the approach previously described. Learn more about how to use distance as a reinforcer in the Fear Free course Addressing Fear & Aggression in Avian Patients: A Constructional Approach.

Training for transportation is a behavior that can be taught even if a bird doesn’t know how to step up on hands or is not entirely comfortable with people. It is an important first step toward making an avian veterinary visit Fear Free. More details about training for transportation and how to train other behaviors to facilitate caring for avian patients are available in the Fear Free Veterinary Certification Program – Avian.

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

Barbara Heidenreich is an animal training consultant specializing in exotic animals. She consults worldwide working with zoos, universities, veterinary professionals, and conservation projects. She has worked onsite with over 80 facilities in 27 countries. She is an adjunct instructor at Texas A & M University. She has authored two books and contributed to four veterinary textbooks. She is a coauthor of two Fear Free® Avian Certification Courses. Much of her work focuses on training exotic species to cooperate in medical care. Barbara is an advisor for the Animal Training Working Group and the Parrot Taxon Advisory Group for the European Association of Zoos and Aquariums. She has provided her expertise to conservation projects The Kakapo Recovery Program and The Borneo Orangutan Survival Foundation. Her goal is to leave behind a legacy of kindness to animals by sharing her expertise.

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How to Make Dentals Fear Free for Pets, Clients & Yourself

Jan Bellows, DVM, DAVDC
Wouldn’t it be wonderful if you could approach dentistry without fear, anxiety, or stress? It can be done and it’s not all that difficult. Let’s dissect the touchpoints of dental fear and how to replace dread with confidence.

Client Fear

1. Fear of Anesthesia

This is generally your client’s number-one trepidation. Fortunately, modern, safe anesthesia procedures include (1) evaluating the patient with physical and laboratory exam beforehand, (2) tailoring medication protocols to the patient, and (3) constant monitoring while anesthetized and during post-anesthesia recovery. Sharing these safety measures with your clients goes a long way to alleviate their fear.

2. Fear of Tooth Loss

Often clients will ask “How will my dog eat if you extract so many teeth?” The reply should be “Better than ever before because by removing the diseased teeth, the mouth will now be pain-free.”

3. Fear of Expense

This concern is often shared by both the client and veterinarian. To mitigate this fear, concentrate on what needs to be done to provide the pet with a pain-free, healthy, “happy” mouth. When asked “What is this going to cost?” early in the exam, answer that you will discuss fees “before we leave this room” and “cost is going to be part of the good news.” This can help set the client’s mind at ease and allow them to focus on their pet, the exam you’re performing, and the expertise you’re sharing. Once you’ve established an optimum treatment plan, you can work together to find the best way to make it happen, including payment.

Keep in mind that clients are used to going to their own dentist and are familiar with dental costs. Fortunately, most veterinary practices offer financing, such as the CareCredit healthcare credit card,  as a payment option. This allows clients to pay for their pet’s dental care over time in budget-friendly monthly payments rather than the entire cost upfront.

Functional vs. Optimal Care

There are bound to be challenges on the path from the basic dental care to optimum care. Most clients want to do the very best for their pet, but cost and time commitment with after care can be barriers. Our job is to provide them with solutions that make the best care possible—budget-wise, time-wise, and health-wise.

Root planing, local antimicrobial administration (LAA),  and laser periodontal surgery are often recommended for optimum care, but these simply may not be in the financial comfort range of some clients. This is where payment options can help to pay for the care they want for their pet or they can choose functional care.

Some pet owners may be unable or unwilling to provide needed follow-up care. In these cases, multiple extractions are usually necessary to create a pain-free, functional mouth. It may not be gold standard, but the pet will receive great basic care that supports quality of life.

Perhaps the most important thing to remember is that moving clients from fear to acceptance for their pet’s dental care is possible when we take the time to communicate the value and not just the cost.

Veterinary Fears

1. Oral Surgery

While the goal in veterinary dentistry is to save teeth, it often becomes necessary to remove some or all of the teeth. Indications for extractions include fractured teeth, advanced periodontal disease, non-functional orthodontic disease, and chronic ulcerative conditions. Oral surgery fears include excessive bleeding, inability to remove the entire tooth, jaw separation, and dehiscence. Fortunately, these worries are easy to change into happy opportunities.

Excessive bleeding can be mitigated through avoidance, realizing that in the maxilla the most troublesome area surrounds the infraorbital artery, which exits the infraorbital canal just above the maxillary third premolar. In the mandibles the area to avoid is the mandibular canal. When either of these are breached, bleeding occurs, which can be minimized by elevating the head with towels, applying a hemostatic agent (Vetigel®), and gauze pressure.
Inability to remove the entire tooth through root separation can usually be prevented by examining intraoral radiographs before the procedure, large exposure, and gentle luxation with a sharpened luxating elevator.
Jaw separation, occurring usually secondary to advanced periodontal disease, is rare. Consultation with a veterinary dentist is recommended.
Dehiscence is also rare and, in most cases, should be left alone to self-heal.

2. Not enough time

This proven workflow can eliminate time fears.

A client calls to schedule a teeth-cleaning visit due to oral malodor. The client care coordinator shares that your practice provides more than teeth cleaning. The client will be scheduling an appointment for oral prevention, assessment, and treatment (Oral PAT). This is the time to be sure clients understand the value of complete oral care:

There is a dental cause for their pet’s halitosis.
This will be diagnosed during the initial oral examination, pre-anesthesia testing, as well as a tooth-by-tooth examination under general anesthesia.
Recommended treatment for the cause will be discussed, and it can be performed during the same anesthesia, time permitting, or at a later time.
The doctor will make plaque and tartar control suggestions the client can perform at home to support overall oral health.

Here’s a timeline example…

9 a.m. The owner brings their dog or cat into the exam room. Review the history and previous laboratory results, examine the pet, and focus on the oral cavity. Discuss owner willingness and ability to provide daily plaque control. Share the value of the services, then discuss fees for initial diagnostics and dental scaling and radiograph imaging before the client leaves the exam room. The client agrees in writing that they understand:

Anesthesia will be performed, and they have been informed of the associated risks.
There will be additional fees if extra care is needed to treat the cause of the malodor.
Payment options are discussed openly.

Next, inform the client what to expect from the day and arranges a time (1 p.m.) to speak to the owner while the pet is still anesthetized after the cause of halitosis has been determined.

9:30 – 11 a.m. The staff acquire pre-anesthetic test results to share with the veterinarian and prepare the patient for anesthesia.

11:30 a.m. – 12:45 p.m. The patient is anesthetized, teeth are cleaned, intraoral radiographs are exposed and placed in  a template for the veterinarian to examine chairside. The veterinarian is handed a dental probe to conduct the tooth-by-tooth examination and treatment plan, dictating results to an assistant who creates the dental chart. The assistant tabulates additional fees and creates a report or takes cell phone images, which are emailed to the client.

1 p.m. Talk to the pet owner to review what was found and describe optimum treatment and why it is important for their pet. Fees for the additional care are discussed, along with payment options.

3 p.m. Therapy (e.g., extraction of multiple teeth and application of a locally applied antimicrobial to stop bleeding on probing points) is completed.

5:30 p.m. The client meets with the doctor to review the diagnostics and therapy. A follow-up appointment is set to evaluate healing and create a daily plaque prevention program tailored for the pet.

3. Proper Assistance, Equipment & Instruments

An assistant goes far to lessen the load on the veterinarian during dental treatment.

Proper instruments and equipment are also important:

Elevators: Because there are a variety of sizes of teeth, one needs a variety of sizes of dental elevators. Generally, select the elevator that best fits the contour of the tooth to be extracted. The Heidbrink and Miltex 76 are root tip picks useful in elevation and for extracting retained root tips. They also can be used to cut the gingival attachment off the tooth prior to displacement with dental elevators.

Extraction Forceps: Smaller extraction forceps have been designed for dog and cat teeth. They have more parallel jaws, increasing the surface contact and are much more effective than the human incisor forceps formerly used in veterinary dentistry.

Magnification & Lighting: One frustrating aspect of oral surgery is the limited access and poor visibility. These problems may be decreased using magnification (2.5-3 power) and head lamps.

Sterilization of Equipment: Since extraction is a surgical procedure and the instrument penetrates tissue sterile instruments should be used. While it is true that the tissue surrounding the tooth is already infected, it is inappropriate to add different species of bacteria to the infection. Chemical disinfectants may be effective, but they take time to work, and must be thoroughly washed off prior to use.

Hemostatic Agent: Vetigel® is used to syringe over a bleeding area. Within a minute the bleeding generally stops.

Flaps: Surgical extractions are performed by making releasing incisions on the mesiobuccal and distobuccal line angles between adjacent teeth. These releasing incisions are joined by an intrasulcular incision that follows the gingival margin. The periosteum and gingiva are elevated off the bone with a periosteal elevator, to create a full-thickness gingival flap. The buccal plate of bone over the tooth is removed with a water-cooled high-speed bur. The root is removed, and the flap is closed without tension over the alveolar socket.

Postop

Radiographs taken postoperatively allow the practitioner to verify that the entire tooth has been extracted. Radiographs create a permanent record of the procedure. The possible pain to the patient caused by the disease condition or the procedure creates the need for consideration of pain medication administered by injection of a local anesthetic, parenteral injection, and oral pain relief medication.

Complications

Tooth roots may become separated during the extraction procedure, creating non-extracted root fragments. The preferred treatment in this situation is to create a buccal flap over the fragment for removal.
Collateral damage to other oral or extra oral structures including perforation and orbital contusion of the eye with sharp dental instruments.

Using proper instrumentation and extraction technique makes the extraction simpler, safer, and easier on the patient and practitioner. Multirooted teeth should always be sectioned prior to extraction to prevent the likely hood of fractured root segments. Difficult extractions can be accomplished by gingival flap surgery to facilitate atraumatic elevation of the root in a buccal direction. Pre- and postoperative radiographs and pain control help document what has been done and provide the patient with a relatively painless procedure.

Pet Fears

Let’s not leave out the patient, who is our most important consideration. Fear Free practices such as use of nonslip surfaces and techniques such as considerate approach and touch gradient contribute to the success of dental procedures.

Creating a Fear Free dental practice is achievable. I am always happy to help. Please email any questions (dentalvet@aol.com) or call on my cell 954-465-4200.

References

DeBowes LJ. Simple and surgical exodontia.Vet Clin Small Anim 2005; 35:963–984.
Gunew M, Marshall R, Lui M, Astley C. Fatal venous air embolism in a cat undergoing dental extractions.J Small Anim Pract2008; 49, 601–604.
Holmstrom SE, Frost, P, Eisner ER. Exodontics. In:Veterinary Dental Techniques for the Small Animal Practitioner. 3rd ed. Philadelphia: Saunders, 2004, pp. 291–338.
Kapatkin AS, Manfra Marretta S, Schloss AJ. Problems associated with basic oral surgical techniques. In:Problems in Veterinary Medicine. Dentistry. Manfra Marretta S ed., 1990; 2: 85–109.
Reiter AM, Brady CA, Harvey CE. Local and systemic complications in a cat after poorly performed dental extractions.J Vet Dent 2004;21: 215–221.
Reiter AM. Dental surgical procedures. In:BSAVA Manual of Canine and Feline Dentistry. Eds. C. Tutt, J. Deeprose, D. Crossley. BSAVA, Gloucester (UK), 2007, pp. 178– 195.
Scheels JL, Howard PE. Principles of dental extraction.Sem Vet Med Surg 1993; 8:146–154.
Smith MM, Smith EM, La Croix N,et al. Orbital penetration associated with tooth extraction. J Vet Dent 2003;20:8–17.
Van Foreest A: Exodontia (tooth extraction in dogs).EJCAP 1993; 3:35–42.
Verstraete FJM. Exodontics. In:Textbook of Small Animal Surgery. Philadelphia: WB Saunders, 2003; 2696–2709.

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

Dr. Jan Bellows received his undergraduate training at the University of Florida and Doctorate in Veterinary Medicine from Auburn University in 1975. After completing a small animal internship at The Animal Medical Center in New York City, he returned to south Florida where he still practices companion animal medicine surgery and dentistry at ALL PETS DENTAL, in Weston Florida. He is certified by the Board of Veterinary Practitioners (canine and feline) since 1986 and American Veterinary Dental College (AVDC) since 1990 He was president of the AVDC from 2012-2014 and is currently president of the Foundation for Veterinary Dentistry. Dr. Bellows’ veterinary dentistry accomplishments include authoring five dental texts – The Practice of Veterinary Dentistry …. A team effort (1999), Small Animal Dental Equipment, Materials, and Techniques (2005, second edition 2019) and Feline Dentistry (2010, second edition 2022). He is a frequent contributor to DVM Newsmagazine and a charter consultant of Veterinary Information Network’s (VIN) dental board since 1993. He was also chosen as one of the dental experts to formulate AAHA’s Small Animal Dental Guidelines published in 2005 and updated in 2013 and 2019.

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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.

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.

Transport Container Selection

Training to Enter the Transport Container

Addressing Fear Responses

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Client Fear

Functional vs. Optimal Care

Veterinary Fears

Postop

Complications

Pet Fears

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.