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Pheromone Use in Veterinary Clinics: A Fear Free Approach

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

How Calming Pheromones Enhance Veterinary Care

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

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

Pheromone Diffusers in High-Stress Areas

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

Pheromone Sprays for Direct Contact

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

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

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

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

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

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

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

Initial Setup

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

Pheromone Diffuser Placement

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

Pheromone Spray Usage

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

Pheromone Collar and Valerian Spot-On Implementation

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

Staff Training and Education

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

Monitoring and Adjusting

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

Maintenance and Restocking

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

Community and Client Education

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

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

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

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Brought to you by our friends at bSerene.

Top Tips for a Fear Free Approach to Managing Canine OA

Kristin Shaw, DVM
Are you diagnosing and managing canine osteoarthritis the same way you were taught in vet school? Depending on when you graduated, chances are the techniques and treatments you learned may be due for a refresh. This article will offer tips for ensuring you are practicing the best medicine you can for your canine patients while following the principles of Fear Free practice.

Diagnosing OA: You don’t have to cause pain to find pain

If you were ever taught that you had to “push harder” to find the pain—forget that! Instead, there is a very good chance you can diagnose OA pain without even putting your hands on a dog (though that is still important!). Dogs show chronic, OA pain through changes in their mobility, posture, function, mood and behavior.¹ Additionally, joint pain leads to compensatory pain in other parts of the body, including muscles. There are a number of ways we can identify OA pain without trying to make the dog cry out with our palpation.

Use a screening checklist: A recent study found that using an owner checklist that asks questions about a dog’s mobility at home can increase the rate of identifying dogs with OA.² See here for the checklist that was used in this study and is available for you to implement in practice.
Observation is key: Dogs with OA may hide an obvious lameness during a traditional gait evaluation. While it is still recommended to watch how dogs walk on a leash, more rewarding information is often gleaned observing a dog’s posture and from watching how a dog moves through transitions (rising from a down position, moving into a seated or down position).³ When standing, if the spine is not neutral, and/or if limbs are held in abnormal or asymmetric positions, and/ or if weight is shifted off of a limb or body segment, these are all indications of likely joint pain. If any slowness or asymmetry to movement through transitions is seen, there is a good chance the dog has musculoskeletal pain.
Sedate for radiographs! Imagine being pinned to a cold table in a dark room and having your painful limbs manipulated. You would at the very least squirm too! Sedation and analgesia are musts for obtaining high quality, diagnostic radiographs while minimizing stress and discomfort. Also remember to take orthogonal views, centered on the joint of interest, and take both sides for comparison.

Treating OA: Unmanaged OA pain is a life-threatening condition

We care about OA because it causes pain. And not just pain in the arthritic joint, but over time, whole-body pain develops. Additionally, chronic/maladaptive pain is progressive and usually worsens, often drastically, without treatment.⁴ Multimodal, proactive, and continuous pain management is essential to reduce the devastating consequences of unmanaged OA.³

Multimodal is built on effective analgesia: According to the 2022 AAHA guidelines, the first line of analgesia for canine OA should be either NSAIDs or the anti-NGF monoclonal antibodies (mAbs).³ Both of these classes of drugs have proven efficacy and safety in dogs with OA. There are additional benefits of anti-NGF mAbs that may make it a better option for many dogs. Anti-NGF mAbs are administered by a veterinary professional, in the clinic, so take away the caregiver burden of an oral medication, improving owner compliance. Additionally, anti-NGF mAbs directly target a key player of chronic pain, sensitization, and neurogenic inflammation and have an encouraging safety profile. Maintenance of a lean body condition and regular exercise are also required as part of an effective OA plan. Other supplemental therapies may be considered as needed.
Proactive pain relief is standard of care: Canine OA is predictable- it typically develops secondary to developmental orthopedic disease (dysplasia, OCD) or joint trauma. Therefore, as soon as a dog is diagnosed with a joint disorder, which in the case of developmental disease generally occurs in the first few years of life, a proactive OA plan should be put in place. Clients should be educated on OA, the consequences of unmanaged pain, and how to monitor for pain at home. Analgesics should be started when pain is mild rather than waiting until it becomes severe.
Don’t let the pain break through: It is tempting to suggest to pet owners that they give analgesics on an as-needed basis. However, this can become problematic if they don’t recognize the early signs of pain. Chronic pain signaling leads to physical changes in the spinal cord that ultimately result in severe, neuropathic pain.⁴ A study that evaluated maintaining dogs at the NSAID label dosage vs. gradually reducing the dosage of the NSAID overtime, found that the dogs maintained at the label dosage, had the best outcome.⁵ Furthermore, continuous pain management through daily NSAIDs has been shown to improve signs of OA in dogs.⁶ Once a month anti-NGF mAb is given as a monthly SQ injection and controls pain for up to 4 weeks, which may be an optimal alternative to asking pet owners to give a daily medication. Remember to ensure a pleasant and enjoyable visit utilizing Fear Free techniques whenever dogs are coming in for any type of appointment, including monthly injections.

References

Roberts C, Armson B, Bartram D, et al. Construction of a conceptual framework for assessment of health-related quality of life in dogs with osteoarthritis. Frontiers in Vet Sci. 2021.
Wright A, Amodie DM, Cernicchiaro N, et al. Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests. JSAP 1-10, 2022.
Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA Pain management guidelines for dogs and cats. JAAHA 58:55-76, 2022.
Malfait AM, Miller RE, Miller RJ. Basic Mechanisms of Pain in OA: Experimental observations and new perspectives. Rheum Dis Clin N Am 47:165-180 (2021).
Wernham BGJ, Trumpatori B, Hash J, et al. Dose Reduction of Meloxicam in Dogs with Osteoarthritis-Associated Pain and Impaired Mobility. ,J Vet Intern Med 25:1298–1305, 2011.
Innes JF, Clayton J, Lascelles BDX. Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Vet Record 166:226-230, 2010.

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

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The Importance of Managing Pain in the Fear Free Practice

Michael Petty, DVM, CVPP, CVMA, CCRTIf you have ever hit your finger with a hammer, the immediate response is often one of surprise or even frustration. The next day, as you are having trouble using that finger, a common emotion is disappointment at the discomfort you are experiencing and wishing that you had been more careful. What causes that reaction?

The “fear center” and the “pain center” occupy adjacent areas of the brain. The thalamus is the area of the brain that registers pain, and on either side of the thalamus is the limbic system, which is responsible for emotions including fear, anxiety, and the sequelae of stress (FAS).

These two areas of the brain “talk” to each other and send signals back and forth. The thalamus sending signals to the limbic system is what causes your reaction to hitting your finger with a hammer. When this thalamic-limbic crosstalk happens in an animal in acute pain, the animal may lash out at the owner or veterinary staff.

So now consider an animal who is in pain and has been presented to you. If experiencing acute pain, the animal may lash out due to a combination of pain and FAS. If experiencing chronic pain, many of these pets act dull and disinterested. The owner may even comment that the pet just doesn’t socialize and lacks the energy and mobility that she used to demonstrate. Even worse is the animal who has chronic pain, say from osteoarthritis, and now has an acute injury on top of it. The distress in some of these animals is almost too much to bear.

It is easy for us to recognize and treat acute pain, but the diagnosis of chronic pain states can be difficult for a variety of reasons. It takes time to take a thorough history and perform a complete pain exam on dogs and cats. However, there are many resources available to make that task easier, including pet owner-friendly screening checklists for osteoarthritis (Cat, Dog) and expert tips for the OA exam (feline OA exam).

Even with successful diagnosis, the treatment of chronic pain can sometimes be difficult especially if your treatment is narrow in focus. But it is essential to make a timely diagnosis of chronic pain and provide effective analgesia to be successful in therapy. And it is also important that the owner understands your diagnosis, whether through education alone or with the help of radiographs and teaching tools (feline and canine chronic pain). The owner is an essential member of the pain treatment team, both in the evaluation of treatments over time but also in enlisting them in the day to day therapies that might be required.

My approach to the treatment of chronic pain in dogs, for example, is to build a pyramid of treatments, and on the base layer I start with an NSAID. The NSAID I use most commonly is Rimadyl® (carprofen), which I really like for its effects on both pain and inflammation. For many chronic OA cases, there are other factors that can influence the ability to manage both pain and disease progression, and they should all be looked at.

For example, consider the animal next. Is he overweight? One study showed that in an obese dog, losing only about 10 percent of body weight can significantly improve lameness¹. In other words, weight loss for an overweight dog can amplify the pain relief achieved with an NSAID alone

What about exercise? Again, one human study showed that one-half hour of exercise 5 days a week for people with knee OA was the equivalent of – you guessed it: an NSAID! So now you have tripled your pain-relieving efforts by building a solid foundation of multi-modal therapies, upon which you can add other therapies as needed.

It is beyond the scope of this writing to discuss all possible treatments: medications, physical therapy, acupuncture, and so forth, but I encourage everyone to read or re-read the 2015 AAHA Pain Management Guidelines for a thorough review of all of the pain management options we have for both acute and chronic pain.

What does the future hold for us? The most exciting thing I have seen on the horizon is the introduction of anti-NGF monoclonal antibodies. NGF, or Nerve Growth Factor, is one of several major “players” in the transmission of pain via the nociceptors. The use of these monoclonal antibodies holds great promise to reduce the sensation of pain in our patients with osteoarthritis. More information about the action of anti-NGF monoclonal antibodies can be found at the New Science of OA Pain website.

IMPORTANT SAFETY INFORMATION FOR RIMADYL: As a class, NSAIDs may be associated with gastrointestinal, kidney and liver side effects. These are usually mild but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including Rimadyl. Use with other NSAIDs or corticosteroids should be avoided.

See full Prescribing Information at:
https://www2.zoetisus.com/content/_assets/docs/Petcare/rimadyl-prescribing-information.pdf

Reference:

Marshall WG, Hazewinkel HA, Mullen D, et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun 2010;34(3):241–53.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.Sponsored by our friends at Zoetis Petcare. ©2021 Zoetis Services LLC. All rights reserved RIM-00324

That Hurts, But I Won’t Tell You About It: How to Find and Help Your Feline OA Patients

Jason Doolittle, DVMFelis catus – the domestic cat – is an amazing animal who delights and surprises even those of us who have spent years working with them. Among their many unique personality traits is their ability, highly evolved and adapted over thousands of years, to mask their pain when frightened, surprised, or otherwise stressed. It should be no surprise, then, that when your feline patients are in an unfamiliar environment, surrounded by sights, sounds, and smells they don’t recognize (such as a veterinary exam room), they will be inclined to mask their pain.

Cats in these situations also commonly experience fear, anxiety, and stress (FAS). FAS can cause a cat to mask their pain but could also result in behaviors easily mistaken for signs of pain. Partnering with your client, the cat owner, is essential to make an accurate diagnosis of pain in your feline patients.

Helping our feline patients with osteoarthritis (OA) starts at home, with our clients. As you are aware, cat owners are highly attuned to even small changes in their cat’s habits, personality, and idiosyncrasies that make them unique. Partner with your clients and teach them to screen for OA pain at home with a validated Cat OA Checklist produced by Zoetis. On this website, there are three simple screening steps that should only take your clients a few minutes to complete:

The first step utilizes animations to show healthy cat movement in performing several activities (e.g., climbing upstairs) compared to how cats move with joint disease. Your clients will be asked to check on the animations that are consistent with how their cat moves and that are suggestive of OA-related pain.
The next step evaluates, on a scale, the cat owner’s perception of their favorite feline’s emotional and physical well-being. Because OA is a chronic disease that can affect cats emotionally, this is an important step in connecting to the disease state.
The third, and final, step briefly summarizes, with yes/no questions, general behavior changes.

Once complete, clients can enter their email address to receive a copy of the checklist results. In some cases, clients will see the need to bring their cat into you for evaluation; others will need some encouragement to make an appointment. Consider recommending that your clients email the checklist results so you can identify those who might need to be seen.

To help prepare you for these kitties who will be coming to your office, Zoetis has created a website that provides you with resources such as helping to build cat owner awareness of feline pain, talk through the OA checklist they have completed, and feline orthopedic exam resources, including demonstration videos. This website contains a link to a printable version of the Cat OA Checklist that could be used, for example, with a client who has come into your office with their dog but has a cat at home that you haven’t seen in several years to encourage them to seek veterinary care for their feline companion.

It is important to remember that using Fear Free and Cat Friendly principles may mean that some cats who are coming to you to be evaluated for OA may require pharmaceutical help to remain calm. Keep in mind that some anxiolytic regimens may also produce analgesia and alter your exam findings. Objective diagnostic tools, such as orthopedic radiographs, are also an important part of the complete clinical evaluation.

Orthopedic exams and diagnosing OA in cats are yet more reminders that cats are not small dogs! As you partner with your cat-owning clients by asking them to screen their cats in the environment where they are most likely to show signs of OA, you will be better able to diagnose your arthritic feline patients. This partnership will greatly enhance your reputation amongst your clients who will see you as a trusted advisor to their beloved and treasured cat companion.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.Sponsored by our friends at Zoetis Petcare. © 2021 Zoetis Services LLC. All rights reserved. NA-02588

A sick dog is lying on the carpet. Treatment of dogs at home

Talking About OA with Your Clients Doesn’t Have to be Painful

Mary Ann Vande Linde, DVM, Vande Linde & Associates, Brunswick, GeorgiaOsteoarthritis is the most common joint disease diagnosed in humans and pets. What does this mean to a veterinary team? It means that a high percentage of pets and their owners have some familiarity with the discomfort and pain of joint disease. I’m sure we have all had clients tell us they have noticed a change in their pet’s activity, but they usually pass it off as normal for his/her age or suggest their pet is just “slowing down.” This belief does not mean that they don’t care; they just do not understand that what they are seeing may be due to pain. There are some simple communication tools your team can utilize to add value and increase a client’s understanding and acceptance that osteoarthritis (OA) is not normal, and their pet has options.

One of my mentors once told me “never tell a client what you can show them.” A client may see their pet hiding or not playing, and they will need assistance determining if their pet is painful or fearful. Using the Fear Free Strategies of Considerate Approach (CA) and Gentle Control (GC) allows the pet to be comfortable enough to exhibit OA signs in the client’s presence. With CA, a relaxing atmosphere can be created where the pet can have room to move and be observed. Adding pheromones to help keep them calm and non-slip surfaces both on and off the exam room table enables them to safely explore. In addition, with GC, veterinarians can examine the pet where he or she prefers and is most comfortable. Make sure to plan ahead by having materials easily accessible, and have assistance available in the room so the veterinarian can keep a gentle reassuring hand on the pet. Later during the physical exam, the doctor can communicate how their assessment relates to what the client sees their pet experiencing.

To be efficient and consistent communicators, teams need tools that open clients’ minds to possibilities. The Zoetis Canine and Feline OA Screening Checklists can be a discussion starting point. These checklists have “cartoons” of cats and dogs doing common activities around the home that have been identified through research as top behaviors that can indicate OA pain.^1,2

This visual checklist allows the client to see their pet’s behavior changes through the animations. They can see how a healthy cat moves compared to a cat who has unhealthy changes from OA pain. With a checklist a client can tell the veterinarian what they see in comparison to the pictures, or they can review a video of what their pet is doing compared to the cartoon. By reviewing the checklist with a trained technician or veterinarian, the client can offer insight into how they view their pet’s mobility, behavior, and daily comfort. This checklist can be used prior to any exam with an email electric copy, or completed in the room by computer, phone, or as a printed hard copy. This could be a valuable addition to any biannual or annual checkup.

Age is not a disease. And we have tools, strategies and skills that make client discussion interactive, efficient and fun. Clients love to learn about their pets, they want a plan, and they want to feel confident they have made good decisions. Combining the tools of an interactive team checklist, Fear Free strategies of CA and GC and using open questions with active listening create productive discussions, save time, and produce healthier teams and pets. Go ahead talk about OA with these tools: it’s painless.

References

Enomoto, M. (2020). Development of a checklist for the detection of degenerative joint disease-associated pain in cats. Journal of Feline Medicine And Surgery
Wright, A. (2019). PVM1 Diagnosis and treatment rates of OA in dogs using a Health Risk Assessment (HRA) or Health Questionnaire for OA in general veterinary practice Value In Health, 22, S387
Adams, C., & Kurtz, S. (2017). Skills for communicating in veterinary medicine. Oxford: Otmoor Publishing.

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

Sponsored by our friends at Zoetis Petcare. NA-02335

Communicating the Value of Fear Free to Your Clients

Dr. Julie Reck, Owner, Veterinary Medical Center of Fort Mill, Fort Mill, South CarolinaMore than ever, pet owners have a strong bond with their pets. That means they are expecting their pet’s experience at the clinic to be enjoyable. Fear Free provides that excellent “customer” experience for both the pet and the pet owner. However, a client’s first Fear Free experience will likely be different from previous veterinary visits and could seem strange. It is important to ensure that each client fully understands that Fear Free considers both the medical and emotional well-being of their pet and realizes the significance of taking both aspects of the pet’s care into consideration.

Three Key Messages for Our Practice

We believe in the power of positive reinforcement. Patients will be treated kindly and receive lots of treats and verbal encouragement.
Fear Free is reinventing the definition of a successful veterinary visit. It is no longer acceptable to “just get it done.” We take into consideration where the patient is emotionally and proceed appropriately, which may mean that some things will not get done during a visit. For example, toenail clipping may have to be done another day if the patient elevates to moderate signs of fear, anxiety, and stress (Level 3 FAS).
Our hospital has a consistent approach to handling and treating our patients: Everyone is practicing Fear Free techniques with every patient.

Below are tips for successfully communicating the benefits of Fear Free to your clients.

Maximize Your Social Media Presence

Currently I have owners seeking out my clinic specifically for the Fear Free experience, but in the beginning this was not the case. It became obvious to me that the benefits of the Fear Free visit needed to be stated clearly in all my communications.

For the pet owner, the Fear Free journey begins before they get to the clinic. I want my clients to be educated consumers, so they “know before they go,” or, in other words, they know what to expect when they arrive at my clinic. My website and my clinic’s Facebook page fully communicate this to pet owners. We take a proactive approach to prepare the client for a positive experience. This includes stating our philosophy on what a good veterinary experience looks like for the pet and the pet owner using videos, testimonials, news feeds, or stories to keep pet owners informed and prepared for that great Fear Free experience.

The Customer Service Representative (CSR) Prepares the Client and Pet for the Visit

Our CSRs are the next line of communication. They are trained to answer any questions about Fear Free and are critical in making sure that the pet arrives safely and prepared for the visit.

Safety includes recommending that the pet is either in a carrier or harnessed/seat belted while in the car, and that they have a collar and leash if walked into the clinic or stay in the carrier until in the exam room. The carrier can provide the pet a sense of comfort.

Being “prepared” for the visit means making sure the pet arrives hungry and that we have their favorite treat ready for them when they arrive. A day or two before the visit, we send the owner a reminder email and/or text with these same instructions.

Continuing to Communicate During the Examination

The examination provides an opportunity to have a conversation with the pet owner, allowing them to feel more involved with the entire process. I will explain what I am doing, such as standing behind the patient instead of examining their head and face first. I will also describe the patient’s emotional status based on the patient’s body language and my physical findings. This prepares the owner for any diagnostic and/or treatment recommendations that I make, and they are more likely to be compliant with my plan.

Additionally, if the patient’s level of FAS does not allow the completion of the exam or planned procedures, such as nail clipping, the client will be more likely to understand because of the ongoing conversation about the patient’s behavior and emotional status.

It is also important that the pet owner understands their pet’s level of fear, anxiety, and stress will change, based on the situation. A dog who typically loves coming to the clinic may behave differently when coming in for examination and treatment of a painful ear infection. Where we may have never needed to sedate in the past, it is necessary now to ensure that the patient had the best possible experience because the dog’s pain has exacerbated his level of fear.

For patients with a history of severe veterinary visit FAS who we are seeing for the first time, we will inform the pet owner that the first visit will be a consultation. We take the patient’s history, perform a visual examination, but forgo the physical examination to keep the FAS level as low as possible. We may prescribe PVPs and/or schedule a series of “Happy Visits” where the patient arrives, receives treats, then leaves before we ever get to the hands-on physical exam.

What About the Client Who Fails to See the Benefits of Fear Free?

For clients who are more interested in “just getting it done,” I will inform them that the goal is to consider the long-term emotional wellbeing of their pet rather than the short-term approach of “just getting it done.” Some clients will understand and comply. For those who do not, we will agree to disagree and part ways.

It is important that the clinic owner and staff back this decision and uphold the values the Fear Free team has agreed upon. This is especially true if the pet owner is loud and unpleasant. Professional affirmation for the decision and support from colleagues can reinforce that one negative encounter with a client cannot undermine all the positive feedback and improved patient outcomes that comes with being Fear Free.

I have found that it is the small consistent changes that accumulate over time that get you to Fear Free. You might start with pheromones and see a subtle difference, then add in Considerate Approach and Gentle Restraint with liberal use of treats and see more of a change. As you continue to master the techniques and communicate the benefits of Fear Free, you will find that you and your staff are emotionally enriched, your clients have a renewed feeling of trust and bonding to you, and your clinic and your patients are actually happy to see you!

Sponsored by our friends at Zoetis Petcare. NA-02292

5 Ways to Have the Worm Conversation with Your Clients

When clients come to your clinic and discuss the parasites that worry them most, they often start with ticks and fleas because they’re visible — they can see the threat. As a veterinary professional, however, you know there are other dangerous parasites they can’t see, including more than just heartworm. You also know that recommending broad-spectrum parasite protection isn’t a sales tactic; it’s good medicine. So how do you start the conversation about the importance of protecting dogs against other types of parasites in a way that pet owners will understand, appreciate, and ultimately listen to?Here are five conversation starters to help your clients understand the risks and why intestinal parasites can pose a bigger problem than they may think.

1. Parasites disrupt the pet owner-pet bond.

No pet owner wants to see the dreaded “rice” on their dog’s rear, or learn their dog has been shedding eggs from intestinal parasites and contaminating their yard. Intestinal parasites aren’t just stressful for pet owners, but for pets, too. An indoor dog could suddenly be relegated to the outdoors or confined to a single room – all while a frantic pet owner tries to reach their veterinarian after hours. Dogs are intelligent creatures, but that doesn’t mean they will understand why their owner is suddenly distant, worried or disgusted. The bottom line: Parasitic infections can undermine efforts to create a warm, inviting, Fear Free home for a pet.

2. Intestinal parasite prevalence rates are rising.

The average number of heartworm-positive dogs per clinic increased by 21.7 percent in a 2017 survey conducted by the American Heartworm Society.¹ While pet owners may recognize the importance of protecting against heartworm, they might not realize the threats posed by intestinal parasites as well. Along with the increasing threat of heartworm, prevalence rates of intestinal parasites are also on the rise. In shelter dogs:

Canine hookworm (Ancylostoma caninum) prevalence rates increased from 19.2 percent average prevalence nationwide in 1996 to 29.8 percent in 2014^2,3
Canine whipworm (Trichuris vulpis) prevalence rates increased from 14.3 percent average prevalence nationwide in 1996 to 18.7 percent in 2014^2,3

3. Pets are out and about (and exposed) more than ever.

Dog parks are prime areas for the spread of parasites like hookworm, whipworm and roundworm. In a pilot study conducted across the Dallas-Fort Worth area, 80 percent of sampled dog parks had at least one dog test positive for intestinal parasites.⁴ If a client frequents dog parks or other areas with lots of dogs, they should know that it increases their dog’s risk of picking up a parasitic infection.

4. Shelter dogs may increase parasite prevalence in your area.

Did you know nearly two thirds of animal shelters and rescue organizations do not test, treat or provide heartworm prevention before transporting dogs? From 2014 to 2017 shelters imported 114,000 dogs to Colorado, and during that same time period Colorado saw a 67.5 percent increase in heartworm prevalence. Even if you practice in an area with historically low parasite prevalence, shelter dog relocation may contribute to a higher local risk of parasitic disease for your clients.⁵

5. Owners and their families are at risk, too.

Pet owners often don’t realize that zoonotic disease transmission is a real threat to their families, especially young children.⁶ If clients question the necessity of intestinal parasite protection, explain that roundworm eggs can remain in an environment for years⁶ — leaving pets and human family members at risk long after the problem was thought to be “over.” Even walking around barefoot in their own yard could be a risk, because infective hookworm larvae can penetrate human skin to spread zoonotic disease.⁷

Regardless of the many Fear Free reasons to protect against intestinal parasites, educating pet owners on the risks of these “hidden” parasites can be a challenge. Using the conversation starters above can help support a recommendation for heartworm prevention that also protects against hookworm, roundworm, whipworm, and tapeworm, as well as potentially increasing compliance. After all, a client who understands the value of intestinal parasite protection for their pet is that much more likely to administer it.

References

1. American Heartworm Society. AHS survey finds increase in heartworm cases. Available at: https://d3ft8sckhnqim2.cloudfront.net/images/bulletin/AHS-1705-May-17-Summer-Bulletin.pdf?1535050388. Accessed June 20, 2019.
2. Blagburn BL, Lindsay DS, Vaughan JL et al. Prevalence of canine parasites based on fecal flotation. Comp Cont Educ Pract. 1996;18(5):483-509.
3. Blagburn BL, Butler JM, Mount J, et al. Prevalence of internal parasites in shelter dogs based on centrifugal fecal flotation [abstract]. In Proceedings AAVP 59th Annual Meeting. Denver; 2014. 26-29 July 2014.
4. Elanco Animal Health. Data on file.
5. Drake J, Parrish RS. Dog importation and changes in heartworm prevalence in Colorado 2013-2017. Parasite Vector. 2019;12:207.
6. Companion Animal Parasite Council. Ascarid. Available at: https://www.capcvet.org/guidelines/ascarid/. Accessed May 16, 2018.
7. Companion Animal Parasite Council. Trichuris vulpis. Available at: https://www.capcvet.org/guidelines/trichuris-vulpis/. Accessed May 16, 2018.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.This post is brought to you by our sponsor, Elanco, the makers of Credelio^® (lotilaner) and
Interceptor^® Plus (milbemycin oxime/praziquantel).INDICATIONS FOR CREDELIO

Credelio kills adult fleas, treats flea infestations (Ctenocephalides felis) and treats and controls tick infestations [Amblyomma americanum (lone star tick), Dermacentor variabilis (American dog tick), Ixodes scapularis (black-legged tick) and Rhipicephalus sanguineus (brown dog tick)] for one month in dogs and puppies 8 weeks or older and 4.4 pounds or more.

IMPORTANT SAFETY INFORMATION FOR CREDELIO

The safe use of Credelio in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures. The most frequently reported adverse reactions are weight loss, elevated blood urea nitrogen, increased urination, and diarrhea. Please see full Credelio product information for complete safety information or contact your veterinarian.

INDICATIONS FOR INTERCEPTOR PLUS

Interceptor Plus prevents heartworm disease (D. immitis) and treats and controls adult hookworm (A. caninum), roundworm (T. canis, T. leonina), whipworm (T. vulpis) and tapeworm infections (T. pisiformis, E. multilocularis, E. granulosus and D. caninum) in dogs and puppies 6 weeks or older and 2 pounds or greater.

IMPORTANT SAFETY INFORMATION FOR INTERCEPTOR PLUS

Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of Interceptor Plus (milbemycin oxime/praziquantel), dogs should be tested for existing heartworm infections. The safety of Interceptor Plus has not been evaluated in dogs used for breeding or in lactating females. The following adverse reactions have been reported in dogs after administration of milbemycin oxime or praziquantel: vomiting, diarrhea, depression/lethargy, ataxia, anorexia, convulsions, weakness, and salivation. Please see full Interceptor Plus product information for complete safety information or contact your veterinarian

Credelio, Interceptor, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates.
© 2019 Elanco. PM-US-19-1483

Walking the Line: Preventing Lyme Disease for Fear Free Clinics

By David Hustead, DVM, M.P.H.Balancing the importance of necessary care with the emotional care of pets in the Fear Free clinic can be challenging. There are countless situations, from the dog hit by a car to an outbreak or emerging disease, where the timeliness of medical care seems to outweigh the need to take things slowly and minimize fear, anxiety, and stress (FAS) in the pet.

Consider Lyme disease. While we as well as our clients may be reluctant to add another injection to a dog’s prevention program, new information about Lyme disease’s risks, transmission, and prevalence provides a compelling reason to reconsider that reluctance. What information do we need to balance those risks with the benefit of prevention?

The risk of Lyme disease is increasing, changing, and spreading.

It’s important to understand that what we know about the risk of Lyme disease may be outdated. There is increasing evidence the risks of Lyme disease continue to expand for both people and dogs in the U.S. The CDC reports that vector-borne disease has more than doubled from 2004 to 2016. Of this, human Lyme disease accounts for 82 percent. Additionally, during this period, nine new vector-borne diseases were first observed in the U.S.¹

The risk to dogs is also increasing in areas not normally considered at-risk for Lyme disease. According to the Companion Animal Parasite Council (CAPC), while the Northeastern states, upper Midwest, and Pacific Northwest still have the majority of canine Lyme cases, dogs exposed to Borrelia burgdorferi continue to be discovered outside of those areas. Their biggest areas of concern for increases in canine Lyme disease in 2019 include eastern Pennsylvania, eastern Ohio and Kentucky, West Virginia, western Virginia and North Carolina. Northwestern Minnesota and some areas in Indiana are also expected to see higher than average seroprevalence in 2019.

Other longstanding beliefs about transmission may now be outdated. For instance, many of us think the risk of disease transmission from exposure to the Lyme disease tick vector I. scapularis is greatest in the spring, but the CDC says the risk of exposure to these ticks is really greatest throughout spring, summer, and fall. In addition, adult ticks can be active at any time of the year when the temperature is above freezing.³

Consider the critical role of the veterinarian.

It’s easy to see that Lyme disease prevention is a critical issue to raise with clients, and one that requires the expertise of a veterinarian. There is no replacing the combination of client education about the disease and exposure risk reduction and proper vector control, including systemic or topical insecticides and vaccination. But some Fear Free veterinarians are hesitant to add a Lyme vaccine to their protocols, thinking it means yet another needle stick and more vaccine volume administered. The good news for Fear Free Certified practitioners is that, for the majority of your patients, you can add a Lyme vaccine without adding needle sticks or more volume.

For example, dogs needing only a Lyme vaccine can receive Elanco’s TruCan™ Ultra Lyme. TruCan™ Ultra Lyme has only half the volume of most vaccines. While half the volume may not seem like a big deal to you, clients interested in Fear Free techniques will appreciate a reduced-volume vaccine. Let them know you have a Lyme vaccine that offers the same protection but with half the dose volume.

Elanco has options for dogs who need distemper and parvo protection as well as those at risk of Leptospiroris, another disease with changing risk. TruCan™ Lyme L-4 + TruCan™ DAPPi+Lyme L-4, and TruCan™ DAPPi+Lyme CL-4 all provide protection with one needle stick and the same vaccine volume as a 4-way Lepto-only vaccine.

TruCan, Elanco, and the diagonal bar logo are trademarks of Elanco or its affiliates.

References

1. ¹ Rosenberg, R. Et al. Vital Signs: Trends in Reported Vector Borne Disease Cases US and Territories 2004-2016. MMR Weekly 67 (17) May 4 2018.
  ² Yabsley, M. Despite the Availability of Preventative Measures—the Risk of Vector-Borne Disease Remains High in 2019. CAPC website accessed on 16 May 2019 at https://capcvet.org/articles/despite-the-availability-of-preventative-measures-the-risk-of-vector-borne-disease-remains-high./
2. ³ CDC accessed Geographic distribution of ticks that bite humans. Accessed at:https://www.cdc.gov/ticks/geographic_distribution.html

This article is brought to you in collaboration with our friends at Elanco.

Taking the Fear out of Disinfection

Until recently, disinfection was considered to be a necessary evil, killing infectious microbes at the cost of exposing pets and people to harsh chemical odors. Disinfectants with unpronounceable names, such as sodium hypochlorite (bleach), quaternary ammonium compounds (QUATs), and potassium peroxymonosulfate, may have been the industry standard for a long time, but just like any other aspect of animal health, we always strive to do better for our pets and create a more positive experience for them in and out of the vet clinic.Accelerated Hydrogen Peroxide^® (AHP^®) technology had been used extensively in human healthcare to kill some of the toughest pathogens while putting patient safety at the forefront. When Virox Animal Health saw the same need for veterinary care, they knew that AHP would be a perfect fit to help protect people and animals while reducing fear, stress, and anxiety in a veterinary hospital. That led to the creating of Rescue, a disinfectant specifically tailored to protect companion animals and the people who care for them.

While traditional disinfectants have been a trade-off between safety and efficacy, Rescue eliminates the need to make this choice. Rescue’s safety profile, coupled with the lack of harsh chemical odor, realistic contact times, and superior cleaning powers, can help your facility along its journey in becoming Fear Free.

Reducing FAS in the disinfection process doesn’t, however, mean a loss of efficacy. AHP disinfection covers all the bases in a Fear Free approach to animal health. These include:

1. Other chemicals like bleach and QUATs can be harsh. We all know that from experience, but we might not realize that bleach can cause serious skin and eye irritation and respiratory illness¹. QUATs, although safer than bleach, have been associated with asthma and can also be irritating to the eyes and skin². Rescue kills those tough-to-kill pathogens, but its gentle formulation is non-toxic and non-irritating for the safety of your patients, staff, and clients.

2. Bleach and QUATs can often take up to 10 minutes of contact time to kill pathogens, which can really slow down your practice. When was the last time you waited 10 minutes for a disinfectant to do its job before wiping it off? Not to mention the fact that these chemicals may not stay wet on the surface for long enough to meet this contact time. Rescue has realistic contact times, ranging from 30 seconds to 5 minutes. Furthermore, its wetting agents help make sure that it stays wet long enough to disinfect. This means less product used, less waiting between patients, and a more efficient practice overall.

3. Rescue has broad-spectrum bactericidal and viricidal claims against the vast majority of pathogens we encounter in the veterinary setting, so you can be confident that even the toughest pathogens don’t stand a chance. AHP also has none of the odors associated with chemical disinfection, preventing additional stress to our patients during their visit.

4. Cleaning power. Many older disinfectant chemistries have been poor cleaners and were only able to kill pathogens on surfaces that had been pre-cleaned with soap and water. AHP contains powerful detergents, which break down soil and allow it to work in the presence of organic material. This brings cleaning and disinfection into one easy step, saving valuable time and resources along the way. Rescue is also a natural odor eliminator, which may help get rid of some of the smells that can contribute to fear, stress, and anxiety within your clinic.

References

This article is brought to you in collaboration with our friends at Virox.This article is brought to you in collaboration with our friends at Virox/Rescue Disinfectants.

Take a Fear Free Approach to Sharing the Fear Free Approach with Colleagues

By Linda Lombardi
Introducing Fear Free techniques to colleagues who aren’t familiar with them or who may be resistant to change can be daunting, but Fear Free principles apply to people as well as pets. Here’s how they can help.

Tabitha Kucera, a veterinary technician, has learned a lot from her experiences teaching Fear Free to other veterinary professionals, and maybe the biggest lesson is the importance of using the same principles on people as you do on animals.

“Positive reinforcement encourages initiative and creativity, it forgives mistakes, it creates enthusiastic learners and accelerates learning,” she says. “It’s the same for people.”

Build a Constructive Culture

The benefits should seem obvious once you’ve worked with animals that way. But applying these methods doesn’t always come naturally, she says. She recalls a class she attended at the Karen Pryor Academy. Most of the students were trainers, along with Kucera and two other vet techs. At one point, each person did an exercise in front of the class and then fellow students were asked to talk about what they thought had been done well.

“For the techs it was harder than for the dog trainers, and that was an epiphany for us,” she said. “We talked about it later—it’s that we’re not used to getting constructive feedback.”

Not only was it more difficult to give positive comments, it was also frustrating at first to get them.

“We were like, why don’t you tell me what I did wrong? Just tell me what I did wrong so I can fix it.”

But if you’ve studied behavior, you know all the reasons why “Just tell them when they’re wrong” is a bad way to train. One is that just saying “no” to the wrong behavior doesn’t tell the learner what the right behavior is. If you want staff to use less stressful techniques, saying “Don’t do this,” while well-meaning, doesn’t communicate the desired alternative.

“If you’re used to scruffing, I can’t just tell you not to scruff, which is what I see a lot of,” she says. “I hear a lot of ‘less is more,’ but what does that mean? You need to define the behavior you want.”

Say No to No

Maybe even more important is the effect of all those “nos” on the recipient.

“With positive reinforcement, the biggest difference is we focus on the good,” she says. “The way some other training techniques work—and the way people often work with each other—is we focus on the negative: I’m going to tell you what you did wrong and completely ignore all the good stuff you did. That creates an environment where people are afraid to make mistakes and afraid to ask questions.”

Being told that you’re wrong is essentially a form of punishment, and learners who are afraid to make mistakes because of repeated punishment soon shut down and are afraid to try anything. That makes it impossible to learn something new. And imagine the frustration of doing the same thing for years and then being told it’s wrong. We wouldn’t do that to an animal, but we often don’t realize we’re doing exactly that to our fellow humans.

“You can’t punish them when this is how they were taught,” she says. “I say, ‘You’re not wrong in what you’re doing, but fortunately medicine progresses, and we’ve learned a lot of great new ways to handle animals that make it easier for us and for them.’”

Be careful, too, of how interactions can convey the message “You’re wrong” without saying exactly that out loud. “You can’t run over and say, ‘Let me take over,’ because then you just insulted that person,” she says. “When I see things that are concerning, I’d just say, ‘Hey, you guys need some help?’”

Show, Don’t Tell

Simply using the techniques and letting people see what happens can be the best way to start. “First thing first, wherever I am, I use these skills, and people notice,” Kucera says. “Soon they’re coming to me and asking if they can learn this.”

It’s important to remember that trying something new can be anxiety-provoking, especially if you’re invested in and comfortable with techniques you’ve been using for years. Make it clear that it’s okay to try and fail. “I also don’t say ‘It’s do this or die,’” she says. “Try it one time, and if it doesn’t work, we’ll do it the way that you’re comfortable.”

Another thing that we know for our animals but often forget for our fellow humans is that different reinforcers work for different individuals. When she’s trying to persuade people of the benefits of Fear Free, Kucera says, everyone cares about decreasing fear and stress in the animals, but other motivators can differ by role. For a practice owner, she’ll talk about the business advantages, while for a tech who restrains animals, she’ll say, “You’re in your 30s; you need to go home and not be in pain every day.”

Set Realistic Goals

When Kucera talks to people who are excited by her presentations, she often has to talk them down a bit. “I say, ‘I love your enthusiasm, but I don’t want you to go back to your shelter or hospital and say we have to do all this right now,’” she says. “Because I did that in the past, and it shuts people down.”

Remember that new skills need practice. “I set realistic expectations for people: I don’t expect you to do this perfectly tomorrow,” she says. And start slow, just like you would with a pet. “Pick one or two things for your practice or shelter and start there, because from there it’s going to spread like wildfire but not if you don’t set your staff up for success.”

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

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