Reducing Vet Clinic Anxiety: Fear Free, Low Stress Handling and Cat Friendly Veterinarians

Reducing Vet Clinic Anxiety: Fear Free, Low Stress Handling and Cat Friendly Veterinarians

By Victoria Schade and comments by Diane Weinmann

A visit to the vet clinic can be stressful for both pets and their people. For many cats and dogs, a simple wellness exam is actually a series of increasingly scary and uncomfortable manipulations that might result in the animal lashing out at the practitioner. And for pet parents, the stress of watching their best friend go through necessary yet anxiety-inducing exams might deter them from returning to the veterinarian for important health checks.

 

That doesn’t have to be the case. Three revolutionary certifications are changing the way veterinarians interact with their patients, and in turn, are changing the way pets and their people view their time in the vet clinic. Practitioners report less stress on both sides of the exam table, which leads to better diagnostics and happier, healthier patients.

 

What Is Fear Free Certification?

 

Developed by Dr. Marty Becker in 2016, the mission of Fear Free Certification is to prevent and alleviate fear, anxiety and stress in pets by inspiring and educating the people who care for them. The certification process includes a series of courses, both online and in person, that is available to veterinary professionals as well as all individuals employed at a vet clinic, from veterinarians and nurses to customer service representatives and practice managers.

 

The Difference Between Traditional and Fear Free Handling

 

According to Dr. Joanne Loeffler, DVM and Fear Free Certified Practitioner at the Telford Veterinary Hospital in Telford, Pennsylvania, the primary difference is the way the practitioner interacts with the patient.

 

“The traditional way of doing veterinary medicine was to make the pet deal with whatever procedure we needed to get done,” says Dr. Loeffler. “That would mean pinning an animal down, forceful restraint, etc., for sometimes unnecessary things, like a nail trim.”

 

Dr. Loeffler says that using Fear Free techniques allows the practitioner to change their approach to consider the animal’s emotional state in order to accomplish procedures. She adds, “Fear Free is a culture change from the way most of us were taught how to handle animals. In the time I’ve been involved in Fear Free, I’ve seen such a change in the compliance rate of my patients and clients. Fear Free is about treating the animal with respect and working with them to realize the vet’s office isn’t such a scary place.”

 

Fear Free Certification and the Diagnostic Process

 

“Lower stress means better diagnostics,” says Dr. Loeffler. “By having a more compliant patient, we can get more accurate heart rates, temperatures and blood pressures, and even some bloodwork values (like glucose) are more accurately assessed on a calm patient versus a stressed one. Also, when a pet has continued low-stress visits with us, a pet owner will be more likely to bring them in earlier if they get sick, which often translates into a better and quicker response to treatment.”

 

What Is the Cat Friendly Practice Program?

 

Established by the American Association of Feline Practitioners (AAFP) and the International Society for Feline Medicine (ISFM), the Cat Friendly Practice program (CFP) is a global initiative designed to elevate care for cats by reducing the stress for the cat, the caregiver and the entire veterinary team.

 

According to Dr. Elizabeth J. Colleran, DVM, MS, Diplomate Feline Specialty Practice and Cat Friendly Practice Task Force Chair, CFP is a self-paced online program that walks veterinary practices and professionals through all the tasks necessary to reduce the fear and stress of a cat’s visit to the vet clinic.

 

How Cat Stress at the Veterinarian Is Different Than Dog Stress

 

“Cats have a very deep connection to their home. They don’t like to leave it. Ever.” Dr. Colleran explains. “The anxiety begins as soon as they leave their ‘home range.’ From there, each new experience adds a bit more stress: strangers, loud noises, unusual odors, quick movements. Once fully anxious, they will stay that way for a long, long time. Cats have uniquely heightened senses and are more sensitive to stimuli than many other animals—sensations can be overwhelming for cats.”

 

Cats can also show redirection anger, which means that they will lash out at anyone in front of them at the peak moment of stress. Many owners will try to calm their cats during stressful times, putting themselves at risk of scratching, or even worse, a cat bite.

 

Benefits for Veterinarians Using Cat Friendly Practice Protocols

 

Cat Friendly Practice veterinarians note that the designation can decrease anxiety for everyone in the exam room. In a 2017 survey, CFP veterinarians said that their patients are less stressed; their clients are happier about the visit experience; and their clients noticed that how much these specialized vets care about cats. “Understanding how cats experience the world gives CFPs the tools to make the changes essential to make health care easy,” Dr. Loeffler says.

 

What Is Low Stress Handling Certification?

 

The Low Stress Handling Certification program was developed by Dr. Sophia Yin and released in 2014. Certification involves completing 10 online lecture and lab courses, passing a multiple-choice exam at the end of each lecture, and passing a final multiple-choice exam. Dr. Sally J. Foote, DVM, CABC-IAABC, LSHC-S and Low Stress Handling Silver Certified veterinarian states, “This is an in-depth program in the fundamentals of behavior, understanding the patient in front of you right now, and how to approach and deliver care right now to this animal in a less stressful way.”

 

The Difference Between Traditional and Low Stress Handling

 

Dr. Foote notes a connection between the traditional use of force during an exam and the animal’s stress levels. “The most common misstep by veterinary clinics not using Low Stress is adding more people for restraint to get the job done, like vaccinations, nails or blood draw, and not removing or reducing the triggers that are increasing the stress in the animal.” She adds that recognizing when the animal has had enough, and either using medication to assist the exam process or splitting up care, is also important for the health of the animal and safety of the practitioner.

 

How Does Low Stress Handling Aid Veterinarians and Pets?

 

Low Stress Handling techniques teach veterinarians to better understand the emotional states of the animals they’re examining, which can reduce the animal’s reactivity, and in turn reduce injury risk to the practitioner. Dr. Foote states that clients are more likely to come in when care is needed rather than trying to avoid the stress of care on the pet.

 

“I have also heard many veterinarians say that the client finds the veterinarian more credible because the veterinarian recognizes what this pet is feeling,” says Dr. Foote. “So if this vet can recognize stress and fear, they certainly must be able to recognize a bigger medical problem.”

 

Helping Your Pet Feel More Comfortable at the Vet

 

Dr. Foote says that creating a handling plan based on the animal’s needs and combining the efforts of both the veterinarian and pet parent in reducing the patient’s stress is the most effective approach.

 

She suggests open communication with your veterinarian as a way to reduce stress in the exam room. “Tell the veterinary staff and veterinarian before the exam begins what part of your pet’s body they do not like touched [and] how they like to be approached—for example, no reaching or avoid looking in the eye.”

 

Cats

 

Much like with dogs, the process of traveling to the veterinarian often sets the stage for intensifying anxiety. Dr. Loeffler says that one of the most powerful ways cat parents can reduce this stress buildup is to teach their cats to love their cat carriers. Leave the carrier out and place bedding and cat toys inside well in advance of a scheduled visit, so that when the time comes to head to the cat veterinarian, the cat will already have a positive association with the carrier.

 

Dogs

 

Dr. Loeffler believes that the first step to a happier vet visit for dogs is a stress-free car ride, as well as teaching your dog simple placement cues that are helpful during the exam. Dr. Loeffler says that teaching a dog to stand for an exam and blood draw can go a long way in making the exam more comfortable for everybody involved.

 

Bringing a hungry pet and high-value dog treats can also help, as well as establishing a comfort level with muzzling beforehand, since veterinarians often need to examine areas that may be painful, which puts them at risk for biting.

 

You can also talk to your veterinarian about using anxiety management products for dogs or cats, like holistic calming treats or sprays that can help to diffuse stress.  Diane recommends rescue remedy the premade Bach Flower Essence.  Give 5-6 drops to your dog or cat directly into their mouth or on food 10 minutes before leaving your house.  You can re-dose with no issues and there are no interactions with any meds your pet may be on!

 

Vet Checks- What’s is all about?

By Dr. Becker and Diane Weinmann

dog with vet
dog with vet

When you take your dog or cat for a wellness exam, do you have any idea what your veterinarian is looking for as he or she pokes, pushes, prods and palpates your pet? My educated guess is, probably not! I know I don’t have a clue….but I do ask and you should too!

While some vets are quite forthcoming and explain what they’re doing and why each step of the way, others are considerably less communicative.

Of course, some clients aren’t especially interested in the details of their pet’s physical exam. But if you’re curious about what your vet is doing and learning about your pet during an exam, I encourage you to ask questions. If an answer you receive is confusing, ask for clarification and don’t feel shy about asking what is normal and what is not!

Your Dog’s or Cat’s Physical Exam

The physical exam is a critically important part your pet’s wellness checkup. All body systems should be assessed to check for any abnormalities.

During the physical exam your vet should also check a pet’s weight, muscle tone, and joint range of motion, and measure the animal’s current status against past exam findings as well as norms for the breed, age, and gender.

The following chart provided by dvm360 with Dr Becker’s additions, may help you better prepare for your next veterinary wellness visit with your dog or cat.1

Body Part What Your Vet Is Looking For
Mouth ·         Signs of periodontal disease in teeth and gums

·         Bad breath

·         Tooth wear

·         Fractured teeth

·         Plaque accumulation patterns

·         Tongue coat and color

·         Gum hydration and color

Neck ·         Irregularities or changes in size of lymph nodes and thyroid gland

·         Cervical range of motion

·         Muscle tension from collar

Eyes ·         Signs of disease

·         Discharge

·         Squinting or tearing

·         Abnormal movement or reaction to light

·         Clouding of the lens

·         Iris health and irregularities

·         Eyelid, corneal, and sclera (the white part) health

·         Changes in vision

Ears ·         Signs of an ear infection (pain, tenderness, redness, swelling, yeasty smell, discharge)

·         Excessive wax

·         Color of the pinna (flappy part)

Heart ·         Weak or abnormal heart sounds

·         An abnormally fast or slow rate

·         Irregular beats or murmurs

Lungs ·         Wheezing, crackling, or other abnormal lung sounds
Abdomen ·         Any irregularities in the margins of the liver, spleen, kidneys, and bladder

·         Masses or tumors

·         Thickened intestines

·         Mammary chain abnormalities

Base of tail ·         Abnormalities in anal glands

·         Fecal mats

·         Evidence of soft stools

·         Growths

·         Parasites, like tapeworm segments and flea dirt

Legs ·         Limited range of motion in all limbs

·         Signs of pain or discomfort

·         Grinding sound in joints

Coat, skin, and nails ·         Poor overall quality of coat

·         Lumps and bumps

·         Warts and skin tags

·         Rashes

·         Areas of hair loss or excessive dander

·         Matted or saliva-stained fur

·         Fleas or ticks

·         Calluses

·         Ingrown, overgrown, or flakey toenails

·         Dehydration

Holistic vets will also palpate the vertebrae down the spinal column, assess joint range of motion and health, assess the body according to TCM (traditional Chinese medicine), ayurvedic or homeopathic principles, and assess pain or guarding behaviors as well as areas of tension, heat or cold.

This list is very comprehensive and most, if not all, of these areas are checked when I perform an acupressure session. The outcome or findings from checking these areas on your pet will help determine how to proceed with the acupressure session and what points will require work.

Other Tests Commonly Performed During Wellness Checkups

  • Complete blood count (CBC)
  • The CBC gives information on hydration status, anemia, infection, the blood’s clotting ability, and the ability of your pet’s immune system to respond. It provides a detailed look at the blood itself and reveals problems such as anemia or the presence of infection.
  • Urinalysis
  • The urinalysis is used to assess the overall health of your pet’s urinary tract, including the kidneys and bladder, and to check for other health indicators such as glucose regulation and liver function. A complete urinalysis measures the function of the nephrons in the kidneys and gives information about your pet’s metabolic and fluid status. The test is also used to evaluate substances in the urine that might indicate an underlying disease process.
  • Thyroid screenDecreased levels of thyroid hormones often signal hypothyroidism in dogs, while high levels indicate hyperthyroidism, commonly diagnosed in cats. Performing a complete thyroid panel is important, as measuring just a T4 may not reveal an underlying thyroid problem.
  • The thyroid screen helps diagnose thyroid disease, which is an especially common ailment in older cats and dogs. T4 (thyroxine) is a thyroid hormone.
  • Glaucoma screen
  • Glaucoma testing measures the pressure in each of your pet’s eyes quickly and painlessly. This is an important test because undetected glaucoma can lead to permanent blindness.
  • Retinal exam
  • This eye test is used to check for evidence of problems deep in the eyes by viewing the structures beyond the lens, through the pupil. The retinas should be healthy and there should be no signs of bleeding, degeneration, inflammation, or detachment.
  • Blood pressure measurement
  • This test checks your pet for hypertension (high blood pressure). Like humans, pets with hypertension are at significantly increased risk for kidney problems, heart disease, blindness, and other complications. Cats are especially prone to high blood pressure.
  • X-raysAbdominal x-rays can be used to assess the liver and kidneys. X-rays best define problems within the skeletal system, such as arthritis and bone tumors.
  • Since many vet clinics don’t have digital x-ray equipment and their x-rays still involve radiation, I don’t typically order them unless the results of other tests indicate a potential problem requiring further investigation.
  • Radiographs (x-rays), if indicated, can also be helpful as part of a pet wellness checkup. If your vet finds abnormalities on physical examination, digital x-rays may be needed to identify the underlying problem. Chest x-rays, for example, can reveal certain things about the heart and lungs.
  • SNAP 4Dx Plus or Accuplex4 (dogs)
  • These tests check for tick-borne illnesses, including heartworm, Lyme disease, ehrlichiosis, and anaplasmosis. They should be done once or even twice a year for dogs living in areas where ticks are a problem.
  • FeLV/FIV testing (cats)These viruses can suppress the immune system and lead to secondary infections, anemia, and even cancer. Early identification of viral positive cats gives you the best chance of managing infections optimally. As an involved, hands-on guardian, you are in the best position to make informed decisions for your pet — decisions that may not always agree 100 percent with the recommendations of your veterinarian.
  • Let me give you an example: I went to my vet for my husky, Neko. He was due for his shots and I was prepared to tell the vet what I wanted and why. They seemed surprised but understood that I was prepared for this visit. I discussed the Lepto shot at length with the vet talking about the pros and cons and the how my dog could come into contact with the disease. After careful consideration I decided that they vet’s responses to my questions and the type of area I frequently walked my dog necessitated him receiving the shot. After I agreed and he received the shot I found out that the shot actually only works for approximately 5 different strains of Lepto while there are 50 or more strains to the disease! I was not a happy camper. Needless to say, my dog has not received the shot again. Be wise people, consider carefully. I am not hating on vets – I love them, in fact, some of my favorite people are vets; however, we all have our unique way of looking at health and wellness. Make sure it’s the appropriate choice for your pet!
  • Partnering with your veterinarian in the care of your dog or cat should always be the goal. While it’s true your vet is the degreed veterinary professional in the partnership, you know your pet better than anyone, and are therefore the primary advocate for your animal companion. Tell your vet what you have observed, any behavior changes or anything you can think of that could make a difference to the quality of life your pet may have.
  • When it makes sense (like if you’ve just rescued a kitty or your cat has never been tested), these tests are run to check for the presence of the feline leukemia and feline immunodeficiency viruses. These viruses can suppress the immune system and lead to secondary infections, anemia, and even cancer. Early identification of viral positive cats gives you the best chance of managing infections optimally.Partnering with your veterinarian in the care of your dog or cat should always be the goal. While it’s true your vet is the degreed veterinary professional in the partnership, you know your pet better than anyone, and are therefore the primary advocate for your animal companion. Tell your vet what you have observed, any behavior changes or anything you can think of that could make a difference to the quality of life your pet may have.

    As an involved, hands-on guardian, you are in the best position to make informed decisions for your pet — decisions that may not always agree 100 percent with the recommendations of your veterinarian.

    Let me give you an example: I went to my vet for my husky, Neko.  He was due for his shots and I was prepared to tell the vet what I wanted and why.  They seemed surprised but understood that I was prepared for this visit.  I discussed the Lepto shot at length with the vet talking about the pros and cons and the how my dog could come into contact with the disease.  After careful consideration I decided that they vet’s responses to my questions and the type of area I frequently walked my dog necessitated him receiving the shot.  After I agreed and he received the shot I found out that the shot actually only works for approximately 5 different strains of Lepto while there are 50 or more strains to the disease!  I was not a happy camper.  Needless to say, my dog has not received the shot again.  Be wise people, consider carefully.  I am not hating on vets – I love them, in fact, some of my favorite people are vets; however, we all have our unique way of looking at health and wellness.  Make sure it’s the appropriate choice for your pet!

     

Being Proactive with your Pet’s Health – Annual Exams

By Dr. Becker and comments by Diane Weinmann

dog with vet
dog with vet

Dr. Becker recently ran across an online column about the importance of being proactive in identifying health issues in pets. I liked what she learned and what was said.

“At least once a week I diagnose a pet with a terminal illness that in the parents’ eyes came on suddenly,” writes Dr. Perry Jameson of Veterinary Specialty Care in Mt. Pleasant, SC. “But I know it took months to develop.”1

Dr. Jameson writes about Sadie, a 7-year-old Golden Retriever whose appetite and energy level had been down for less than a week before her owner brought her in. The ultrasound showed fluid in Sadie’s abdominal cavity, masses in her liver and spleen, and several enlarged abdominal lymph nodes. Jameson knew he was looking at metastatic cancer and a very poor prognosis.

Sadie’s devastated mom couldn’t believe that her precious dog, visibly sick for less than a week, had a terminal illness. But Jameson knew the cancer had been spreading in the dog’s body for much longer.

“Dogs and cats are so good at masking symptoms,” says Jameson. “A small discomfort that you and I would complain about, they tolerate. They want to please us and will act normal as long as they can until the disease process reaches a point they can no longer tolerate. Occasionally by that time, it has reached a point where there is little therapy we can offer.”

Detecting Health Problems Before They Become Crises

While it was too late for Sadie, Jameson also wrote about a cat patient with a newly diagnosed heart murmur. The kitty was acting normally according to his owner, but an echocardiogram showed significant heart changes that left untreated would have likely led to blood clots or heart failure.

In another case, a dog was sent to Jameson because her calcium level was elevated on a blood test, and she was drinking more water than usual. Dr. Jameson discovered she had an anal sac tumor, which was producing a hormone that caused elevated calcium levels, along with increased thirst and urination. Fortunately, the mass was found early enough to be removed before it spread.

Finally, Jameson wrote about an 8-year-old Springer Spaniel whose regular veterinarian had noticed a slight liver abnormality on the dog’s annual bloodwork. She had been acting normally and was very energetic according to her owner. However, an ultrasound showed a small tumor on her right adrenal gland that had invaded a major vessel in her abdomen.

The dog had surgery right away and the mass was removed successfully. According to Dr. Jameson, “Had she come in when symptomatic, the tumor probably would have grown to a size where removal was impossible.”

Why I Recommend Regular Wellness Visits

Dr. Jameson encourages pet owners to take their companions to the veterinarian for at least one physical a year, and twice annually for animals over 8 years of age.

As a proactive wellness veterinarian, I prefer to see each of my healthy patients twice a year, and more frequently as necessary for older pets and those with chronic conditions. A dog’s or cat’s wellness and nutritional needs change yearly, and over the age of 8 can require fine-tuning every 4 to 6 months. I want to regularly review each patient’s weight, muscle tone, joint range of motion, diet, supplement protocol and exercise habits with the owner.

My goal is to help my clients avoid preventable disease in their pets. I don’t follow the traditional medical approach, which is to wait around until an animal is sick or debilitated and then attempt to fix the problem or simply treat the symptoms.

I view regularly scheduled wellness visits as opportunities to check the status of your pet’s health and take proactive steps to prevent serious disease from developing.

Wellness exams are a perfect time for you and your vet to discuss any and all changes in your pet’s health, for example, if your pet’s endurance level has changed, if there is plaque or tartar on any teeth, if there have been changes in sleep or bathroom habits or water intake, or if your pet has had exposure to ticks or other infectious pathogens that may need to be addressed.

We want to keep your pet in the white zone of good health and out of the black zone of disease. In between those zones lies the grey zone, which is where dysfunction in the body begins and gradually moves the state of your pet’s health in the direction of full-blown disease.

To successfully reverse or stall dysfunction in the grey zone, we have to deal with it there, which means we must regularly check your pet’s health status. For pets over the age of 8, I almost always find a health related change occurring at every 6-month exam that we can address proactively.

Most importantly, by making intentional, regular changes to a pet’s wellness protocol (via a supplement, diet, or therapeutic exercise routine), we can dramatically slow down aging and potentially slow the onset of degenerative disease.

Organ Function Should Be Checked at Least Yearly

For middle-aged and older pets, Dr. Jameson also recommends that a complete blood count (CBC) be done annually to check for liver, kidney, and thyroid issues, protein levels, and calcium and electrolyte levels.

One of the best ways to keep on top of a patient’s health is by tracking blood work changes over time. Let’s say your cat’s kidney enzymes (BUN and creatinine) are climbing, but are still within normal reference ranges. Many veterinarians will note the elevation but wait until the levels climb out of the normal range before taking action.

However, my approach is to view those slightly elevated levels as requiring attention, and long before your kitty is diagnosed with chronic kidney failure, I’ll make recommendations for supporting and enhancing kidney function so that we can prevent full-blown disease.

In addition to organ function evaluations, I suggest completing a urinalysis and internal parasite analysis annually as well.

I did not do this with my cat Milo and now he is gone! I wish I had annual blood counts down and maybe I would have been able to stop his kidney issues from happening. Since he always seemed healthy and was an indoor cat I felt he didn’t need to go to the vet. BIG MISTAKE!   I will never assume that again however it provides little comfort to me now …he cannot be replaced!

When I had a geriatric workup performed on my golden retriever who was 14 years old, I was astounded by what was uncovered. She had tumors all around her lungs and was being suffocated. I had no idea! She had simply slowed down and had lost some weight which I thought was normal for a senior dog! WRONG AGAIN!

Wellness Exams Should Be a Proactive Review of Your Pet’s Health

Being proactive means being focused on initiating change rather than simply reacting to events as they occur.

Dr. Becker uses what she calls the Three Pillars of Health as a proactive approach to wellness. These pillars form the foundation for your pet’s health, quality of life, and longevity.

  • Pillar #1 is species-appropriate nutrition. The diet you feed your cat or dog should be balanced and biologically appropriate for a carnivore. Over time there will be changes required to your pet’s diet which may include the reduction or increase of balanced fats (depending on your pet’s activity and metabolic health), an increase or change in protein sources, an increase in antioxidant or phytonutrient intake, and/or an increase in essential fatty acids, depending on your pet’s lifestyle and age.
  • Pillar #2 is a sound, resilient frame. This aspect of your pet’s health involves maintenance of the musculoskeletal system and organs. In addition to maintaining your pet’s weight (monitored by twice yearly weigh ins) proactive vets will monitor changes in your pet’s muscle tone, range of motion, strength, balance, and brain-body connection, and suggest specific exercises or changes in your exercise routine to minimize atrophy and age related changes over time.
  • Pillar #3 is a balanced, functional immune system. The goal here is to keep your pet’s immune system in balance. It should protect against pathogens, but not be over-reactive to the point of creating allergies and other autoimmune conditions. Wellness veterinarians will replace vaccines with titers, offer detox protocols when necessary (if pets are exposed to heartworm, flea, or tick chemicals), and evaluate your pet’s immune health risks that change over time, including your pet’s risk of breed related cancers.

 

  • I wish more veterinarians would reject the traditional notion of preventive healthcare, which too often centers around re-vaccinations and chemical pesticides, and instead help their clients understand the value of a proactive approach to keeping their pets healthy.
  • You know what? I have the same wish Dr. Becker has! It was that tradition notion of re-vaccinations and chemical pesticides that kept me from making annual check ups to my pet’s vet. So now I know better. I know what to look for and what to do. I know I will schedule annual exams for all my beloved furry family members. Will you?Cat at the vet