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.
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.
Alison Gerken, DVM, Lisa Radosta DVM, DACVB, Tamara Grubb, DVM, PhD, DACVAAHetch-Hetchy is the sweetest, most affectionate cat I have ever known. For the past 12 years, he has seen me through veterinary school, my father’s passing, my marriage, and most recently, a cross-country move to start a veterinary behavior residency. This guy has been the most devoted, loving companion, but he is not the bravest of souls. When Hetch goes in for a veterinary visit, he often leaves with a urethral obstruction (UO). While not fractious at the veterinary hospital, he becomes very stressed and has an impressive ability to wiggle out of any restraint.
The stress of veterinary visits frequently resulted in urethral obstructions for Hetch.
Hetch has had myriad health issues over the last year, necessitating four hospitalizations and at least 10 veterinary visits. Fortunately, pre-medication at home with buprenorphine and trazodone in addition to a quick injection of alfaxalone at the hospital has allowed for almost effortless hospitalizations and has prevented further UOs. Hetch had never needed to be boxed down.
When Hetch recently needed an anesthetic procedure, I researched veterinary specialists in my new area and dropped him off at a trusted specialty hospital. I reminded the staff that Hetch blocks when stressed and attached a note to his carrier requesting that I be called if he became stressed. I thought I was doing everything right to prevent another UO. However, when I picked Hetch up from the hospital after his procedure, I found my normally mellow cat panicking inside his carrier. When I inquired as to why Hetch was so distressed, I was astonished to learn that he had been “boxed down” that day. In other words, rather than being given a fast-acting injectable medication to induce anesthesia, he was stuffed into a box that was then filled with anesthetic gas – a prolonged and stressful way to be anesthetized.
When we returned home, Hetch began vocalizing and walking in and out of his litterbox. I panicked when I realized we might be facing another UO. Fortunately, Hetch wasn’t blocked, but for days after that veterinary visit, my normally social, loving kitty hid beneath the bed and barely ate. He was traumatized, and the only difference in that visit from all of his others was that he was boxed down. Not only was I incredibly saddened to think of my own cat being subjected to the inhalant chamber, I was also deeply troubled to learn that inhalant chamber use is not uncommon in veterinary medicine.
Why “Boxing Down” Animals Isn’t a Good Choice
Most of us who have been practicing for longer than a decade have used inhalant chambers to “box down” feline patients. It seemed to work, and the patient was able to be treated. Why throw away a potentially useful sedation protocol? Because the use of inhalant chambers or masks (also called “boxing” or “masking”) for sedation or induction to anesthesia is not considered standard of care for a number of reasons. (We should note, however, that mask sedation is commonly used for birds.)
Use of inhalant induction can be dangerous to pets.
In a study on anesthetic risk for death, Brodbelt (2009) showed that inducing and maintaining patients on inhalants alone added to the risk of anesthetic fatalities. The risk is secondary to the high dose (high percentage setting on the vaporizer) of inhalants required to achieve induction.
Inhalant anesthetics are appropriate for maintenance of anesthesia but not for induction.
The high dose can cause dangerous physiologic changes, such as hypotension and respiratory depression. In addition, mask or inhalant induction requires a prolonged period with an unprotected airway (i.e., no endotracheal tube) with an increased risk of airway compromise or obstruction. Because of this, inhalant induction can be dangerous in any animal and is contraindicated in brachycephalic animals.
The excitatory phase of anesthesia (Stage II; Table 1) is exaggerated and prolonged with this type of induction, further increasing the dose necessary to achieve induction. The excitement causes a release of catecholamines, which may cause tachycardia, hypertension, and hyperventilation and may increase the risk of arrhythmias and/or cardiopulmonary arrest.
Once the patient is induced, a higher concentration of inhalant is required for the maintenance phase of anesthesia when compared to the dose of inhalants required to maintain anesthesia in patients who also had premedications or injectable induction drugs.
Use of inhalant induction can be dangerous to humans.
The veterinary healthcare team and any pet parents who are present may be potentially exposed unnecessarily to anesthetic inhalants. No matter how tightly the induction chamber is sealed or the mask is fit, it is never totally leak-proof. There will be contamination of the environment with the inhalant gas. Although not consistently linked, health concerns due to exposure to anesthetic gases have been shown to range from reproductive effects such as spontaneous abortion (Shirangi et al. 2008) to genetic damage (Cakmak et al. 2019). OSHA states: “The waste anesthetic gases* and vapors of concern are nitrous oxide and halogenated agents (vapors) such as halothane, enflurane, isoflurane, and desflurane. Some potential effects of exposure to waste anesthetic gases are nausea, dizziness, headaches, fatigue, and irritability, as well as sterility, miscarriages, birth defects, cancer, and liver and kidney disease.” (https://www.osha.gov/SLTC/wasteanestheticgases/index.html)
*Waste anesthetic gas is inhalant anesthetic gas not metabolized by the patient and is exhaled back into the breathing system. It should be evacuated from the anesthetic machine by the scavenging system. Unfortunately, the gas often leaks from the machine or breathing system, causing environmental contamination and human exposure.
The view on dangerous results related to use of chamber inductions in animals is shared by both veterinary and human-health experts:
“Chamber inductions should never be routine but rather a ‘last resort’ and only when other approaches have failed.” (Robertson et al. 2018)
“Mask or chamber inductions can cause stress, delayed airway control, and environmental contamination and are not recommended by the authors.” (Grubb et al. 2020)
“Chamber induction in unpremedicated, agitated cats is the least desirable technique described in these Guidelines, since an agitated cat will require more inhalant anesthetic to achieve the desired endpoint. This increased inhalant anesthetic requirement results in severe depression of the cardiovascular system. Additionally, an increased release of catecholamines predisposes the cat to development of cardiac arrhythmias.” (Robertson et al. 2018)
“The use of an induction chamber with gas anesthetic as a method of restraint may mean less control of the patient’s airway and raises concerns about other safety issues for the cat and the staff.” (Robertson et al. 2018)
“A disadvantage of this technique is the unavoidable release of anesthetic gases and exposure of personnel when the cat is removed from the chamber.” (Rodan et al. 2011)
Stress has many definitions, but according to the National Research Council Committee on Recognition and Alleviation of Distress in Laboratory Animals, it is defined as a real or perceived perturbation that threatens homeostasis.
Inhalant chambers are not considered standard of care. Their use should be avoided for a number of reasons.
The stress response is a normal part of daily life but becomes harmful when triggered too intensely or for too long (Hekman, 2014). Different stressors cause varying levels of activation of these responses, but it has been shown that uncontrollable stressors from which an animal cannot escape and which cannot be mitigated activate the stress response more strongly across species (Dess, 1983).
Activation of the sympatho-adreno-medullary (SAM) axis in response to an acute stressor initiates an immediate response, often known as the “fight or flight” response. SAM axis activation leads to mydriasis, increased heart rate, increased blood pressure, cutaneous vasoconstriction, increased plasma glucose, and increased free fatty acid concentrations (Hekman, 2014).
A slower response to a stressor is mediated by activation of the hypothalamic-pituitary-adrenal (HPA) axis, with effects seen in minutes to hours to days. This response mediates release of glucocorticoids from the adrenal cortex. Glucocorticoids affect a wide range of physiologic functions including, but not limited to, metabolic processes such as protein, glucose, and fatty acid metabolism; immune function; gastrointestinal motility; growth; thyroid function; and reproduction (Hekman, 2014).
The overall effect of these responses is to mobilize energy stores, increase oxygen intake, decrease blood flow to non-critical areas, and inhibit digestion, growth, immune function, reproduction, and pain perception (Tynes, 2014).
Several studies have demonstrated that inhalant chambers are significant stressors. Reiter et al 2017 found that inhalant anesthesia increased concentrations of various hormones, including cortisol, corticosterone, and other glucocorticoids in mice, indicating activation of the HPA axis. The mice in this study appeared agitated and dug in the corners of the induction chamber. Similarly, a study by Flecknell et al 1996 found that induction of anesthesia in an inhalant chamber and an inhalant face mask caused all animals to avoid inhaling anesthetic vapor and to breath-hold, behaviors indicating that the induction was aversive. Another study by Flecknell et al 1999 evaluating the effects of induction of anesthesia with sevoflurane and isoflurane in an inhalant chamber found that most animals struggled violently during induction and breath-held, leading the study authors to conclude that both sevoflurane and isoflurane were aversive and should be avoided.
Furthermore, inhalant chambers cause increased struggling, breath-holding, and excitement because induction times with inhalant anesthetics are generally slower than intravenous agents such as propofol (Lester et al 2012).
Stress increases morbidity and mortality.
The consequences of physiologic and psychogenic stress on health and welfare outcomes have been documented across a range of domestic species.
Stress can increase susceptibility to infection and sepsis, reduce the rate at which wounds
heal, and increase the risk of gastric ulceration development (Hekman, 2014).
Westropp 2006 showed that cats with feline idiopathic cystitis (FIC) had altered bladder permeability, most notably during the initial period of stress.
Some cats may develop marked hyperglycemia secondary to an acute stressor, including struggling, with some cats having glucose concentrations in the diabetic range (> 200 mg/dL) over 90 minutes after exposure to the acute stressor (Rand et al 2002). This may lead some cats to be treated with insulin despite not being diabetic. Furthermore, struggling in an induction chamber may lead to injury of the patient.
Inhalant chambers perpetuate fear.
The animals considered candidates for use of the inhalant chamber or mask are often displaying aggression or fear and restraint is considered difficult or impossible.
Most animals visiting the veterinary hospital display signs of fear. A study by Doring et al 2009
Fear and stress during veterinary care can contribute to illness and injury.
found that 78.5% of clinically healthy dogs visiting a veterinary hospital in Germany showed signs of fear on the examination table. Quimby et al 2011 found that most cats hid more and had elevated physiologic parameters associated with stress (heart rate, respiratory rate, and blood pressure) when in a veterinary clinic compared to their home. In a survey of over 1,100 cat caretakers in Italy, most cats showed signs of fear during all stages of a veterinary visit, including 73% in the reception, 85% on the examination table, 55% during examination, and 58% after returning home. Restraint, pain, and anxiety led to aggression toward veterinarians and caretakers in these cats (Mariti, 2016).
Use of an inhalant chamber or mask will undoubtedly perpetuate underlying fear in patients already displaying fear. Koolhaas 1997 found that a single experience with a major stressor may have long-term consequences ranging from hours to days to weeks. Mariti 2016 showed that 34% of the cats’ stress following a veterinary visit subsequently worsened with handling in other situations. Landsberg 2013 supports that a single exposure to a stressor can be enough to cause a fearful response in the future. Therefore, the trauma of the inhalant chamber or mask is likely to increase the pet’s fear and anxiety at future veterinary visits. This will compromise the veterinarian’s future ability to provide the highest quality of care to these pets.
Increased fear, anxiety, and stress compromise patient care and veterinary staff safety.
Patients subjected to an inhalant chamber may display more fear and aggression. This can make administration of treatments and medications in hospital or at home following the procedure more difficult or unsafe for veterinary staff or clients.
Dog and cat bites as well as cat scratches are the most common cause of injury to veterinary hospital staff (Jeyaretnam, 2000), so increased pet fear and anxiety compromise the safety of staff.
Stressful veterinary visits have economic implications to the practice.
According to the Bayer veterinary care usage study, their pets’ stress is a leading reason pet parents fail to bring their animals to the veterinary hospital (Volk, 2011). Out of more than 1,000 cat caretakers, 58% reported that their cat hates going to the veterinarian and 38% of the cat caretakers reported that they themselves were stressed just thinking about taking their cat to the veterinarian (Volk, 2011). In a survey of 200 cat owners conducted by the International Society of Feline Medicine and Your Cat magazine, 20% of respondents said their most recent visit to a veterinarian had been sufficiently stressful that they would either avoid going back or would change veterinarians (Rodan 2005).
Cats are already underserved veterinary patients. In the Bayer usage study, 40% of cats had not been to a veterinarian in the last year compared to 15% of dogs (Volk, 2011). More than three-quarters of veterinarians in that study reported that care for cats is one of the most significantly missed opportunities in veterinary practice (Volk, 2011).
Stressful veterinary visits are likely to result in a further decline in cat visits, creating a greater obstacle to reaching the feline market.
Overall, the implications of using an inhalant chamber are far-reaching. For all of the above reasons, taking steps to decrease physiological and emotional stress is an essential medical goal, one that is significantly undermined by use of an inhalant chamber or mask.
Why Chemical Restraint Shouldn’t Be a Last Resort
Chemical restraint is often necessary for animals displaying fear and aggression and should not be considered a last resort (Grubb et al. 2020 Lloyd, 2017). According to the American Association of Feline Practitioners/International Society of Feline Medicine Guidelines on Feline Friendly Handling, indications for chemical restraint include the following:
–when an animal shows fear, anxiety, stress, or aggression;
–situations in which pain, discomfort or surgery is anticipated and where analgesia alone will be insufficient;
–when gentle restraint does not provide sufficient safety for the team.
Fortunately, many alternatives to inhalant induction exist to achieve chemical restraint, starting with premedication at home.
Evaluating Patient Fear, Anxiety, and Stress and Determining the Need for Pre-Visit Pharmaceuticals
Premedication at home may reduce the need for the inhalant chamber or mask and may reduce the need for injectable sedation or general anesthesia. It can make handling the patient more pleasant for all. Use of the FAS scale will aid in determining which pets may benefit from pre-visit pharmaceuticals (PVPs).
The FAS scale was created to rate a patient’s level of fear, anxiety, and stress in the veterinary clinic. It is a useful tool to determine if a PVP and/or injectable sedation is indicated.
A pet with FAS scores of 2 or 3 displays some lack of interest in treats, toys, and/or attention. This pet may fidget and have difficulty settling. This is consistent with moderate fear, anxiety, and stress, and a pre-visit pharmaceutical is recommended.
A pet with FAS scores of 4 or 5 displays little to no interest in treats; exhibits a fight, flight, or freeze response, and may display aggression. This is consistent with a high degree of fear, anxiety, and stress, and pre-visit pharmaceuticals combined with injectable sedation if needed is recommended. (Martin K and Martin D, 2007).
When scheduling veterinary appointments or procedures, ask clients about the pet’s behavior in the veterinary hospital. If the pet has a history of being fearful in the hospital, have the pet parent administer oral anxiolytics and/or sedatives such as gabapentin, trazodone, buprenorphine, transmucosal dexmedetomidine, and benzodiazepines prior to arrival.
Using PVPs
All pre-visit pharmaceuticals have variable effects in individual animals and should be tested prior to the veterinary visit to evaluate time to onset, effect, duration of effect, and possible adverse effects. This information will enable the veterinarian to evaluate the pre-visit pharmaceutical plan and make adjustments if warranted to ensure an optimal outcome.
Potential pre-visit pharmaceuticals include gabapentin, trazodone, benzodiazepines, some opioids, and some formulations of alpha-2 agonists. Oral acepromazine and melatonin can also be considered (Costa et al. 2019), keeping in mind, however, that acepromazine should never be used alone, as it is a tranquilizer but not a good anxiolytic. Before prescribing a medication as a pre-visit pharmaceutical, the attending veterinarian should consider the age of the pet, any interactions with other medications or supplements currently being administered, the pet’s overall health status, interactions with the chosen anesthetic protocol, and any other contraindications to administration.
Gabapentin
While not labeled for use for anxiety, gabapentin is increasingly used to reduce anxiety in humans and in veterinary patients. In a study by van Haaften et al 2017, 100 mg of gabapentin per cat prior to a veterinary visit resulted in significantly lower stress during transportation and examination as reported by pet parents, and increased compliance during examination as reported by veterinarians. Gabapentin also reduces neuropathic pain, which may benefit patients in which underlying pain may be contributing to fear and aggression.
Sedation is a possible side effect and may vary depending on cat size, so administer 50 mg to petite or geriatric cats. Large cats may require 200 mg for optimal effect. Other side effects of gabapentin include ataxia, hypersalivation, vomiting, and increased appetite.
Gabapentin should be administered three hours prior to the veterinary visit. The capsule may be opened and the powder sprinkled onto 1 tablespoon or less of wet food, tuna juice, Churu, or other tasty food. The effects of gabapentin may last for 8 to12 hours. When using gabapentin, administering an additional dose the night before the veterinary visit may be helpful.
Trazodone
This serotonin antagonist reuptake inhibitor is an anxiolytic and sedative. The dose of trazodone for cats is 50 to 100 mg per cat (not mg/kg). It should be administered three hours prior to a veterinary visit.
Side effects of trazodone may include drowsiness, variable mild gastrointestinal effects such as vomiting, diarrhea, decreased or increased appetite, and paradoxical excitation. When administering a test dose at home prior to the veterinary appointment, have the pet parent assess the pet’s level of sedation three hours after administration by calling the pet in a happy voice, shaking a treat jar, and/or getting out the pet’s favorite toy. If the pet readily rises and runs over to the pet parent, then the dose should be increased by 25% and another test performed at home. Duration of effect is 4 to 12 hours.
Benzodiazepines
These potent anxiolytics have a rapid onset of action with effects that last a few to several hours. They are reasonable options for patients with severe fear and anxiety, but their use is not recommended in patients with aggression.
Benzodiazepines may cause a paradoxical excitement reaction, so it is necessary that they be tested at home prior to a veterinary visit. Other side effects include ataxia, sedation, muscle relaxation, and increased appetite.
Commonly used benzodiazepines in cats include lorazepam and alprazolam.
Lorazepam has no active metabolites, so it is safer for geriatric patients and patients with hepatic disease. The dose of lorazepam for cats is 0.25 to 0.5 mg per cat (not mg/kg). It should be administered two to three hours prior to a veterinary visit.
Alprazolam has a different pathway for metabolism than diazepam, so it may have reduced risk of liver toxicity in cats. The dose of alprazolam for cats is 0.125 to 0.25 mg per cat (not mg/kg). It also should be administered two hours prior to a veterinary visit.
Injectable diazepam is used frequently in cats for anesthesia. There are a few reports of oral diazepam causing fatal hepatic failure when used at high dosages. Use it with caution in cats with hepatic disease and do not exceed clinical doses.
Buprenorphine
Buprenorphine is a partial mu agonist with analgesic and mild sedative effects. It is commonly administered with other sedatives and anesthetics, making it a reasonable option for balanced sedation or anesthesia in cats and dogs. Side effects may include sedation (which is the goal in this situation), hyperthermia, hypothermia, vomiting, and constipation.
Buprenorphine can be administered transmucosally in cats at a dose of 0.01 to 0.02 mg/kg, although a higher dose may be necessary since oral transmucosal uptake is low and variable (Steagall et al. 2014). Buprenorphine should be administered two to three hours prior to a veterinary visit. Duration of action is four to eight hours. Simbadol provides analgesia for 24 hours but efficacy of this duration has not been proven for OTM administration. (Steagall et al. 2014).
Sileo
Sileo, which is transmucosal dexmedetomidine, is FDA-licensed to treat dogs with noise aversions but is used off-label in a number of situations to reduce anxiety in dogs and cats. Sileo is fast-acting and minimally sedating. At a dose of 0.02 mg/kg, it can be combined with buprenorphine for use in cats with more significant fear and stress. In dogs, the dose is 0.01 to 0.04 mg/kg, and combination with buprenorphine is also an option. Sileo should be administered 60 minutes prior to a veterinary visit.
Not only will an effective pre-visit pharmaceutical plan decrease the animal’s fear, anxiety, and stress, it will also allow for easier and safer administration of intramuscular injections of premedications and anesthetics for all involved.
Transportation and Handling on Arrival
Request that the pet parent transport the patient in a soft, squeezable carrier or a carrier with a top that can be easily removed to facilitate low-stress handling. When the pet arrives at the hospital, immediately place the pet, still in the carrier, in a quiet room. Cover cat carriers with towels sprayed with Feliway.
Proper patient handling skills are paramount to minimizing stress and increasing safety during sedation or anesthesia (Yin 2009, Rodan et al 2011). Low-stress handling techniques are intended to minimize fear and pain experienced by pets during veterinary examination and increase safety of the veterinary team (Rodan 2010, Yin 2009). When handled appropriately with gentle restraint and Fear Free techniques, full anesthesia may not be necessary.
Removal From Carrier
Covering or wrapping a cat with a towel can help to decrease stress and increase a feeling of security.
Use gentle restraint when performing a physical exam and administering intramuscular injections. Do not grab and pull the pet out of the carrier and do not tilt to shake the pet out. For markedly fearful and/or aggressive pets who have arrived in a soft carrier, gently squeeze the sides of the carrier to administer an intramuscular injection through the carrier. For pets who have arrived in a carrier with a removable top, gradually remove the top half of the carrier while simultaneously placing a towel between the two halves of the carrier. Cover the pet with the towel, starting at the rear, and gradually move the towel up the pet’s body while removing the carrier top. This will allow for restraint under the towel for an exam and intramuscular injection.
Additional Sedation
If the pet needs a deeper plane of sedation, balanced sedation can be achieved with intramuscular injections of an opioid, dexmedetomidine or medetomidine, midazolam, alfaxalone, Telazol, and/or ketamine. If IV access is possible, propofol can be added to this list of drugs. When using injectable sedation, be aware that fear, anxiety, and stress may produce a more variable and less efficacious sedative response. The protocol may need to be adjusted. For all drugs, if the patient is deeply sedated or anesthetized, provide supplemental oxygen and initiate monitoring of physiologic parameters and support of normothermia.
For the opioids, mu agonists such as methadone, morphine, and hydromorphone provide the most profound analgesia and should be considered for patients undergoing surgical or other painful procedures. Buprenorphine is a partial agonist and may provide more analgesia than butorphanol but may also be less sedating. As previously stated, buprenorphine is absorbed after OTM administration, as is methadone.
Butorphanol provides mild, short-duration (60 minutes in the dog, 90 minutes in the cat) analgesia so is not optimal for painful procedures. However, butorphanol is a fairly effective sedative in both dogs and cats, especially in sick or aged patients. It is often combined with an alpha-2 agonist to increase the depth and predictability of sedation in healthy dogs and cats, as well as to enhance the alpha-2 mediated analgesia. Nausea and vomiting are the main adverse effects. Pre-treatment with an anti-emetic, such as maropitant, is recommended. Oral maropitant can be administered at home by the pet parent, thereby decreasing the likelihood of vomiting from the car ride to the hospital. Oral maropitant is approved for the dog at 2 mg/kg and used off-label in cats at 1 mg/kg (Quimby 2020). Other adverse effects include those listed above for buprenorphine. Naloxone can be used to reverse the effects of all opioids, although buprenorphine binds tightly to opioid receptors, making full reversal difficult.
Alpha-2 agonists, such as dexmedetomidine and medetomidine, provide fairly rapid analgesia and sedation and their effects can be reversed. There is a ceiling on the degree of analgesia, so further dosing acts to increase the degree of sedation, duration of sedation, and potential adverse effects. Alpha-2 agonists produce an initial hypertension and reflex bradycardia. Avoid using them in patients with most cardiovascular diseases. Alpha-2 agonists may also cause nausea and vomiting. Oral maropitant can be administered by the pet parent at home prior to the visit. Otherwise, administer maropitant SQ prior to the alpha-2 agonist if possible or administer maropitant SQ or IV once the cat is sedate.
Dexmedetomidine will markedly reduce the amount of induction and maintenance drugs required for anesthesia; use half or less of the standard induction drug dose. Wait at least 15 to 20 minutes after administering dexmedetomidine before induction to allow maximum effect to occur. Because level of sedation can be tailored to the patient by adjusting the dose and because the effects of alpha-2 agonists are reversible, this class of drugs is commonly used for sedation of pets admitted for outpatient procedures. The alpha-2 drug effects do not always require reversal, but reversal allows rapid return of a fully conscious pet to the pet parent.
Patients should be calm during both induction and recovery. Excitement should be avoided.
Alfaxalone is an anesthetic drug that can be used at low dosages for sedation or high dosages for anesthesia. It has a short time to onset and rapid duration of action with minimal adverse effects, which include dose-dependent minimal to mild cardiovascular and respiratory depression. It can be safely combined with other premedications such as opioids, dexmedetomidine, medetomidine, midazolam, and acepromazine. Alfaxalone can be administered intramuscularly (IM) and is a good option for cats but its volume makes it impractical for IM injections in larger pets. When used as a sole agent, recovery can be rough so balanced premedication protocols will help to diminish or eliminate this effect.
Ketamine is a dissociative anesthetic that is effective when administered intramuscularly and can be used at lower dosages for sedation and higher dosages for anesthesia. It provides analgesia when used at low doses and administered as an infusion. It is often combined with a benzodiazepine (midazolam or diazepam) for induction. Cardiovascular and respiratory depression are uncommon but could occur if the drug is administered to a severely compromised patient at an anesthetic dose.
Anesthetic dosages may need to be avoided in pets with a history of seizures or suspected intracranial disease, although recent data indicate that the drug may be used with caution in these pets. Anesthetic dosages should be avoided in cats with hypertrophic cardiomyopathy or pets with other cardiac diseases in which tachycardia could be detrimental. Use anesthetic dosages with caution in pets with renal disease. Ketamine is excreted unchanged by the kidneys in cats, and drug accumulation, with subsequent prolonged recoveries, could occur. However, low sedative dosages and the even lower infusion dosages used for analgesia are generally appropriate in all of these patients.
Telazol (tiletamine/zolazepam) is a combination of a dissociative agent (tiletamine) and a benzodiazepine (zolazepam) that can be administered IM and can be used at lower dosages for sedation and at higher dosages for anesthesia. Telazol is an excellent option for FAS-level 5 cats and dogs because the small volume needed to produce sedation or anesthesia can easily and quickly be administered IM. It has a quick onset and longer duration of action than ketamine, and it is not reversible. According to the product label, Telazol is contraindicated in pets with pancreatic disease or severe respiratory and/or cardiovascular disease; however, clinically these are precautions but not contraindications. Follow the same precautions as those listed for ketamine.
Conclusion
Taking steps to increase his comfort and reduce fear, anxiety, and stress have improved Hetch’s veterinary visits.
Overall, the use of inhalant chambers and masks is dangerous and stressful for both pets and anesthesia personnel. Stress causes deleterious effects on health outcomes and compromises mental wellbeing. Given the many alternatives that exist, use of an induction chamber or mask is a poor choice for sedation or induction and should be avoided for all patients. We as a veterinary community must prioritize practices that are both safe and stress-reducing for our patients and colleagues.
Hetch-Hetchy’s comfort for veterinary visits and procedures has increased substantially thanks to an effective protocol of pre-visit pharmaceuticals (0.02 mg/kg buprenorphine OTM and 50 mg trazodone PO 3 hours prior to getting into the car), an intramuscular injection of a sedative (alfaxalone) as needed, and low-stress handling. Having seen how swiftly he responds to this approach has highlighted the recent use of an inhalant chamber to sedate him as an archaic, inhumane practice that needs to be eliminated from our practices.
Table: Stages and Planes of Anesthesia
Stage
Description
Details
1
Disorientation, sedation
Occurs following premedications
2
Delirium, excitation, uncontrolled movement
Occurs during induction and recovery. Anesthetic plans should be designed so the patient spends minimal time in this phase. Induction should be rapid (use injectable drugs) and recovery should include sedatives if excitement/dysphoria occurs.
3
Unconsciousness, surgical plane of anesthesia
Plane 1: Light anesthesia, depth inadequate for moderately-severely painful procedures unless local anesthetic blocks are part of the protocol.Plane 2: Moderate anesthesia, adequate for painful procedures with administration of appropriate analgesia.
Plane 3: Deep anesthesia, required if analgesia is not part of the protocol. More physiologic depression occurs in this plane than in previous planes.
Plane 4: Excessively deep anesthesia, dangerous physiologic depression. Turn the vaporizer off and start ventilating for the patient to speed inhalant elimination.
4
Too deep!
This stage is between respiratory arrest and circulatory collapse. Take the patient off the anesthetic and prepare for CPR.
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This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Photos of Hetch Hetchy courtesy Alison Gerken, DVM; inhalant photo courtesy Tamara Grubb, DVM, PhD, DACVAA; cat inhalant chamber from Advances in Anesthesia; fearful cat from Napa Valley Holistic Veterinary Services; cat wrapped in towel courtesy Tamara Grubb, DVM, PhD, DACVAA.
Tony Johnson, DVM, DACVECC It is a frustrating condition with many names: Feline Lower Urinary Tract Disease, Feline Urologic Syndrome, Feline Interstitial Cystitis, even the rather whimsical Pandora Syndrome. Anyone who has treated it knows the stress and anxiety it can induce in those treating the disease, as well as in patients suffering from it, not to mention their anxious owners.
That same stress and anxiety also contribute to the disease process itself. As an ER vet, I know the plumbing aspect of the disease very well and can usually get them unblocked and on more stable footing in short order. What I don’t usually have to deal with are the softer aspects of the disease – softer, but no less important. That usually falls to general practice veterinarians, who have to take the reins from ER vets like me and manage their patients long-term.
In the spirit of adhering to the Veterinarian’s Oath and reducing animal pain and suffering, I’d like to offer up some points to consider when either treating a cat with a urinary obstruction or managing a non-obstructed cat with signs of lower urinary tract disease.
Are you incorporating appropriate analgesia and sedation in your treatment protocol?
This is a painful condition. Pain causes stress, which can exacerbate the disease – and make future trips to the vet even more stressful. Making sure you have incorporated appropriate analgesia when unblocking a cat, and when managing a catheterized cat in the hospital, is a vital part of treatment – and one that is often overlooked. Proper (and safely chosen) sedation, and incorporation of a sacrococcygeal block while unblocking, good pain control with buprenorphine or a full-mu opioid agonist, and home analgesia for three to five days after discharge will help to minimize the pain and anxiety of an episode of urethral obstruction. Owners will appreciate advanced pain control protocols and knowing that you are taking their pet’s emotional wellbeing into consideration. It also makes cats easier to handle in the hospital and more likely to come back for future visits – everybody wins!
Suggested Protocols
Sacrococcygeal block:
Use 0.1 mL/kg of either lidocaine or bupivacaine
Unless the cat is very sick and moribund, this is typically done under heavy sedation or anesthesia
Move the tail up and down in a “pumping” motion, palpating the sacrococcygeal region.
The first movable space at the caudal end of the sacrum is either the sacrococcygeal or intercoccygeal space. Either site is okay and there’s no need to differentiate which site you are in.
Insert a 25-ga needle through the skin on midline at a ~45° angle.
If bone is encountered, withdraw the needle a few mm, redirect slightly at a steeper or flatter angle and reinsert. This is known as “walking” off the bone.
Repeat this process until the needle is in intervertebral space. A “pop” may be felt and there should be no resistance to injection.
Note: Since many cats who are blocked may also have some degree of acute kidney injury, NSAIDs should be used cautiously or not at all in acute obstructions. They may be helpful in cats with normal renal function for non-obstructive episodes.
Are you reducing stress in the household? In your hospital?
Imagine you are a hospitalized blocked cat: fluorescent lights, a painful catheter, Elizabethan collar, barking dogs – sounds awful, right?
Do everything you can to reduce the stress of hospitalized cats. Put yourself in the patient’s position and imagine what their existence in your hospital is like. If you don’t have a “cat room,” try and keep cats in the quietest part of the hospital, out of sight and sound of dogs. Allow time for rest and a break from medical procedures and provide a box or other structure in the kennel where the cat can hide.
Both at home and in the hospital, use of feline facial pheromones (Feliway®) may help alleviate stress and anxiety. Consider installing one in your ICU and changing it regularly. A few sprays of Feliway® on your patient’s bedding may also help. The Feliway® diffuser can be particularly helpful at home.
Make sure cats at home have distractions and safe spaces to hide from dogs, children, and other cats. During stressful times (moving, boarding, redecorating, addition of new pets or children to the home) consider advising clients to spend extra time with their cats or discuss safe sedation and anti-anxiety protocols and environmental enrichment to reduce fear, anxiety, and stress.
Stress can bring on this condition, and the things we have to do to treat it are often stressful and uncomfortable, creating a continuous positive feedback loop. Owners are stressed, vets are stressed, and (most of all) patients are stressed. Do everything you can to reduce the anxiety and discomfort of feline urologic conditions and you will not only be keeping up your part of the Veterinarian’s Oath, you’ll be practicing better medicine as well.
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.
Rachel Lees, RVT, KPA CTP, VTS (Behavior)Cats are often considered a more independent, self-sufficient species compared to dogs, largely because they do not need humans to take them outside to eliminate. Most cats successfully learn to eliminate in the home by going to a litter box.
Nonetheless, feline elimination issues are one of the biggest behavioral problems clients bring to veterinarians. Often, the problem develops because human preferences regarding litter box location and type don’t match up with the desires of their feline companions.
As veterinary professionals, we must feel comfortable teaching clients what their cat wants from an elimination station. This article will review cat preferences regarding desirable locations, litter box styles, litter types, and more. This information can not only help the cat who is eliminating outside the box but can also help new kitten owners be successful from the start in setting up their new cat’s environment.
Litter Box Design and Location
Place litter boxes in safe, low-traffic areas but right off a high traffic area, so it is easily accessible. Keep them away from loud appliances such as washers and dryers, furnaces, dishwashers, air conditioners, or toilets. All these items have the potential to frighten the cat with unexpected sounds, interrupting the normal elimination pattern. An example of a safe, quiet location is a spare bedroom or bathroom that is rarely entered.
Many commercial products also offer “hidden” locations where cats can eliminate, disguised as planters or side tables, for instance. Although this hides the litter box from the human, it may also place it in a higher traffic location. Keep this in mind when giving recommendations on litter box placement. Everyone prefers privacy for elimination, even cats.
Litter box design preferences differ from cat to cat and human to human. Most cats prefer an open litter box. Most cat owners prefer a covered litter box. Covered litter boxes may trap odors and make the human environment smell better but for those reasons they may not be as desirable for the cat. If boxes are not cleaned regularly, the odor may be aversive to them.
Most commercial open litter boxes are too small for the average cat. The size of the litter box should be one and a half times the length of the cat’s body. Most veterinary behavior teams recommend using storage containers, Tupperware bins, dog litter boxes, or cement mixing pans. It is also important to find out if litter box sides are low enough for the cat to jump in without injury or pain. Using a litter box that cleans itself is typically not recommended as the sounds and machinery can scare the cat.
Litter Preferences
Many different types of litters are on the market: scented, unscented, clumping, non-clumping, wheat, newspaper, sawdust, pine, and more. A study by veterinary behaviorist Jacqueline C. Neilson DVM, DACVB, found that cats generally prefer unscented clumping litter beneath their paws. And although scented litters may be more desirable to humans, cats often disdain them. Cats are far more sensitive to odors than humans. Keep in mind as well that crystal-like litter can feel unpleasant to sensitive paws. When the cat eliminates the crystals can “pop,” causing a startling sound. Recommend giving cats the most preferable substrate—a plain, unscented litter—to set them up for success.
Since Flushing Isn’t an Option: Cleaning Tips
Litter boxes should be scooped once or twice daily. Cats prefer a clean location to eliminate. When boxes are not cleaned at least once daily, this can cause an aversion as the cat may not want to step and eliminate in a litter box filled with yesterday’s urine clumps and stool piles. Most humans would not desire this either.
To make boxes as attractive as possible, they should be emptied, cleaned with a mild, unscented detergent, and refilled with fresh litter at least once a month. Avoid cleaning the box with strongly scented cleanser.
Recommendations for Multi-Cat Homes
Design, location, cleaning, and substrate preferences are identical, but in homes with more than one cat, owners should provide one box for each cat, plus one extra. Place boxes on separate floors and rooms of the home to prevent one cat from blocking access to a box.
Keep in mind as well that using covered boxes in multi-cat homes can create increased anxiety if one cat is a stalker. If victim cats venture into the box to eliminate, they cannot see if the stalker cat is creeping up on them. If there is low-level aggression between the cats, and the victim cat is attacked when coming out of the box, the experience can create litter box aversion. For this reason, open litter boxes should be recommended in multi-cat homes.
Remember: It’s a cat’s world. We just live in it!
Author’s Note: Elimination out of the box is not always a behavioral concern and can very well be a medical cry for help. It is always important to rule out a medical condition before blaming behavior. Every patient who eliminates out of the box should be examined by a veterinarian and medically worked up (CBC/Chem/UA) before specific recommendations are made.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Rachel Lees, a Level 3 Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and lead veterinary behavior technician at The Behavior Clinic in Olmsted Falls, Ohio. She loves helping people create and maintain a strong human-animal bond.
Kim Campbell Thornton Whether they are going through training or learning to overcome previous fears, dogs do best when people give them time and space, in tandem with management and—if needed—medication, to develop confidence.
Body Language Messages
I’ve been a volunteer puppy raiser for Summit Assistance Dogs for about seven years. Each year I’ve raised a pup following Summit’s training guidelines based on positive reinforcement and what puppies can handle at each developmental stage. Each pup explores the world in tiny increments based on what they tell me through body language about how the new environment feels to them. Sometimes we don’t even get out of the car if the pup seems to be hesitant. If they’re not ready for a new place, we go somewhere they have already been to build confidence. Each pup is born with unique strengths and levels of confidence. The big and bold ones move through environments more quickly than timid pups. My current pup, Jazz, came to me at 11 months of age. She was timid about change, so we moved slowly and calmly. We joined a scent work class, which allows the dogs to move freely at their own pace. This built her confidence quickly and now she rocks in almost any setting. Watching what your pet tells you through body language (relaxed, happy, withdrawn, cowering) is key to a truly Fear Free companion.
Anne Campbell, Greenbank, Washington
Muzzle, Medication, Management, Magic
Alaska is a three-and-a-half-year-old white German Shepherd, who was adopted from a pet store when she was three months old. Early veterinary visits had caused her to become fearful. Medication didn’t help and she required heavy restraint. Her pet parents called our clinic about taking her on as it had been suggested that she might prefer a female veterinarian.
We requested that they start to get Alaska comfortable with a muzzle at home and to do drop-in visits when our clinic wasn’t busy. They did all this over the course of a month. For the first visit, we asked Alaska’s previous vet to write her a prescription for Trazodone and advised her owner to give it on an empty stomach 12 hours and two hours before the exam, because of the hepatic first pass effect of the drug.
We booked out extra time for the visit. We took down preliminary info like diet, likes and dislikes, activity, allergies, etc., from mom while dad waited outside with Alaska. Her mom told us that at the previous vet, the exam room was small and that Alaska didn’t like being confined, so we pushed our rolling exam table against the counter, leaving an open space in the exam room. We had already started the lavender diffuser and Baby Einstein classical music.
To mask any hospital odor, the tech, assistant, and I washed our hands and exposed arms, dried them thoroughly, and applied Bath and Body Works Stress Relief Eucalyptus and Spearmint body lotion. The pet parents walked a muzzled Alaska into the room and we gave her space to walk and investigate. The assistant crouched to her level, and I sat on the lowered rolling table. We stretched out our arms for her to sniff….no growls! However, her ears were flat back. I called that to everyone’s attention and explained to her parents that she was wary, stressed, and afraid, and that we needed to move cautiously and slowly. As she made her rounds to us and looked us in the face, we closed our eyes or turned away, so we weren’t staring at her, while we talked to her gently and started to stroke her.
We started feeding her peanut butter, and I was able to look at her eyes from an angle, and slowly went to her ears, but she raised her lip at the otoscope, so I stopped and let her regroup. Mom then said she didn’t like ears, feet, or back touched. Eventually, Alaska’ s ears came from flat to sideways elevated to straight up. She nudged the assistant for attention, and I was able to palpate her abdomen, examine her haircoat, and auscultate her heart and lungs. The assistant continued with the peanut butter, mom with bits of chicken, and lots of neck rubs and sweet talk, and I was able to give her four vaccinations. We paused at that point, as she needed to have blood drawn for a heartworm test.
I wish I had grabbed my cell phone; Alaska was lying in the middle of the floor, back legs curled around, front feet outstretched, ears straight up, and if it weren’t for the panting, looking completely relaxed as if she were at home. The parents were amazed and happy; this had never happened before.
While they wanted to get everything done in one visit, I persuaded them that we should stop at this point so she would have a positive visit to build on. (I had squirted some alcohol on a lateral saphenous vein to see how she would take it, and while she didn’t growl, she didn’t like it, so more peanut butter to the rescue.) The owners concurred, and I had them take some Solliquin to start her on, and advised them to come back in a month. In all likelihood we will have to give some IM dexdormitor to draw the blood, but I think we can build on today’s visit. The pet parents couldn’t stop thanking us for taking the time and making the extra effort to understand their beloved dog. I love Fear Free!
Cathy Grey, DVM, Oakdale Animal Hospital, Oakdale, New York
Caring for Canasta
Canasta is fearful of strangers and handling, which makes veterinary visits difficult for both Canasta and her caregiver. I recently started working with Canasta on basket muzzle training and being more comfortable with strangers, but she was in need of bloodwork immediately. Her veterinarian prescribed pre-visit pharmaceuticals, and I worked with the technician to create a handling plan and came to the visit to assist. When Canasta walked in wearing her basket muzzle, I used gentle control to restrain her while the technician drew blood. Canasta even took a treat from the technician when we were done, which is a huge win! Her mother was crying, knowing her dog did so well, and I will continue to work on cooperative care with the caregiver and Canasta.
Tabitha Kucera RVT, CCBC, KPA-CTP, Chirrups and Chatter Cat and Dog Behavior Consulting and Training, and Lyndhurst Animal Clinic, Lyndhurst, Ohio
Want to be featured? Submit your success story here!This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Kim Campbell Thornton is content manager for Fear Free Pets and is a Level 3 Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985.
Kim Campbell Thornton It’s not just dogs and cats who benefit from Fear Free techniques at the veterinary clinic. Humans often find that they are calmer and happier as well.
Fear Freed
My sister has a beautiful kitty named Sushi whom she adopted about eight years ago. Her veterinarian, Dianicia Kirton, DVM, whose Hopkinton, Massachusetts, practice is Fear Free certified, has been recommending that Sushi get her teeth cleaned but my sister was hesitant. The veterinarian addressed each of her concerns until eventually she was ready to move forward. A few weeks later, Sushi’s mom brought her in for the teeth cleaning, although she was still nervous and reluctant. The veterinarian and staff were very calming and worked on Sushi quickly. Everything went well, and Sushi was her normal, happy self afterward. My sister told the vet that she felt like she had been “Fear Freed,” and Dr. Kirton responded, “Yes, it’s as much for the people as it is for the animals.” My sister was happy with the whole experience and thankful to have found a practice that uses these methods!
Kay Henze
Penny-Wise Visits
Pennie, a 7-year-old 78-pound Chesapeake Bay Retriever, had never had a full veterinary exam after her puppy vaccines because she bared her teeth and growled at veterinary team members at every clinic she was taken to. When she was brought to us, we implemented several Fear Free strategies, spending 45 minutes building her trust both outside the clinic and in the exam room. We were able to get her to stand on the lift table and receive vaccinations without being muzzled. On her third visit, we were able to lift her lips and examine her teeth. Now she boards with us routinely and is a big part of our veterinary practice family. Implementing these Fear Free tools has changed Pennie’s life and her owner is now able to better understand and relate to her dog, making it much safer to take her for walks and be groomed.
Dr. Sarah Lavelle, Ark Veterinary Practice, Belgrade, Montana
Happy Cats and People
We love our Fear Free veterinary hospital. At TLC, there are separate areas for cats and dogs. We took our two cats in last week, and the exam room was comfortable, with shelves for the cats to explore. A board listed the names of the technician and veterinarian who would be seeing the cats, so we knew who would be treating them. The technician who went over the intake information was sweet and tender with Lucy and Lilu. An email ahead of time alerted us that a new veterinarian would be seeing the cats. She was calm and handled the cats gently. Both cats were calm throughout the visit—although Lucy didn’t much like having her teeth examined—and when they got home they came out of their carriers calmly and went about their day. Lilu was her regular self and didn’t hide away as she has on some prior visits to other clinics. The clinic called the next day to see how the cats reacted to their vaccines and visit. We feel we have found our new clinic! Katherine and Brent Williams, Albuquerque, New Mexico
Zola’s Optimism
Zola has been to a number of veterinary clinics before and has always been nervous and reactive. During her first appointment she was quite nervous, but with the help of some peanut butter as a distraction she allowed us to pet her. We decided that that was a win and that Zola would benefit from coming back another time after having gabapentin to help calm her. At her next visit, Zola was visibly more relaxed, and we had a Kong full of peanut butter ready for her. Knowing that Zola did better with minimal restraint we kept her focused on the Kong and were able to do a full exam, vaccinations and a blood draw. Zola’s owners had never seen her so relaxed at the vet and she has since come back willing and happy to see us. Anne McClanahan, DVM, Four Lakes Veterinary Clinic, Madison, Wisconsin
Want to be featured? Submit your success story here!
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Kim Campbell Thornton is content manager for Fear Free Pets and is a Level 3 Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985.
Kim Campbell Thornton It’s not unusual for dogs to be fearful of veterinary visits, but it doesn’t have to be that way. Many dogs have benefited from Fear Free techniques to help them get through what was once a frightening event and even learn to love it. Here are some of their stories.
Kindness Worth Traveling For
I’m a Fear Free trainer, but there are no veterinarians I trust in my town, so I travel an hour to TLC Pet Hospital in Albuquerque and have had the most amazing experiences, thanks to the patience, kindness, and knowledge of the staff there. My dogs are fearful, and one is especially vet-phobic after traumatic experiences elsewhere. Some of his past vet visits have been so anxiety-inducing for him that I also end up in tears. But with gabapentin on board and the Fear Free approach from Dr. Long and Sam the veterinary assistant, my dog was wagging, approaching them, licking their faces, asking for pets, and acting like the brave and social dog he is at home. All of us in the room were floored by the change! At the next checkup he took food from them, did some chin-rest stationing with them, targeted their hands, and showed off his tricks. My own fear, anxiety, and stress levels have been drastically reduced thanks to their dedication to Fear Free vet visits. I’ll continue to do the two-hour round trip because I love having a veterinarian who listens to me and treats me like an adult, and because my dogs’ mental and emotional health is taken as seriously as their physical health at TLC. I am so thankful for their care and commitment to Fear Free vet visits and their overall friendly clinic.
Erica Beckwith, CTC, CBCC-KA, Fear Free Certified Professional, A Matter of Manners Dog Training, Santa Fe, New Mexico
Blood Draw Pugcess
Tater Tot is a Pug who needed a dental cleaning. Since he would be undergoing anesthesia, we required blood work beforehand. Tater Tot was generally friendly, soliciting attention and being food motivated, but when we attempted to occlude his lateral saphenous vein, he stopped eating and attempted to bite the technician holding him. He became distressed and tried to back up, so the technician placed him on the floor, where he again tried to bite her. The owner agreed to bring him in later on some anxiety medication.
Tater Tot came in a second time on gabapentin as well as clonidine. He appeared less excited and fidgety, but still sought attention. We offered him baby food on a disc toy and did his blood draw on the floor instead of the table. He ate throughout as we attempted to collect blood from his lateral saphenous veins. After poking both legs without success, we held him in position for jugular venipuncture, performed some brief desensitization and counterconditioning for that positioning, and successfully drew blood from his jugular vein. He went straight back to the baby food after the blood draw.
Maria Marano, The Ohio State University Veterinary Medical Center, Community Practice, Columbus
Toby Turns Around
I work closely with the veterinary hospitals in my town. The team at Appalachian New River Veterinary Associates (ANRVA) referred Toby to me. Toby was terrified at the veterinary hospital and could not take food, even as a young puppy. I established a rapport with Toby away from the veterinary hospital. I did this using special food and something else Toby loved – play! Toby learned foundation behaviors that gave some predictability to our sessions and helped him feel safe.
The team at ANRVA invited me to work with Toby in the exam rooms during their lunch break. Since Toby already had negative associations at the veterinary hospital, we started those sessions with just Toby’s owners and me. Toby and his owners entered the exam room the first time and surprise – I was there with some extra-special food for Toby (hamburger) and his favorite toy. Toby readily ate the memorable food and played with a toy. He even performed some simple behaviors. We repeated this a couple of times, and by the third time, Toby was excited to get to the exam room. Then we incorporated Dr. Suan Koh into our play and training sessions and, later, Dr. Cathy Kreis. Some of the support staff also got in on the fun.
Toby was successful for many reasons. He had committed owners who took the time to help Toby feel better about his veterinary care. The team at ANRVA is as committed to Toby’s behavioral health as they are to his physical health. They encourage and welcome clients to come in for happy visits with their pets. And, finally, both the owners and veterinary team are committed to positive reinforcement training.
Marge Rogers, CBCC-KA, CPDT-KA, Certified Fear Free Professional, Rewarded Behavior Continues, West Jefferson, North Carolina
A Win for Maxwell
Maxwell is a 7-year-old retriever/hound mix who was rescued from a hoarding situation with more than 100 dogs. Maxwell was the most fearful of them. We don’t know a lot about Maxwell’s day-to-day life while on the hoarder’s property, but volunteers reported that he was kept in a small shed without much social interaction.
Not surprisingly, he was fearful of people and of being touched or handled. The veterinary facility that provided Maxwell’s initial care was unable to examine him or perform any medical or handling procedures unless Maxwell was placed under anesthesia or heavy sedation. Maxwell would shake uncontrollably and withdraw if any person approached him. Unfortunately, during his initial care, some handling interactions were forced on Maxwell to which he responded by “gator-rolling,” snapping, and inflicting a severe bite to one of the vet techs.
After moving to a foster home, Maxwell was taken to see the wonderful Dr. Lynn Honeckman, owner of Veterinary Behavior Solutions and a Level 3 Fear-Free Certified Professional. She diagnosed Maxwell with severe global fear of people and new environments and started him on a course of daily behavior medication in an effort to reduce his anxiety.
Maxwell did not do well in his initial foster homes, so in December 2018 he moved into a new foster home, where he has remained and is doing very well. During his initial visit as well as his behavior rechecks, Dr. Honeckman recommended introducing Maxwell to cooperative care behaviors and made specific recommendations of pre-visit pharmaceuticals to help alleviate Maxwell’s fear during veterinary visits.
Since December 2018, Maxwell has been a client at Loch Haven Veterinary Hospital (one of the lead veterinarians, Dr. Jim Martin, is Fear Free certified and the entire hospital including all technicians follow the Fear Free approach). Since then, every veterinary visit has consecutively been more positive and more stress-free for Maxwell. Prior to his visits, Maxwell receives a combination of gapabentin and Sileo. His appointments are scheduled during times when the hospital is less busy, and the staff ensures we get put into a treatment room right away, where Maxwell is given ample time to acclimate before any staff enter the room. Physical handling is kept to a minimum and all procedures follow the Fear Free approach. One of Maxwell’s many cooperative care behaviors was to comfortably wear a basket muzzle. Although he has shown zero signs of aggression since switching to Loch Haven Veterinary Hospital, Maxwell now happily wears the muzzle for any physical handling in the exam room, which allows everyone to feel comfortable and at ease. Now – almost a year later – Maxwell no longer (or only rarely) shakes when entering the veterinary hospital. He willingly accepts treats while waiting in the exam room and is eager to perform his chin rest behavior while waiting to be seen. As his foster mom, I am overjoyed by Maxwell’s progress, none of which would have been possible without his dedicated veterinarians. Their care, patience, and understanding in using a Fear Free approach has made a world of difference for Maxwell and we could not be more grateful to them.
In his foster home, Maxwell has blossomed into a happy and playful dog who is particularly fond of his canine housemates. New environments will likely always pose challenges for Maxwell, but at home he has found his happy place.
Daniela Ackerman, Orlando, Florida
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This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Kim Campbell Thornton is content manager for Fear Free Pets and is a Level 3 Fear Free Certified Professional. She has been writing about dogs, cats, wildlife, and marine life since 1985.
Mikkel Becker One of the best ways to earn a pig’s trust and friendship is by appealing to the pig’s big appetite. The saying “eat like a pig” holds true for many pigs who are highly focused on food. At The Center for Bird and Exotic Animal Medicine near Seattle, Washington, Dr. Alicia McLaughlin and her team have found that food talks when it comes to swaying swine to seeing veterinary team members as friends rather than foes, and in doing so, obtaining their calm cooperation.
Creative strategies have also shown big benefits for some of Dr. McLaughlin’s patients. One strategy that works for some pigs is to “fork” the pig using gentle presses of a fork on the pig’s back. Pigs who are calmed by such touch will often lie down on their side to soak up the soothing massage, exposing their underside and allowing belly and foot exams to be completed with the pig’s willing cooperation.
Dr. McLaughlin also incorporates the owner’s participation into the care experience. With one pig, the trick for getting a willing hoof trim was as simple as the owner bringing in a favorite treat: cucumbers! On one end of the pig, a person held on to a whole cucumber for the pig to chomp on, while at the undercarriage another team member performed hoof care. By the time the entire cucumber was finished, so was the hoof care, making it a win-win for pig and people.
One technician during the exam or care is often charged with the task of giving tasty treats with the pig’s owner nearby to keep the swine distracted during the exam. The trick of treats is finding what works best for each patient. Pig owners are encouraged to bring in their pig’s favorites in addition to the ones already on hand in the hospital.
Three delectable delights for pigs to pig out on during Fear Free exams and procedures are peanut butter, cream cheese, and Cheerios. For instance, peanut butter placed on a tongue depressor or smeared inside a small bowl may be used to distract the pig during the exam.
One of the greatest challenges of pig exams is getting a weight. Pigs don’t like to be lifted or restrained, and with the size of many pigs, doing so to get the swine onto the scale would be upsetting, causing avoidance in the future.
A solid approach is to get the pig to move onto the scale on his own. This is best achieved with a combination of teamwork, time, and treats.
“Make your job as easy as possible by creating a chute-type scenario leading up to the scale using human bodies or other items to funnel the pig onto the scale,” says Dr. McLaughlin.
A line of Cheerios or other tasty treats can be placed for the pig to follow through the chute and onto the scale. In the center of the scale, place a pile of treats to keep the pig in place momentarily while being weighed.
Most important, avoiding force is critical for earning trust.
“Don’t push it. I’m a firm believer in giving a pig a little more time, and it will end up taking less time in the long run,” says Dr. McLaughlin.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Mikkel Becker, CBCC-KA, CPDT-KA, KPA CTP, CDBC, CTC, is lead animal trainer for Fear Free Pets. She is a certified behavior consultant and trainer who specializes in reward-based training that’s partnered closely with the pet’s veterinary team. Mikkel is coauthor of six books, including From Fearful to Fear Free.
Rachel Lees RVT, KPA CTP, VTS (Behavior)Every year, many pets are relinquished and sometimes euthanized for a variety of behavioral concerns. Among them are separation related issues. Dogs with separation-related diagnoses make up 10 to 20 percent of the cases referred to veterinary behaviorists.
Cases range from mild–showing minor body language changes during the owner’s departure–to severe–dogs injuring themselves and destroying the home by chewing through drywall and jumping out windows. Regardless of severity, it is important to obtain a diagnosis and begin treatment to not only keep these patients safe from anxiety and self-injury and the family’s home undamaged, but also to keep intact the human-animal bond.
Beginning Treatment
Obtaining a diagnosis from a veterinarian is the first step toward treatment. The patient should be medically worked up and assessed as there may be underlying medical or anxiety-related concerns that will exacerbate this issue. After a medical workup, the veterinary medical team can assist the owner by reviewing the veterinarian’s treatment plan, including safety, prevention, management, and behavioral therapy.
Depending on the diagnosis and severity of the problem, the veterinarian may also prescribe medications to reduce patient stress and anxiety during departures. The veterinary medical team can discuss trialing medications and potential side effects on a case-by-case basis.
Eyes in the Sky: Videotaping Alone Time
With advances in technology, we have a variety of ways to watch pets who are home alone. For a potential separation-related issue, it’s vital to recommend that the client have video and camera accessibility to the pet during departures. Not only can we evaluate the pet’s distress levels during departures, but this can be an important tool for the veterinarian in determining a diagnosis. We may find that the patient is not always distressed during departures and that an outside stimulus is causing the dog to panic. The veterinarian would diagnose and treat this problem very differently.
Lonely No More: Avoiding Alone Time
For severe cases where self-injury and destruction in the home are concerns, the veterinarian may recommend avoiding leaving the pet alone. This is not a long-term fix but can help keep the pet safe during treatment and behavior modification. Owners may have a pet sitter stay at the home during work hours or use boarding facilities or daycares.
Changing the Meaning of Time Alone
Part of behavioral therapy for separation distress is to change the way the patient feels about being alone. A great way to start this process is with high-value food for the patient to enjoy during departures. A lickable item is easy to ingest and easy for a pet to focus on when distressed. Think peanut butter, cream cheese, spray cheese, cheese spread, canned pumpkin, yogurt, mashed potatoes, and canned dog food. Food-enrichment items such as food bowl mazes, Kongs, plates, bowls, and muffin tins can be used to administer these treats.
Another benefit of using food is that we can monitor the patient’s stress level. If a patient is a peanut butter Kong fanatic when the owner is home, but that same patient will not touch the peanut butter during a departure, this tells us the patient is too stressed and anxious to enjoy the food enrichment offered. Relay this information to the veterinarian so the treatment plan can be altered.
Long-Term Success
Medications can help to reduce the patient’s anxiety, but behavioral therapy is crucial to long-term success. A treatment plan should include the following:
Shaping relaxed and independent behaviors: The goal is to teach the patient that calm, cool, collected behavior brings reinforcement. Positive reinforcement and clicker training can be helpful in implementing this step.
Creating a non-stressful and consistent departure routine to reduce overall anxiety: Instruct the owner to start working on short departures with the pet showing limited signs of stress and anxiety. The home will be set up in a consistent, predictable way while food enrichment is offered. “Safety cues” (bandanas on the door, scents, etc.) can be added to communicate to the pet that the owner will be back momentarily.
Changing the meaning of current departure cues: Departure cues are common indicators that owners will be leaving the home: putting on shoes, picking up keys/purse, or putting on a jacket. Owners should perform these cues during times when departures are not taking place. With repeated exposure, the pet will not always associate these cues with departures. Positive reinforcement can also be added in with the cue to create an even more positive association.
Medications and Supplements
Combining behavior therapy with psychotropic medications and supplements can improve the prognosis for separation anxiety. Primary medications such as fluoxetine (Reconcile) and clomipramine (Clomicalm) are licensed for use for in dogs with separation anxiety.
Other as-needed, event, or triage medications can be used for the departure itself to help reduce panic and stress. Some of these medications include Trazodone, Clonidine, or benzodiazepine(s) and are off-label use. The prescribing veterinarian will select these medications on a case-by-case basis. Pheromones (Adaptil) and supplements such as Zylkene (milk casein), and Anxitane (L-theanine) may also be suggested.
Consider referring severe cases to a veterinary behaviorist to help prevent the problem from becoming worse. For more information about separation anxiety, see or refer clients to the videos on separation anxiety at FearFreeHappyHomes.com.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Rachel Lees, a Level 3 Fear Free Certified Professional, is a veterinary technician specialist in behavior, a KPA certified training partner, and lead veterinary behavior technician at The Behavior Clinic in Olmsted Falls, Ohio. She loves helping people create and maintain a strong human-animal bond.
Fear Free is a concept that benefits both animals and the people working with them. This is especially evident when the animal being cared for is of tremendous size and strength, such as the pig patients of Fear Free certified professional Dr. Alicia McLaughlin at The Center for Bird and Exotic Animal Medicine near Seattle, Washington.
“When pigs are stressed, they communicate their stress very clearly, both vocally and with their body language, which can be very upsetting for their family and veterinary staff. When pigs are less stressed, their families are more relaxed, and their veterinarian is able to provide better quality medical care,” says McLaughlin.
Handle With Care
Coercive handling causes increased tension for everyone. Forced handling is also likely to create fear memories and aversions that make the pig more challenging to work with and create a greater safety risk for both pig and people.
“Pigs are very touchy about their bodies. Many don’t like being touched unless they are being scratched in certain areas. If they feel that any handling attempts are coercive, they’re likely to react strongly and negatively,” says McLaughlin. “Most pigs have an extreme dislike for restraint, having their facial area handled, or being picked up. Forcing a pig to remain still with restraint even momentarily for sedation can cause tension for everyone. Many will vocalize in distress when this handling occurs; with squeal decibels rivaling those made by a fighter jet.”
Most pigs who come in are open to the veterinary experience if the staff interacts in a way that signals they are friendly, not threatening. Encouraging the pig’s willing participation during care using treat rewards, setting a soothing care environment, and using calming aids are all approaches resulting in less stress and greater success.
Reading Porcine Body Language
Rewards and food aren’t the only things that work to keep pigs calm during Fear Free care. Carefully observing the pig’s body language for signs of fear, anxiety, and stress (FAS) throughout care is also key for keeping the pig in a calmer, more amenable state and for keeping both pig and humans safe in the process.
Signs of FAS in pigs include muscles tensing, shying away, lowering the head, moving into a corner, or finding security by moving their body next to a wall. In some cases, FAS may be subtle, with one potential indicator being the pig coming up to take treats, but then retreating to a safe distance immediately after the interaction. Loud squeals and excessive vocalizations are audible signs of a pig’s distress.
When in a state of FAS, pigs will attempt to avoid the situation and move away or hide. If pushed, though, pigs on rare occasions may try to bite. Biting is rare, a last-ditch escape effort from pigs who are responding to the situation as if they’re going to die.
Sedation Can Help
It’s far better to note early signs of FAS and make ongoing adjustments to keep the pig calm than it is to risk escalation and the creation of fearful memories of the experience. Sedation isn’t a last resort for pig care, but a protective practice used early and often when it comes to reducing the FAS pigs experience. In many cases, full sedation is recommended to eliminate the distress and ensuing struggle that could otherwise occur if the pig becomes upset. But before jumping immediately to sedation, Dr. McLaughlin is careful to make the sedation itself as non-stressful and Fear Free as possible.
Sedating a pig can be tricky, especially since most pigs are averse to having their faces touched or to being held in place even momentarily. It’s important to Dr. McLaughlin to keep sedation minimally stressful. Oral pre-sedation medication, such as Valium that’s ground up and placed on food, can take the edge off before sedation. With pre-sedation medication on board, the pig is often calm enough to tolerate minimal restraint while a gas mask is placed over the face. No more than a minute later, the pig is out and ready to be cared for.
“Time pressures can result in handling and care being more coercive than we want it to be. There is something to getting it done quick and dirty. But there are long-term effects that go with that and it’s not my preference to do that,” says Dr. McLaughlin.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Mikkel Becker, CBCC-KA, CPDT-KA, KPA CTP, CDBC, CTC, is lead animal trainer for Fear Free Pets. She is a certified behavior consultant and trainer who specializes in reward-based training that’s partnered closely with the pet’s veterinary team. Mikkel is coauthor of six books, including From Fearful to Fear Free.
year I’ve raised a pup following Summit’s training guidelines based on positive reinforcement and what puppies can handle at each developmental stage. Each pup explores the world in tiny increments based on what they tell me through body language about how the new environment feels to them. Sometimes we don’t even get out of the car if the pup seems to be hesitant. If they’re not ready for a new place, we go somewhere they have already been to build confidence. Each pup is born with unique strengths and levels of confidence. The big and bold ones move through environments more quickly than timid pups. My current pup, Jazz, came to me at 11 months of age. She was timid about change, so we moved slowly and calmly. We joined a scent work class, which allows the dogs to move freely at their own pace. This built her confidence quickly and now she rocks in almost any setting. Watching what your pet tells you through body language (relaxed, happy, withdrawn, cowering) is key to a truly Fear Free companion.
store when she was three months old. Early veterinary visits had caused her to become fearful. Medication didn’t help and she required heavy restraint. Her pet parents called our clinic about taking her on as it had been suggested that she might prefer a female veterinarian.
Canasta is fearful of strangers and handling, which makes veterinary visits difficult for both Canasta and her caregiver. I recently started working with Canasta on basket muzzle training and being more comfortable with strangers, but she was in need of bloodwork immediately. Her veterinarian prescribed pre-visit pharmaceuticals, and I worked with the technician to create a handling plan and came to the visit to assist. When Canasta walked in wearing her basket muzzle, I used gentle control to restrain her while the technician drew blood. Canasta even took a treat from the technician when we were done, which is a huge win! Her mother was crying, knowing her dog did so well, and I will continue to work on cooperative care with the caregiver and Canasta.
veterinarian, Dianicia Kirton, DVM, whose Hopkinton, Massachusetts, practice is Fear Free certified, has been recommending that Sushi get her teeth cleaned but my sister was hesitant. The veterinarian addressed each of her concerns until eventually she was ready to move forward. A few weeks later, Sushi’s mom brought her in for the teeth cleaning, although she was still nervous and reluctant. The veterinarian and staff were very calming and worked on Sushi quickly. Everything went well, and Sushi was her normal, happy self afterward. My sister told the vet that she felt like she had been “Fear Freed,” and Dr. Kirton responded, “Yes, it’s as much for the people as it is for the animals.” My sister was happy with the whole experience and thankful to have found a practice that uses these methods!
Pennie, a 7-year-old 78-pound Chesapeake Bay Retriever, had never had a full veterinary exam after her puppy vaccines because she bared her teeth and growled at veterinary team members at every clinic she was taken to. When she was brought to us, we implemented several Fear Free strategies, spending 45 minutes building her trust both outside the clinic and in the exam room. We were able to get her to stand on the lift table and receive vaccinations without being muzzled. On her third visit, we were able to lift her lips and examine her teeth. Now she boards with us routinely and is a big part of our veterinary practice family. Implementing these Fear Free tools has changed Pennie’s life and her owner is now able to better understand and relate to her dog, making it much safer to take her for walks and be groomed.
We love our Fear Free veterinary hospital. At TLC, there are separate areas for cats and dogs. We took our two cats in last week, and the exam room was comfortable, with shelves for the cats to explore. A board listed the names of the technician and veterinarian who would be seeing the cats, so we knew who would be treating them. The technician who went over the intake information was sweet and tender with Lucy and Lilu. An email ahead of time alerted us that a new veterinarian would be seeing the cats. She was calm and handled the cats gently. Both cats were calm throughout the visit—although Lucy didn’t much like having her teeth examined—and when they got home they came out of their carriers calmly and went about their day. Lilu was her regular self and didn’t hide away as she has on some prior visits to other clinics. The clinic called the next day to see how the cats reacted to their vaccines and visit. We feel we have found our new clinic!
reactive. During her first appointment she was quite nervous, but with the help of some peanut butter as a distraction she allowed us to pet her. We decided that that was a win and that Zola would benefit from coming back another time after having gabapentin to help calm her. At her next visit, Zola was visibly more relaxed, and we had a Kong full of peanut butter ready for her. Knowing that Zola did better with minimal restraint we kept her focused on the Kong and were able to do a full exam, vaccinations and a blood draw. Zola’s owners had never seen her so relaxed at the vet and she has since come back willing and happy to see us.
I’m a Fear Free trainer, but there are no veterinarians I trust in my town, so I travel an hour to TLC Pet Hospital in Albuquerque and have had the most amazing experiences, thanks to the patience, kindness, and knowledge of the staff there. My dogs are fearful, and one is especially vet-phobic after traumatic experiences elsewhere. Some of his past vet visits have been so anxiety-inducing for him that I also end up in tears. But with gabapentin on board and the Fear Free approach from Dr. Long and Sam the veterinary assistant, my dog was wagging, approaching them, licking their faces, asking for pets, and acting like the brave and social dog he is at home. All of us in the room were floored by the change! At the next checkup he took food from them, did some chin-rest stationing with them, targeted their hands, and showed off his tricks. My own fear, anxiety, and stress levels have been drastically reduced thanks to their dedication to Fear Free vet visits. I’ll continue to do the two-hour round trip because I love having a veterinarian who listens to me and treats me like an adult, and because my dogs’ mental and emotional health is taken as seriously as their physical health at TLC. I am so thankful for their care and commitment to Fear Free vet visits and their overall friendly clinic.
I work closely with the veterinary hospitals in my town. The team at Appalachian New River Veterinary Associates (ANRVA) referred Toby to me. Toby was terrified at the veterinary hospital and could not take food, even as a young puppy. I established a rapport with Toby away from the veterinary hospital. I did this using special food and something else Toby loved – play! Toby learned foundation behaviors that gave some predictability to our sessions and helped him feel safe.
Maxwell is a 7-year-old retriever/hound mix who was rescued from a hoarding situation with more than 100 dogs. Maxwell was the most fearful of them. We don’t know a lot about Maxwell’s day-to-day life while on the hoarder’s property, but volunteers reported that he was kept in a small shed without much social interaction.
