Veterinary Visits Archives - Page 2 of 15

Mealtime Mayhem in Multipet Households

Mealtime Mayhem in Multipet Households

Does mealtime feel frenzied or nerve-wracking when caring for multiple pets in the same household? It’s not uncommon for pet professionals, and even pet parents themselves, to feel frazzled or even anxious during these moments, but have you also considered how the pets might be feeling in the frenzy?

How Low-Volume Vaccines Can Help Support a Fear Free Vaccination Experience

Vaccinations are critical for a pet’s health and safety, but some pet parents may be hesitant to agree with your vaccine recommendations. Pet owners may have needle phobias, be concerned about over-vaccination, or remember past visits when their pets became fearful or stressed about vaccination. Unfortunately, these reservations can mean missed appointments and unprotected pets.Fear Free Certified® Professionals now have a new tool in their arsenal to reduce fear, anxiety, and stress (FAS) surrounding vaccination visits: highly purified, low-volume vaccines from Elanco’s TruCan™ and TruFel™ Ultra line. When vaccinations are more comfortable and less stressful for pets, pet parents are more likely to follow your recommendations and keep their pet’s vaccines up to date.

Fear Free® vaccination techniques

Vaccines are one of the most common services performed in veterinary clinics, which creates daily opportunities to improve the process. Since vaccines are given as subcutaneous injections, we can apply many standard Fear Free principles to reduce FAS. Considerate approach, gentle control, touch gradient, and—of course—a steady stream of treats are great ways to reduce the chances of your patient noticing or reacting to the injection. Allowing vaccines to warm to room temperature, using small-gauge needles, and always changing the needle after pulling up the vaccine are additional techniques you can use to reduce discomfort during injections.

Pets with long-standing needle sensitivities may require pre-visit pharmaceuticals (PVPs) or in-clinic sedation to update vital core vaccines when time is limited. Otherwise, implementing a desensitization and counterconditioning program at home can help pets experiencing fear learn to accept injections.

The Elanco Ultra vaccine technology

Once pets reach a point of vaccine acceptance and cooperation, the last thing you want to do is administer a painful injection that causes them to backslide. Choosing the right vaccines can significantly impact a pet’s reaction to the injection and the likelihood of a successful Fear Free visit. Elanco’s TruCan™ and TruFel™ Ultra vaccines were designed specifically to create a better vaccination experience.

The Ultra vaccine line provides a smaller vaccine volume (0.5 mL) and up to 75% fewer proteins, attributed to Elanco’s PureFil™ technology. Unique combinations, including FVRCP plus feline leukemia for cats (TruFel™ Ultra HC2P-FeLV) and DAP plus leptospirosis 4-way (TruCan™ Ultra DAP + L4) for dogs, ensure that pets are protected with fewer needle sticks and less stress.

Talking points for clients

Vaccine conversations can be sensitive. Vaccine hesitancy isn’t new, but a great deal of misinformation about vaccines during the pandemic may leave lingering doubts in some pet owners’ minds. Clients may also worry about vaccinating their pet too much, and causing pain, discomfort, or a negative reaction.

Elanco vaccines can help you compassionately address client concerns. When a client demonstrates vaccine hesitancy, use the following points to explain how your vaccines support a Fear Free visit and lifestyle.

Possible reduced reaction risk — Ultra purification reduces proteins and debris, which may reduce the chance of a negative reaction.
Comfortable injections — 0.5mL vaccines, which are often used in human medicine, are half the volume of traditional vaccines and allow for faster administration with a smaller needle.
Fewer injections — A variety of vaccine combinations reduces the number of injections required to achieve complete protection, which means fewer needle sticks.

Together with a Fear Free approach, Elanco Ultra vaccines can help transform the vaccination experience and reduce FAS for pets and their families. Learn more about Elanco’s innovative products here, or visit our Fear Free website to access our continuously updated member resources.

The label contains complete use information, including cautions and warnings. Always read, understand, and follow the label, and use directions.

PM-US-24-0284

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 Elanco.

Exploring the Benefits of Veterinary Telemedicine: A Fear Free Future

Exploring the Benefits of Veterinary Telemedicine: A Fear Free Future

Veterinary telemedicine holds tremendous potential for improving animal welfare by increasing veterinary access for pet owners, reducing unnecessary pet fear, anxiety, and stress, and enhancing shelter programs. While federal and state laws have expanded access to telemedicine for people, telemedicine for pets remains limited, so the ASPCA is working with state lawmakers across the country to expand access to veterinary care, which can help bridge gaps in care caused by workforce shortages and help keep pets in loving homes. Join ASPCA experts for a special webinar hosted by Fear Free to learn about the ASPCA’s work to improve access to veterinary care through telemedicine and how you can get involved to help pass laws that effectively empower veterinarians to use telemedicine technology to help more animals in need.

Pheromone Use in Veterinary Clinics: A Fear Free Approach

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

How Calming Pheromones Enhance Veterinary Care

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

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

Pheromone Diffusers in High-Stress Areas

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

Pheromone Sprays for Direct Contact

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

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

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

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

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

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

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

Initial Setup

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

Pheromone Diffuser Placement

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

Pheromone Spray Usage

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

Pheromone Collar and Valerian Spot-On Implementation

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

Staff Training and Education

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

Monitoring and Adjusting

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

Maintenance and Restocking

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

Community and Client Education

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

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

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

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Brought to you by our friends at bSerene.

Recover DogCover

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

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

What is the ReCover DogCover?

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

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

A different breed of healing: DogCover benefits

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

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

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

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

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

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

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

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

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

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Brought to you by our friends at ReCover.

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

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

By Julie Liu, DVM

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

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

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

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

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

Summary

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

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

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

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

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

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

By Julie Liu, DVM

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

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

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

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

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

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

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

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

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

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

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

By Julie Liu, DVM

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

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

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

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

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

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

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

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

By Julie Liu, DVM

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

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

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

Location, location, location. When handling any pet, try to choose the area where the pet prefers to be and is most comfortable. There are multiple places where a pet can be handled other than an exam table, such as the floor, on a lap, on the bench, or in the bottom of their cat carrier. In general, many pets with high FAS also do better with the owner present.
Give every pet a sense of choice and control where possible. Encourage voluntary movement by calling the pet using a happy voice, asking the owner to call them over, or luring them to move of their own free will with a treat or toy. Many dogs also know cues for sit and down, so instead of pushing a dog’s rear end down and pulling their legs out to get them sternal, ask or lure the dog to a sit and down. Respect the cat’s choice to stay in the carrier and access them by removing the top of the carrier and covering them with a towel to facilitate hiding. When restraining a pet, especially a high FAS pet, allowing them to stay in the position they prefer goes miles toward keeping them calm, whether it’s allowing a dog to stand instead of sit for a jugular draw or allowing a cat’s front end to remain sternal instead of forcing them into full lateral to reach the medial saphenous.
Less is more. Use the minimum number of people needed and the least amount of restraint needed while staying safe. The more hands on a pet and the more people crowded around them, the more likely they are to become stressed.
Prevent and treat for pain. Pain contributes to FAS and vice versa, and as mentioned in a 2022 Fear Free roundtable³, pain and fear are “two sides of the same coin.” Dull needles also hurt more, so try to make it common practice during sample collection to not reuse needles. During unsuccessful blood draws, I often see people pulling the needle out of a pet’s skin, re-palpating the vein, and then pushing that same, microscopically shredded needle back into that pet’s skin for a second or third attempt as the pet gets more and more stressed.
Sedate early, not as a last resort. With many high FAS pets, you will often reach a limit for what PVPs can accomplish. Injectable sedation may be the best way to help minimize FAS. Sedating earlier when the patient is calmer will be safer for the pet and likely allow you to use lower doses of anesthetic drugs. Familiarizing yourself with Fear Free in-clinic sedation protocols, lowering the charge for sedation to get client buy-in ($70 is more palatable than $140), and getting staff members comfortable with sedation/monitoring will also prove invaluable. Another way to approach stressful procedures for high FAS pets is to tack them onto an already-scheduled procedure involving general anesthesia. Depending on the patient’s needs, these could include shaving a matted cat, microchipping, trimming or dremeling nails, performing a cystocentesis, aspirating a growth in a sensitive location, expressing anal glands, or performing an orthopedic exam/radiographs. For more info on Fear Free in-clinic sedation, check out Fear Free Level 1 module 7b⁸, Fear Free Level 3 module 1⁹, and these other Fear Free resources^{10, 11, 12, 13}.

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

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

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

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Resources

Serene Vaccines: The Fear Free Vaccine Experience

Serene Vaccines: The Fear Free Vaccine Experience

There are many lifestyle factors that influence the decision to vaccinate or not, and we must learn to be proactive in addressing potential concerns that may arise for pet parents. Brought to you by our friends at Elanco.

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