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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 OnePart Two & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.    

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
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 OnePart Three & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.              

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s
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 resources10, 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 TwoPart Three & Part Four of this series.

 Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Resources

  1. Moral stress the top trigger in veterinarians’ compassion fatigue | American Veterinary Medical Association
  2. https://journals.sagepub.com/doi/full/10.1177/1098612X221128760
  3. https://fearfreepets.com/pain-and-fear-two-sides-of-the-same-coin/
  4. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/
  5. https://fearfreepets.com/treat-ladder/
  6. https://fearfreepets.com/top-10-treats/
  7. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2019/01/Keep-Calm-and-Muzzle-On-1.pdf
  8. https://fearfreepets.com/courses/fear-free-certification-program/
  9. https://fearfreepets.com/courses/fear-free-certification-level-3/
  10. https://fearfreepets.com/fas-spectrum/
  11. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Dog-Sedation-Pain-Algorithm-2020.pdf
  12. https://fearfreepets.com/wp-content/uploads/delightful-downloads/2020/08/Cat-Sedation-Pain-Algorithm-2020.pdf
  13. https://fearfreepets.com/calming-pet-owners-concerns-sedation/
  14. https://www.felinegrimacescale.com/
  15. https://fearfreepets.com/courses/fear-free-level-2/
  16. https://www.avma.org/resources-tools/practice-management/communicating-clients-using-right-language-improve-care
  17. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-cat/
  18. https://fearfreepets.com/resources/fear-free-store/fear-anxiety-and-stress-spectrum-dog/
  19. Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018 Nov;32(6):2115-2122.
  20. https://www.youtube.com/watch?v=ExaL-pp9Kok&t=1531s

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.

Fear Free Spaces: Designing your Fear Free Environment

Do you want to create a space that better reduces fear, anxiety, and stress (FAS) in pets? Join us as Roger Layman, Elite FFCP, AIA, NCARB, discusses how Fear Free can enhance your clinic or shelter design, whether you are rearranging, remodeling, or building a brand new space. A new building or remodel provides the perfect opportunity to interweave FAS-reducing design into your plans, but your current space can also be reimagined to reduce FAS. Register now to learn how to create a safe and serene space for pets, pet parents, and your team!

Muzzle training is essential training for a new dog. Creating comfort and ease with wearing a muzzle can help build confidence and make treatments easier for both you and the dog. Mikkel Becker, CBCC-KA, KPA CTP, CDBC, CPDT-KA, CTC, and Debbie Martin RVT, CPDT-KA, KPA CTP, VTS (Behavior), will show you how to safely and effectively muzzle train.

You must be a Fear Free member and logged in to view this webinar

By Shepherd Veterinary Software

Fear, anxiety, and stress (FAS) are not exclusive to our veterinary patients. For some practice owners, the mere thought of switching to a cloud-based software triggers a similar negative spiral. Fear of change can prevent them from appreciating how a serverless system could optimize their workflow and support future practice growth.

Like any fear, apprehension about changing software is best conquered with knowledge. Let Shepherd Veterinary Software address the most common fears and stressors. Learn about the comfort and peace of mind that comes with being in the cloud.

Fear: Data migration will be an enormous hassle

This is perhaps the biggest concern among veterinary practice owners and managers—for good reason. In the past, transferring inventory and patient records was painstakingly inefficient, not only because of data loss during the transfer, but also due to the financial loss from closing the practice during the process.

Reality: Modern cloud-based veterinary practice management systems (PIMS) such as Shepherd Veterinary Software provide step-by-step assistance that streamlines the data migration process. Shepherd’s experienced team understands the implications of switching from server to cloud-based software and provides a wealth of resources and advice to ease the transition and help you anticipate and minimize potential challenges.

Anxiety: My team will struggle to learn the new system and be less productive

No matter how inefficient or frustrating your current PIMS, most team members will find switching to a new, entirely unfamiliar software daunting.

 Reality: Modern software options have intuitive, user-friendly designs that reduce errors and increase productivity for all skill levels. With the help of self-paced training modules, ongoing software support, and skill-building resources, most veterinary staff can feel confident using a new PIMS like Shepherd in as little as a few hours. And, if the team hits a snag during the learning process,  Shepherd’s support team is only a call or click away.

Stress: My practice data will not be secure stored in the cloud

When it comes to practice data, on-site servers can provide practice owners with false peace of mind. A physical unit in your clinic or hospital may feel well protected, but server-based PIMS are often more vulnerable to cyber attacks and malware, not to mention physical threats such as fire and water damage.

Reality: Remote cloud-based storage safeguards your practice’s data through expert monitoring that will identify and address any threat. Automatic security updates and patches keep the system one step ahead of hackers and cyber threats, and automatic syncing ensures access to the latest patient and practice information. There’s also no costly downtime waiting for IT or the release of a system-wide update.

Fear: The benefits won’t be worth the effort

Cloud-based veterinary software is a significant investment of a practice’s finances and resources. It’s only natural to question its proposed benefits and value.

Reality: As veterinary teams quickly discover, serverless software delivers powerful, game-changing advantages that extend beyond practice management to elevate patient care, enhance the client experience, and shape future growth.

  • Improved accuracy — Automated charge capture ensures consistency across all documents, including the patient chart, estimate, and invoice.
  • Increased revenue — Smooth workflows and quick-fill SOAPs mean you can fit in more appointments and care for more patients without staying late.
  • Easier oversight and case management — Remote access allows you to view the practice dashboard, inventory, and patient records from any location with an internet connection.
  • More time to spend with patients and clients — Automated features and powerful integrations eliminate the need for time-consuming repetitive tasks so you can focus on patient care.
  • Stronger client relationships — Enhanced communication tools, such as messaging and pet portals, help develop the veterinarian-client-patient bond.
  • Better job satisfaction — Increased efficiency and smooth workflow put the joy back in veterinary medicine, resulting in a healthier practice culture.

Anxiety: Team members fear that remote access will blur the work-home boundary

Many professionals have discovered that working remotely has an unexpected downside—an “always available” mentality that erodes the work-home life boundary. As a result, some practice owners and veterinary team members may hesitate to embrace remotely accessible cloud-based PIMS. They fear that because of the flexible software, they will be pressured to always be available.

Reality: Remote access can re-envision rather than add to the workload. It allows veterinarians and practice leaders to check in on daily operations, review the schedule, answer questions about a specific case, and take much-needed breaks without losing touch—or control—of the practice.

Stress: Clients won’t understand the change, especially if service is disrupted

Successful software transitions rely on careful planning. It’s important to notify clients as early as possible about anticipated schedule changes or closures. Instead of explaining that your practice is “changing software,” talk in terms of client benefits (e.g., better communication, reduced wait times, simplified check-in).

Reality: This change can build excitement! Upgrading your software demonstrates your practice’s commitment to exceptional client and patient service. With the right approach, you can help anxious clients understand that the temporary inconvenience will result in long-term gain.

Change is never easy, but the transition to cloud-based software is nothing to fear. Discover how veterinarian-designed Shepherd Veterinary Software can elevate your practice’s performance, increase efficiency, and help you rediscover the joy of veterinary medicine. Contact the Shepherd team to schedule a personalized demo and let your software-switching fears float away in the cloud.

Tail Wagging Treatments: Fear Free in Veterinary Rehab Settings

There are a wealth of opportunities after graduation, one of those being veterinary rehabilitation. Whether you become a rehabilitation veterinarian or weave rehabilitation into your general practice treatment plans, join us as we discover how to reduce fear, anxiety, and stress in pets during their rehabilitation. This webinar will discuss the possibilities of veterinary rehabilitation post-graduation, common stressful events for pets during their rehabilitation treatments, and methods to reduce FAS within your treatment plans.

Fear Free Practice Certification:
Are you looking to take Fear Free to the next level at your practice? Interested in learning how the practice certification process works, what your practice needs to be eligible, and how it can benefit you and your patients? Curious about creating a more positive work environment and team culture? Join Dr Jennifer Merlo, Director of Veterinary Affairs, and hospital as we discuss all things Practice Certification. Come armed with questions about the process, benefits, and how to get started!