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Sunday, November 26, 2017

Dancing around thresh hold
I have recently returned home from a week of presenting at  the Veterinary Congress of Quebec,  and to the Pet Professional Guild in Orlando Florida.  At both conferences, I educated on less stressful handling during veterinary care.  The Quebec audience was veterinarians and veterinary staff while the Orlando audience was primarily dog trainers and other non veterinary animal behaviorist who also offer counter conditioning animals to veterinary care.

In french - translation -  less stressful handling of companion animals 
 One concept that I needed to emphasize was knowing the thresh hold for panic or aggression for the animal in front of you, in situations.  For example, for a particular dog, the prick of the needle for an injection may be the trigger that causes this dog to stop taking a reward and start to struggle.  This dog may be eating treats, relaxed but as soon as it sees the veterinarian moving close and feels the needle, then snapping, or lunging occurs quickly.  It is difficult to counter condition a trigger so deeply related to fear so how can one administer needed care, like a rabies vaccination, or insulin injection?  Knowing this animal's  triggers to anxiety and understanding this animal's signals are  individual.   Yes, it is best to reschedule an appointment using pre exam medication but at times this is not feasible.  If the patient is vomiting and needs an anti emetic injection to control vomiting, or an overdue rabies vaccine on a dog with a bite history - that will need to be taken care of immediately.

 So,  how do I keep care  low stress knowing the injection will cause stress?  The answer is keeping the care short and sweet.  You remove as many stressors as you can, giving rewards to counter condition for all parts of the exam and when the moment of stress comes, you give the injection quickly and remove your hands and move the dog away praising and giving rewards from the handler, then the vet to help them settle.  You have crossed over the threshold for aggression, but quickly removed triggers to help the dog come down below threshold and take the reward.   This stimulus - stop - reward  is dancing around threshold.

Allow the handler to evaluate, communicate and reduce escalation 

I call this technique dancing around threshold ,because it is like stepping  over and under the threshold line.  The action is quick administration of stressor, then removing the stressor,  to bring them down.  You wait a few minutes with reward to prevent further escalation,  before another stimulus .  Think of some one doing the cha cha where they step forward and back over an imaginary line.   This technique is reserved for needed care, not elective.   It takes clear communication between the handler and the person administering an injection,  to co ordinate rewarding then watching the body language of the animal as the care administrator ( veterinarian or other technician )actually gives the injection. If we sense  the animal will snap, the handler will quickly hold the animal as the injection is given, then lead the animal away or give  a rewards as the veterinarian moves away for a few moments,  The key points are that the stimulus has to last less than 1 second, and the time for hold - stimulus - release - reward or lead away had to happen in less than 3 seconds.  So this is fast work.    Just like in dancing you are moving back and forth around the threshold line, not staying on the high side very long.

What is good about this technique is that the animal learns that the high stress point is going to be short, they are not stimulated to escalate up the ladder of aggression from where the present high point is, and the warnings they show us are heeded for reducing stress and anxiety.  By heeding these warnings, the animal learns to warn and give more time before escalating to panic or biting.

Knowing the animal in front of you for their triggers, and their body language is essential.  Even if you are  not certain if a nervous animal will escalate higher, bet on the side of fast escalation. So keep the stressor short and sweet with lots of rewarding before and after.  Understanding that both the handler  and care administrator must communicate that the animal is approaching thresh hold is of utmost importance.  If the threshold for panic or aggression is not recognized, and the animal is triggered for more than 1 second, it will escalate - you are taking too long and are forcing the animal to react.  This is a video of a dog who is nervous but we keep the actions short and sweet that would trigger him up to panic  . video of nervous dog dancing around threshold 

 Clear understanding of the animal indication that it is over  thresh hold takes experience and education.  The lab 3 and 4 of the Handling, Moving and Restraining modules of the Low Stress Handling Certification program demonstrates this very clearly. Dr Yin works with an aggressive dog pointing out the threshold for stress during a counter conditioning session.  For many pets, they may shut down just arriving at the veterinary office.  If care can be rescheduled, then have a house call for this pet.  Another idea, is to do the exam or care in the car or grounds outside the building.   As a practitioner in a rural community, I have seen many a farm dog less agitated in the bed of the farm truck for exam or vaccination or standing on the grass outside of the building.  It may seem crazy, but I had yellow Lab patient who would be very nervous in the waiting area, and attempt to aggress in the exam room.  Outside, he was calm and happy.  So I would do his exam and vaccinations standing in the grassy area to the side of my building.   When he needed more advanced care, I would give him the sedation injection outside and then take him into the building when he was sedate. It may have looked weird to see me outside listening to a dog's heart , or giving a vaccination but it prevented this  dog from escalating. I was willing to make it less easy for me  for the dog's benefit.  That is what I like about reducing fear and aggression during veterinary care -  you get become  creative in  handling, see a more relaxed patient and deliver more care.

Quick use of a blanket to hood allows an injection to be given with less stress then move the dog away and reward immediately

Dancing around threshold is a skill that veterinarians, technicians, assistants and trainers must learn to prevent escalation of anxiety and stress during needed care or events.  Understanding this animal's body language for escalation, how to block or minimize the trigger to stress and work quickly to lower the stress through rewards and movement away from the trigger is an essential skill.  I look forward to hearing from my readers and attendees to  know how they are starting to use these skills
Dr Sally J Foote DVM