The cost of rough and tumble veterinary visits

Recently, a couple brought in their 2 pug dogs for check up.  I had not seen these dogs for care in a few years.  The couple moved about 3 hours north, and that would have been a bit of a drive for veterinary care!  Now the couple were living back in my area, and the dogs needed a check up.  " really bad breath - be sure to check teeth". was noted on one of the chart.  OK, dental exams are part of check ups so that would be fine.

The dogs were their usual happy, but  mildly anxious selves.  If you have ever  cared for a pug, panting  continuously is normal  for these dogs.  The pushed in face, small nose, long soft palate and big tongue makes creates a small airway.  This is the tricky part of examining  pugs, or any of the brachycephalic ( pushed in face) dogs for that matter.  When they start to fidget, paw, or struggle it can become very difficult for them to breathe.  Examination of the eyes, ears and mouth can be more challenging, because it  involves approaching them from the front.  Many dogs see  this as a threat, pulling away from the approach.   In pulling away, they start to struggle which causes them to breathe harder and pant more intensely.  It is more difficult for them to breathe now, so they continue to struggle trying to escape the restraint.

  In traditional handling, often a second or third person is called in to hold the dog  to  "just get the job done".   The dog will  become very agitated and even have severe difficulty breathing as they struggle.  Now the dog has  learned  to struggle for  any handling right  from the start.  The struggle is real - these dogs are fighting for air.  I am not here to discuss the breed, or breeding that created this health risk.   I want to have everyone understand from the animal's point of view why they resist handling in the first place, and how  traditional handling  creates a very rough experience.  Owners see this struggle,  and know it is not good for their pet.

Back to my story -  I reviewed the history for both dogs with my technician.  Both dogs were presented for nail trim, general exam and " bad breath" for one.  As I reviewed the history with my technician, she noted the dogs had not had veterinary care  since the last time I had seen them a few years before.  The breath was foul, and from the information that the dog did not want to play ball, or use the chew bones, she suspected  mouth problem had been present a number of months.  Why had they not sought care before this I wondered?  I put that in the back of my head and  entered the exam room.

I was  greeted by 2 active,  pugs  slathered with Adaptil ( mother dog calming pheromone) to help calm them in preparation for exam.  My technician knew the Adaptil helped these dogs be calm because we  a medical record system ( Bella Behavior Label System tm)  to record  the handling plan  for each patient.  We still had the medical records from years ago and the tech and I followed that plan  providing  a low stress exam and nail trim.  For the first dog, we used the calming pheromone, a cowl technique , and positioned the owner to continuously deliver baby food by syringe to her dog as I clipped the nails.  There was a little prancing at first, but with the right approach, rewards and low stress restraint the first dog was standing happily for care.

cowl technique - "Low Stress Handling, Restraint, et al" SYin 

When we started the exam on the  dog with the mouth odor, I could see he was more fidgety.  Fidget is a sign of anxiety and normal when there is pain.  Mouth odor usually equals dental disease and mouth pain so I knew I should be careful about examining his head and mouth.   We put the cowl on him and I used a pretzel stick  to lift his lip to avoid  excessive touch which would stimulate pain.

using a pretzel stick to lift the lip minimizes touch and pain 

 His gums  were inflamed with advanced periodontal disease,  to the point one of the first molars was just about ready to fall out.  He was always difficult for the owners to look in his mouth, so they could now see what was causing the foul odor.  I  carefully showed the owners the problem teeth, and the wife was especially upset that her dog was in pain and she had not realized the extent of it.  She could not see the extent at home, and had been in a quandary of what to do for him.    We set up his dental immediately, checked his blood work and started him on medication in preparation for the dental.

I was wondering why they had delayed care for his teeth.  They had smelled the bad breath, suspected dental problems for over 6 months but had not sought care.  My curiosity was not to accuse them of wrong doing but rather understand why they would delay care.  So I asked " From the records I saw that his last exam was from myself a few years ago.  Was it difficult to get him in for care at your new home or was there something else going on?  I was curious and just want to understand".  The husband immediately said " We could not find a vet who would care for them without hurting them. They were all too rough and I was not taking them back"  So I asked for more specifics and the wife added " They just called in more people to hold them harder, or took them to the back and who knows what was going on there.  Here you use the towel and some food and are kind in your care."  The husband added " If they are that rough around us, what are they like handling our dogs when we are not around."    I understood - they had seen the traditional handling which can often escalate fear and anxiety in our patients.  This couple had the money, had the knowledge of what their pets needed and were near a major metropolitan area so there were plenty of clinics around.  Yet despite that they lost trust in veterinary care due to their pet's experience.  

This had his dental 2 days later after being prepped with antibiotic and pain relief.  He had multiple extractions, deep cleaning and treatment to his gums for which he  immediately felt better.  Anesthesia went well and  we used calming pheromones in  cage, kept his area quiet and allowed him to go home early to reduce his stress.  The clients were happy that he was on his way to better health and that we cared for him in a way that was best for him.

The Bayer corporation ran a pet owner survey in 2011 which showed that approximately 35% of pet do not bring their pets in for care due to pet stress.  A repeated study was done in 2014 with not much improvement on this number.  As a veterinarian who has made positive veterinary care a standard in my practice, I am not surprised by these statistics.  I have had many seek my practice like this family because they saw the stress their pet was in during care and wanted to find a different approach.  Presently there is the  Low Stress Handling  tm Certification,  Fear Free sm Certification, and Cat Friendly Hospital programs to help veterinary staff learn specific ways to reduce stress and anxiety in care.  The text book " Low Stress Handling, Restraint , et al" by Dr Sophia Yin ( drsophiayin.com)  is the guide for all animal care professionals.  The American Veterinary Society of Animal Behavior has released a  positive veterinary care position statement.  I encourage all veterinary staff, trainers, groomers, and animal owners to read this statement and owners to seek veterinary professionals who follow these guidelines.  

Change is happening, and thank you to the  owners who make it clear that the animal's experience is essential to choosing  veterinary care. With vocal pet owners, more practices will embrace these standards .  Some veterinary clinics have followed this standards for years and I  applaud all of you. Practices new to  creating less stressful techniques, I am cheering you on as well.  I am especially thankful to the students who have taken the certification programs at the additional time and cost to bring this skill to the profession.  Hopefully it will become a standard for both  veterinarian and technical colleges.

Every day - Every way - Every patient keep it kind and low stress