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Saturday, December 21, 2013

Instruments of terror -  what sets fear off in our pets at the veterinary office

 cat carrier = fear if exams are scary

Last week as I was holding a spoon of baby food that an anorexic cat was finally eating, my tech laid the ear thermometer on the floor next to me.  The cat took one  look at the thermometer, stopped eating, turned away and crept to the back of the cage as I stayed motionless with the baby food.  I asked her to remove the thermometer and when she did, the cat came right back up to me eating the baby food. 
So what was happening here?  The thermometer was an anxiety trigger to this cat.  That one item - an ear thermometer- was enough to shut this cat down.  How often have you had a happy dog suddenly snarl and become agitated  just before an injection is given?  Very likely this dog saw the syringe and that triggered the aggression.  That dog remembered the pain and irritation that the syringe injection gave.
If you don't have a reward, all this dog will remember is the pain
 When I present to veterinarians and technicians, some  of the audience acknowledge the trigger effect of our equipment.  They too have had an episode like the one I had with the cat.  Others can not believe that something so innocuous as a thermometer could set off that much anxiety.  These instruments are triggers.  They are items, or settings that predict for the pet what is coming next which may be unpleasant. 

These are some of the most common triggers that I see ( and my face book friend have added!)
                Stainless steel topped tables       small room syndrome - the close quarters of an exam room
               syringe and needle attached       white coat/smock/scrubs - especially on the DVM
               thermometers                              otoscope
               Stethoscope                      nail trimmers          electric trimmers             
Here is the challenge.- how do we perform our work, needing to use   these instruments and avoid setting off fear aggression and anxiety?   Here are a few tips that have helped reduce the anxiety and aggression we see from patients. 

1.   Hiding these triggers is a first step.  Be creative.  When you have drawn up the vaccines, keep the syringes hidden under a paper towel or piece of paper.  Hold the thermometer palm down so the pet cannot see it.    Cover your table with a beach towel to hide the stainless steel.  Use a towel or blanket as a hood  or a calming cap ( from the  thundershirt company)  over the pet( dog or cat's) face so they cannot see what is happening.   
2. Reduce  pain and discomfort when  using these instruments.  Use lidocaine cream around the rectum and wait a few minutes before using a fecal loop or rectal thermometer.  Smaller gauge needles (25ga for most injections)   reduces pain during injection.  Give pain relief before a procedure such as oral buprenex.
Latex gloves + pain unless you use lidocaine
3.  Reduce the anxiety the pet is feeling.  Try the pheromone products early and often.  Adaptil may take 5-15 minutes to help reduce anxiety.  Give the client a bandana to put on their dog so it is taking effect in the waiting room and during history taking.   Spray feliway on a paper towel to rub on the door of the carrier and on the exam table.   Offer food reward, verbal praise and petting that the pet enjoys throughout the steps of the exam and treatment. 

Here is a video showing how varying the triggers helps a nervous dog in for an exam  nervous dog exam you tube video

  Whatever steps you take with a patient to reduce anxiety,  record it in the record.   This will save staff  time and improve every visit for that pet. I have a medical record labeling system  Bella Behavior Label System available at to make this easy.   It is essential that  the doctor is a part of  stress reduction for this pet. Technicians can take the lead by suggesting  they removing the lab coat or hold the syringe so the pet cannot see it.   Tell your doctors what you notice when the pet became tense and that you want to try reducing anxiety by removing a trigger or 2 and see the effect.  Some of us doctors get so engrossed in doing the tasks of diagnosis and treatment we don't pay attention to  what may be triggering the patient's anxiety.  We can't see how the animal is responding as we bend over to look in an ear or are at the rear of an animal.  Doctors - be open to changing a few things for the benefit of your patients and your staff.  Everyone wins when we decrease fear in the veterinary clinic.
This little dog took rewards because I left my lab coat off - the Bella system reminded me to do this Bella Behavior Label System                  

Dr. Sally J Foote DVM CABC-IAABC