Working in the veterinary field has unique challenges, the largest being the patients can not communicate with us. We struggle every day, performing procedures that are scary and painful for our patients. The pandemic that hit in 2020 made our jobs more difficult. Without their owners present, we had to work on our patients. We saw an influx of puppies that could not be properly socialized. We were wearing masks, and we were all owners, and my team, stressed out beyond our means.
My team and I worked tirelessly educating new puppy owners, old dog owners, and everyone in between on the importance of socialization, and on how to keep their pets stress-free at the veterinary hospital. Some clients were receptive, but the majority of clients did not understand or simply did not want to believe their dog was either stressed or scared. Owners would say, “what does the dog have to be stressed about?” They would be upset when certain procedures could not be performed and many owners just wanted us to “power through” and get it done. They were not understanding how detrimental it would be for us to hold their pet down and forcibly trim their nails or draw blood. Not to forget the physical damage that would be done to the veterinary staff in the process.
My team took a leap of faith and looked at the Fear Free certification. Fear Free is the concept of practicing veterinary medicine in a way that involves the reduction of feelings of stress in our patients, which in return will result in a better experience for all involved — including pets, owners, and the veterinary team. “America’s Veterinarian” Dr. Marty Becker, who has devoted his life to the health of pets and those who love them, created fear Free. He has written numerous books, serves on advisory boards for humane organizations, and is an adjunct professor at multiple veterinary colleges. The Fear Free concept is based on recognizing and taking steps to reduce fear, anxiety, and stress associated with visits to the veterinary hospital and requires good communication between the owner and the veterinary team.
Fear Free’s mission is to prevent and alleviate fear, anxiety, and stress in pets, by inspiring and educating the people who take care of them. It is an all-online education certificate program that has 4 levels. Elite is the highest level you can be. They also offer several modules dedicated to certain aspects of the veterinary career, like dermatology, exotics, and nail trims. They provide unparalleled education on emotional well-being, enrichment, and reduction of fear, stress, and anxiety in pets. Their goal is to improve the experience of every human-pet involved. I started with level one, and now I can proudly say I am elite certified. With my newfound knowledge and fancy badges, I was able to explain to owners why their pets needed sedation for various procedures. We started using peanut butter, Kong toys, and several other Fear Free techniques in the exam room to help distract the patients from their vaccines, blood draw, or nail trim. It shocked most owners when vaccines are given and their pets don’t even move. It has also changed surgical preparation to help the patients’ fear, anxiety, and stress. New species-specific pheromones and new cleaners with no smell have been implanted into the hospital. We have even implemented a new nail Dremel that has removed nail trim fears in dogs. All in all, we have always put the patient first, but now we have learned how to put the patients first in terms of their stress, anxiety, and fear. We will no longer hold a dog down that is scared, we won’t scruff a cat, and we always advocate for chemical restraint. We started talking to every owner about behavior and how they can minimize stress, fear, and anxiety in everyday life. No animal deserves to be frightened to death at the animal hospital. We do our best to prevent stress and fear in all aspects of their visit with us. Teaching owners how to train their pets at home for veterinary visits have been instrumental. One dog comes to mind. She was a feral puppy, trapped in a field like a feral cat. The owners couldn’t even get her near the hospital doors, let alone inside. Teaching the owners, medications, and a lot of patience on the veterinary side, she now drags the owners in the door and straight to the exam room for treats.
To reduce fear, anxiety, and stress (FAS), we first must understand how our canine and feline patients communicate signs of FAS to us. Common signs of FAS in a dog are: a tense face, lips drawn back, tail down, body lowered, dilated pupils, snarling or growling. Common signs of FAS in a cat are tucked tail, crouched posture, hissing, pupils dilated, and ears pinned down to the side. The first step in addressing FAS is a discussion with the owner regarding any concerns they have about coming into the veterinary hospital or known stressors for the pet. We start these conversations while scheduling the pet appointment. A stressor can be any experience, environment, an inanimate or living object that disrupts the body’s normal state of functioning. Examples of stressors to pets include noise, odor, pain, disease processes, and unfamiliar people. Our goal is to reduce stress as it has negative effects on pets, owners, and the veterinary team and ultimately can result in decreased veterinary wellness visits, a decreased ability to appropriately examine and treat the pet, and slower recovery from disease or injury.
The first point where we can reduce FAS is getting the pet to the veterinary hospital. Long before being transported to the veterinarian, cats (and small to medium dogs) should be acclimated to their carriers being safe havens at home. The carrier should be left out in an area of the home where the pet likes to be, with comfortable bedding or a non-slip mat for dogs and with a top-off option to make it more accessible. They can spray the bedding with appeasing species-specific pheromones and toys can also be added for extra incentive. If transporting a medium to large dog, an approved restraint device should be used. Pheromone-sprayed bandanas can be used in medium to large dogs. As with carriers, they should acclimate to large dogs by wearing their restraint device at home. They should secure the carrier or pet in the back seat. The drive should be low stress, avoiding hard stops or starts, and with calm music or silence.
Once you have arrived at the veterinary hospital, to reduce stress in the waiting area, cats and dogs should be kept in separate areas as much as possible and cat carriers should be kept elevated off of the floor on a sturdy table or chair. Our office has a designated area for dogs and a couch available for the cat carriers. Dogs should be leashed and kept close to the owner to minimize stress and interaction with other waiting pets. If a pet is experiencing FAS in the waiting room, then going into an exam room to wait for a veterinary team member may be advised by the nurse or receptionist.
To encourage a positive experience and decreased FAS at the veterinary hospital, rewards such as treats, toys, or petting can be used during an exam or when obtaining diagnostics as long as they do not contraindicate it based on why the pet is at the hospital. It is also important for both the owner and veterinary team to be calm, and speak in quiet voices and for the veterinary team to approach the pet gradually as dogs and cats are sensitive to loud noises and quick movements. If additional restraint is needed for a procedure such as obtaining a blood sample or performing radiographs, veterinary team members may use things like a towel wrap, muzzle, or Elizabethan collar to ensure the patient is adequately restrained and comfortable during the process. If restraint is causing significant FAS, then giving a mild sedative may be recommended by the veterinarian to make sure that the necessary diagnostics can be obtained in the least stressful way for the pet. Having chemical restraint also guarantees that proper diagnostics will be able to be taken. It is always frustrating when radiographs are being taken and the patient refused to participate. Chemical restraints help to utilize the owner’s finances properly, because we can get all the diagnostics done at one time, instead of several visits. Overall, the goal is to make the veterinary experience the least stressful as possible for the pet, which will, in turn, make it less stressful for all involved. In some instances, it can also be beneficial for the veterinarian to provide a mild sedative for the owner to give to the pet at home before coming into the veterinary hospital in a known pet that has significant anxiety or stress associated when coming in for veterinary visits. If you feel that your pet may benefit from taking medications before a veterinary visit to reduce stress, then have a discussion with your veterinarian, as ultimately communication is key in these situations. There are many options for pre-visit medications based on the health status of the pet. The strategies that best work for each individual pet are recorded in the medical record for future reference and updated as needed.
If it is medically necessary for your pet to stay overnight in a veterinary hospital, the veterinary team at a Fear-Free hospital has guidelines in place to minimize FAS as much as possible during their stay because increased stress in a patient can delay healing and recovery, or can even potentially result in the development of additional medical problems. Our veterinary team works to minimize loud noises in the hospital, such as beeps, talking, barking, or loud animals, as well as minimize smells, since dogs and cats have a keen sense of smell, by cleaning surfaces and equipment between patients, changing scrubs if needed, not wearing perfume, and placing calming pheromone diffusers around the hospital. You may also hear or see music or white noise machines as they provide interference with any noise that must occur. Lights are kept low, and pets are given soft bedding and places to hide or a privacy curtain, if appropriate, to make them more comfortable. When moving a pet around in the hospital, whether it be for a walk outside, physical exam, or medical procedure, it is done slowly and calmly, minimizing any interaction with other patients, providing open doorways and non-slick mats if needed. At times, mild sedatives or anti-anxiety medications can be used in the hospital to reduce FAS if needed and if not contraindicated based on the medical needs of the patient. The Fear Free concept doesn’t stop at the lobby or exam room: it extends throughout the entire hospital and is as much a priority of the veterinary team as the medical care for your pet.
The veterinary staff has been able to relax more than well. We are no longer being put through physical wrestling matches with extra large dogs or extremely mean cats. If my staff notices a scared dog, we recommend doing their initial examination in the parking lot. That way, the pet does not feel trapped in an exam room. We built a table outside to help aid us during the parking lot exam if they are exhibiting signs of fear, stress, and anxiety. With patients that are fearful, we recommend their owners bring them to the hospital on various occasions just to visit, so they can develop a positive experience with our staff. This has enabled our pet owners to develop a better bond with technicians and doctors. The owner can see our staff trying to make their pet comfortable and can understand and respect our decisions based on their pet’s actions during that visit. This has been a big win for our veterinarian staff. They can see what the pet is feeling, explain it to the owner, and have a receptive understanding owner that agrees to what is needed. Our veterinary team has been happy, less stressed, and not being physically assaulted by animals anymore.
Fear Free is a new concept in veterinary medicine which aims to recognize and reduce fear, anxiety, and stress associated with visits to the veterinary hospital. Achieving this takes effort and requires active communication between the owner and the veterinary team, but the reward is a better experience and less stress for all involved — the pet, owner, and veterinary team. My team and I were apprehensive if owners would be interested in the Fear Free mindset at all. It pleasantly surprised us to find out our clients embraced the idea and were excited to see it in action. We have found that most owners are understanding and do not want their pets to be stressed out. They have accepted our new policies as best for their animals and do not question us if we say they need to come back. Our owners are receptive to what we explained to them. They listen and implement what we ask of them. No longer do we have owners nervous about how their pets would react. Instead, we have phone calls from owners asking for their pet’s anti-anxiety medication before their appointment. We have happier patients and even happier owners.
Every veterinary hospital is doing the best it can to harbor positive experiences and help pets have less stress during their doctor appointment. They strive for excellence every day. In return, they greet us with happy owners and fewer physical therapy appointments for the veterinary team. We also have had fewer bites and scratches from animals. Implementing fear-free has made a tremendous impact on how veterinary medicine should be practiced. It created an environment for helping animals without seeing them terrified of you.