Blog Archives | Fear Free Pets

Recover DogCover

Jack Meyer — Fri, 01 Mar 2024 08:01:43 +0000

Positive social connections are known to improve human health, so might this be true for dogs as well? Like us, dogs experience the same surge of stress-reducing oxytocin during canine-human interactions.

The desire to lavish sick or injured canine companions with love and support, without compromising the recovery process, is what led to the creation of ReCover DogCover—a disposable stress-free garment that protects healing areas while allowing dogs to maintain their mobility, confidence, and independence.

What is the ReCover DogCover?

When Duke II, a happy and playful dog owned and loved by ReCover’s founder, was diagnosed with cancer, his life changed. The skin beneath Duke II’s once luxurious coat developed painful sores, creating a heartbreaking barrier between him and the gentle snuggles and loving caresses that once punctuated his daily life. Despite trying every commercially available product as well as DIY options for dressing Duke II, there was simply no way to simultaneously keep him clean and comfortable while maintaining his physical freedom and ability to enjoy an affectionate touch.

Duke II’s owner noticed a dip in Duke’s spirits, as well as her own. Then, in a conversation with her dog’s veterinary oncologist, inspiration struck—and the ReCover DogCover was born.

A different breed of healing: DogCover benefits

Unlike other pet bodysuits, the ReCover DogCover is a completely disposable step-in garment designed to protect healing areas from bites, scratches, and other physical irritants. The DogCover’s material is entirely breathable, creating positive airflow to the pet’s skin and supporting natural thermoregulation to keep pets comfortable. Additional benefits to the DogCover include the following:

Step-in, suit-up design — No tugging, pulling, or pinching! The DogCover can be placed with the dog in a standing position—simply put their paws in the leg holes and prepare to suit up.
Custom fit — The full-stretch tear-away fabric ensures a completely personalized fit for every dog, including a tearable perforation along the underside so males can freely urinate without soiling the fabric.
All day and night wearability — The DogCover’s customizable fit ensures you won’t have to remove the suit for bathroom breaks. The dog stays clean and dry.
Flexible, full-stretch material — Whether a dog is on post-surgical crate rest or is allowed to run and play, the DogCover’s soft, stretchy material ensures full-body comfort and coverage.
Antibacterial surfaces — Bacteria-resistant inner layers protect wounds and incisions from irritation and secondary infections.
Water-repellent outer layer, internal absorbency — The DogCover protects the pup from the elements (e.g., rain, puddles), while the moisture-wicking interior draws natural fluids away from the pet’s wound or incision—ensuring a clean and dry environment.
UV-resistant, flame-retardant material — All DogCover materials are thoughtfully selected to ensure the dog’s safety.
Disposable and biodegradable — Don’t worry about disinfecting the DogCover. To ensure the desired hygiene level, each garment is designed for a single use. And because we’re equally passionate about environmental responsibility, the DogCover is 35 percent biodegradable.

In addition to its at-home applications, the DogCover’s convenient, stress-free design and consistent benefits have made it an asset in veterinary clinical settings, including the highly-regarded Animal Medical Center in New York City, where it is being used with great success.

Dressed for success: Reducing post-surgical stress with the DogCover

In addition to protecting your patients physically, the ReCover DogCover enhances their emotional wellbeing by reducing stressors typically associated with the recovery process, allowing them to live a more normal life. Some positive impacts:

Enhanced comfort — DogCover’s soft, flexible fabric and personalized fit are non-irritating, ensuring the pet can enjoy restful sleep—a critical aspect of healing.
Fewer changes to the dog’s daily routine — Dogs thrive on consistency and the ability to predict what happens next. By minimizing potentially stressful changes (e.g., putting on and removing a bandage, wrap, or other recovery device, and limiting specific physical activities or interactions), dogs feel more relaxed and confident.
Inclusion in household activities — Dogs can perform all their normal behaviors while wearing the DogCover, including elimination, eating, drinking, sleeping, going for walks, playing with toys, and simply being part of the family.
Optimal healing and recovery — Recovery complications can delay your patient’s healing and their return to normal, resulting in additional pain, medications, confinement, and stress. The 24/7 protection provided by the DogCover increases the likelihood of a smooth and timely recovery.
Uninterrupted affection — When you don’t have to worry about disrupting your patient’s healing or contaminating their incision, you can feel free to spoil them with affection. These positive interactions provide powerful reassurance and can help your patient feel at ease—even when everything else seems out of sorts.

With the ReCover DogCover premium post-surgical recovery suit for dogs, your patients can experience an enhanced recovery journey with less fear, anxiety, and stress, while you can feel confident and empowered to appropriately manage their care.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Jaime Bast RVT, CCRP, KPA-CTP, FFCP is a copywriter and registered veterinary technician from St. Louis, Missouri. In her free time, Jaime loves learning about canine nutrition, behavior, and training and competing with her American cocker spaniels in a variety of dog sports.

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Brought to you by our friends at ReCover.

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Fear Free Point of Care Ultrasound (POCUS) Guidelines

Jack Meyer — Mon, 29 Jan 2024 08:01:43 +0000

By Marc Bordelon, DVM, MBA

The contemporary use of ultrasound in veterinary medicine has evolved from its inception solely as a referral tool for use by specialty veterinarians to a practical and useful diagnostic tool in general practice and emergency medicine. Veterinarians and staff should be prepared to explain the purpose and procedures involved in point of care ultrasound (POCUS) as well as possible pros and cons to pet parents. Despite being a non-invasive procedure that is virtually painless and quick to perform, there may be concern around logistics, outcomes, and cost. The vet team should be prepared with information to make ultrasound examinations comfortable and pleasant for patients and clients alike.

Client conversations will include questions regarding how ultrasonography and POCUS is used in veterinary practice. Consider the indication for the ultrasound recommendation: is it routine, preventive, diagnostic, or emergency? Routine and preventive medicine ultrasounds are becoming more common. Practices create bundle packages with their wellness exams that are customizable depending on the pet’s age and physical exam findings. It is feasible to say that by looking early and often, a baseline for normal will be established for each patient, and evolution to disease states may be diagnosed sooner, rather than waiting for clinical changes to prompt an ultrasound investigation. Early diagnosis has an immediate impact on patient health and well-being and client experience. Providing routine ultrasounds at an affordable price is simply smart medicine.

Today, routine ultrasonography doesn’t require expensive equipment purchases. Affordable, hand-held ultrasound tools, like the Butterfly iQ+ Vet, are extremely durable, easily connected to a cell phone or tablet, and carried in the clinician’s or technician’s pocket. This model dramatically increases access to ultrasound for every veterinary hospital. Additionally, handheld ultrasound can be utilized in any exam room, with the educated client actively witnessing and perhaps even participating in the process, never having to leave the side of their fur baby.

POCUS examinations are indicated in both routine and emergency care. POCUS is performed using protocols to scan known areas of interest in the thoracic cavity, including heart and lungs, and four quadrants of the abdominal cavity. Abnormalities such as free fluid or air can be quickly identified and may help determine patient stability in the emergency setting, often in 10 minutes or less. This allows the veterinary team to determine the appropriate next steps and monitor patient progress. Questions to consider during the emergency POCUS exam may include the following:

Do these findings explain the pet’s clinical disease state?
What are the next steps in this treatment plan?
Is there an abnormality that requires further exploration?
Should this patient be referred to a specialist?

Utilizing POCUS examinations in practice is a valuable and effective diagnostic tool. Scanning sick patients on the first presentation offers an important baseline for each case. Embedding the ultrasound cost into the exam and making it affordable ensures better compliance. This approach helps forge a strong veterinary-client-patient relationship and may add the satisfaction of an early and accurate diagnosis for the veterinarian.

Multiple studies have proven that early implementation of procedures like POCUS can lead to better case outcomes, quicker workups, increased client satisfaction, and the ability to get a diagnosis early on in the disease state.

Getting Patients Comfortable

Now let’s look at patient protocols. Depending on the type of ultrasound exam needed and the reason for presentation (routine, sick, or emergency) there are several ways to make the ultrasound procedure more comfortable for both patients and clients.

Diagnostic imaging presents a unique challenge because it is important for the animal to remain quiet, comfortable, and still. The use of a sedative, and in some cases anesthesia, will be necessary to collect the desired images for some patients. Use of the following practices can decrease stress for patients and help them remain calm and still during an ultrasound examination in the Fear Free environment:

Introduction and positive conditioning to ultrasound probes and POCUS for kittens and puppies
Non-slip comfortable surface
Warmed ultrasound gel
Calming scents such as lavender and canine or feline pheromones
Relaxing background music or white noise.
Low traffic area with limited distractions
Minimal noise pollution (other animals, people talking, equipment alarms, intercoms)

Positioning is also important in ultrasound examinations. Patients should feel safe and secure during preparation and procedure. Evaluation of fear, anxiety and stress (FAS) should be monitored throughout. Here are several ways to position a pet while helping them to remain comfortable, while first considering physical limitations.

Determine if the procedure can be performed with the patient in a non-traditional position such as standing or laying comfortably on their side.
Determine if the pet can get into position on cue; for instance, rolling onto their side.
If the pet does not know such a cue, use a lure to help guide the pet into position.
If luring doesn’t work, the pet can be physically guided into position, but this is the most stressful option. It is imperative that the pet feels supported and stable when being guided into position.

When the above positioning options aren’t possible, Dr. Caroline Conn of Sweetwater Veterinary Clinic in Santa Clarita, California, an Elite Fear Free Certified Professional, routinely uses the following techniques in her ultrasound exams:

Sedation (after approval from owner, mainly for emergencies and diagnostic abdominal scans)
Performs ultrasound in client presence when possible (increased value for client)
*Cooperative Care technique: This technique takes time for both the veterinarian to teach and client to practice. Absolute buy-in is a must before using this for pre-scheduled appointments. The Cooperative Care technique utilizes the client teaching their pet how to get in lateral recumbency and/or dorsal recumbency on their own at home beforehand, to simulate the positioning of an ultrasound exam.
When the pet is properly positioned, the owner places cool water or non-scented hand sanitizer on the area to be ultrasounded to stand in for ultrasound gel, and uses an object like a remote to simulate use of an ultrasound wand. (Advise clients to wipe off hand gel after use as it can be toxic if ingested.)
Patients remain in position for a few minutes to start, gradually building up to 10 minutes. During this time, the owner gives treats to their pet, which act as a distraction and reinforcement for remaining in position to create a positive experience.
However, it is done, safe handling is a must for both pets and the veterinary team. Utilizing the core Fear Free concepts, such as Gentle Control, Touch Gradient, Considerate Approach, FAS evaluation, and communication, ensure the physical and emotional wellbeing of all involved.

Pain and Fear Reduction

In an emergency situation, medications for pain and fear are often needed. Analgesia and anxiolytics not only help the pet physiologically and emotionally, they also help to reduce the client’s stress when they see that their pet is comfortable.

Reducing pain and fear also has an emotional and physiological advantage because the pet is now more approachable and feels safe being examined or undergoing blood draws or other emergency procedures. This also translates to a safer environment for staff.

Keeping Clients Comfortable

Keeping the client comfortable and informed is almost as important as keeping the pet comfortable. A comfortable patient makes for a happier, satisfied client. In addition to the benefits of hand-held ultrasound devices, here are some additional ways to increase client comfort and decrease their stress:

Have a veterinary technician/nurse or veterinarian greet the client at the door. This lets them know right away that their pet will not have to wait for treatment.
Have their animal’s medical records accessible. If possible, in an emergency situation, speak to their regular veterinarian for background information on the pet.
Take time to connect by greeting the client and the pet, and sharing what information you have about the pet’s condition.
Remember that honesty is the best policy. Be upfront with clients about possible wait times, cost, and the severity of their pet’s emergency.
Reduce pain, fear, anxiety, and stress ASAP. Get approval from the client to administer medications as soon as you have enough information on the case and can determine which medications are appropriate.
Over communicate. If you must take the pet away from the owner for treatment, provide updates every 10 minutes on how the pet is doing. As the case progresses, you can customize the frequency of updates depending on how critical the pet’s situation is.

Summary of Fear Free POCUS

Hand held ultrasound has made the use of POCUS more feasible in all areas of veterinary medicine. As its use and acceptance grow, Fear Free techniques will be incorporated into these procedures. Clients should be educated on the benefits offered by POCUS in routine, sick and emergent cases. Patient comfort must be considered and addressed in all cases (FAS) as the patient is positioned and the scan is performed. Client participation is optimal if it is safe and quiets the pet. If the pet parent cannot be with their fur baby, frequent communication is imperative.

Consider the following guidelines for POCUS procedures, in addition to established Fear Free protocols:

Early introduction and positive conditioning to ultrasound probes for kittens and puppies
Non-slip comfortable surfaces are safest and create less anxiety
Warmed ultrasound gel
Use calming scents such as lavender, or canine or feline pheromones
Relaxing background music or white noise
Utilize low traffic area with limited distractions
Minimal noise pollution (other animals, people talking, equipment alarms, intercoms)

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Marc Bordelon, DVM, MBA, is veterinary clinical senior manager for Butterfly Network. Dr. Bordelon regularly lectures at several veterinary colleges and participates in wet labs and with other professionals in conference settings. Dr. Bordelon formerly owned multiple veterinary practices including a 24/7 hospital and specialty practice, and has routinely performed over 2,000 ultrasounds a year. To contact Dr. Bordelon, you can email him at MarcBordelon@butterflynetwork.com. To contact the Butterfly Veterinary Team please email vetsupport@butterflynetwork.com

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Brought to you by our friends at Butterfly.

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Managing Patients with High Fear, Anxiety, and Stress: When Clients Refuse Your Recommendations

Jack Meyer — Tue, 23 Jan 2024 08:01:43 +0000

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.

This is Part Four of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

Despite our best efforts and education, we may encounter client barriers with providing Fear Free care such as refusal of PVPs or sedation, objections to safety tools like basket muzzles, and declining referral to a positive trainer to help with vet visits. It’s worth exploring other ways to help lower FAS such as regular happy visits, outdoor exam rooms, and calming supplements. However, these options are often insufficient for staff members to handle a high FAS pet safely and compassionately.

Emphasizing the safety component can help get some of these clients on board. Just as with other signs of FAS, we should educate clients when their pet is growling, hissing, snapping, swatting, baring their teeth, or showing whale eye. Some high FAS pets are in such a state of panic and “flight” that they bruise, scratch, and otherwise injure staff members when trying to get away. Clients should be informed that staff safety is non-negotiable (“We need to keep our team members safe”), and that because their pet is showing the highest level of stress possible, we are unable to proceed safely without a change in the plan. The client-facing FAS spectrum handouts for cats¹⁷ and dogs¹⁸ help illustrate these body language cues in a non-judgmental way. We should think as well about the safety of the pet as they could easily come to harm themselves. I had one high FAS canine patient who became so stressed at one visit that she had a seizure the second she walked through the clinic door, and have seen multiple dogs rub their noses raw or bite frantically at kennel bars after being dropped off.

Unfortunately, team safety, emotional health, and all of the myriad reasons to take a Fear Free approach may not be enough to convince some clients. The thought of giving their high FAS pet an anxiolytic or briefly placing a basket muzzle may be so antithetical to a client’s personal beliefs as a pet parent that they will not be swayed regardless of how many options you present.

At this point you need to ask yourself: What will be the emotional toll on me, my team, and my patient if I continue? Is it worth placing myself and my team at risk of injury? How will my decision affect Fear Free clinic culture? These are especially important questions to consider if you’re a hospital leader. Staff members may not feel comfortable voicing their ethical concerns, and leaders must always advocate for the wellbeing of their team. In 2018, the Journal of Veterinary Internal Medicine surveyed nearly 900 North American veterinarians regarding ethical conflict and moral distress¹⁹. When respondents were asked, “How often have you had a conflict of opinion with pet owners about how they wish to proceed in the treatment of pets?”, roughly 53 percent noted “sometimes,” 32 percent replied “often,” and 1 percent answered “always.” In the same survey, over 73 percent of vets responded that “not being able to do the right thing for a patient caused their staff moderate to severe stress” and 78 percent responded that this caused moderate to severe distress in themselves.

In many cases, it will be best for your team to set a boundary and either decline to continue with the visit, or even initiate a respectful conversation about why your clinic may not be the best fit. Boundaries can be scary because many of us in vet med are people pleasers²⁰, and we feel guilty or “bad” for saying no to a client. However, boundaries are essential for protecting the emotional and physical welfare of every member of the team. When it comes to setting a Fear Free boundary, it’s also an animal welfare issue. We shouldn’t feel guilty for refusing to perform surgery on a pet when a client is against pain medications; adequate analgesia is the surgical standard of care. Similarly, we shouldn’t feel guilty for stopping with a high FAS pet when a client doesn’t respect team member safety or value their pet’s emotional health, because Fear Free is the emotional standard of care. Cultivating and retaining clients who are invested in their pet’s emotional needs will help the pet, the client, and the team succeed.

Summary

Vet clinics are often highly stressful places for pets, making high FAS pets common. Focusing on client education, being flexible during the visit, and knowing when to draw an ethical boundary will help team members navigate a safe and humane approach to the patient while keeping their own wellbeing at the forefront.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Dr Julie Liu is a Fear Free and Cat Friendly veterinarian, speaker, and freelancer based in Austin. She serves as the Vice President of the Relief Veterinary Medical Association and recently launched My Family Cat, an in-home and virtual feline behavior consulting practice serving the cats of Austin. Learn more about Dr. Liu and her work at www.fluxvet.com and www.myfamilycat.com.

Continue learning about managing patients with high FAS through Part One, Part Two & Part Three of this series.

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Resources

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Managing Patients with High Fear, Anxiety, and Stress: Communicating with Owners

Jack Meyer — Tue, 16 Jan 2024 08:01:43 +0000

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.

This is Part Three of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

Communicating with clients is an art and can be especially difficult when managing a high FAS patient. Clients don’t always see what we do when it comes to signs of FAS, and they may have different priorities or ethics as a pet parent compared to us as Fear Free practitioners. Words such as “fearful,” “anxious,” or “stressed” may seem meaningless or exaggerated from their perspective.

Communicating Fear Free techniques should start with a discussion of body language, which transforms emotional abstracts into non-judgmental, objective observations that the client can see and hear. You don’t have to be a veterinary professional to witness when a dog is panting and whining or when a cat has flattened ears and dilated pupils. Once the client understands the body language of FAS, we can then communicate the implications of untreated FAS and suggest interventions.

One common scenario is when a pet’s FAS levels escalate during a visit, and none of the Fear Free techniques you’re using are helping. At this point you need to initiate a client discussion about PVPs, sedation, or otherwise changing the initial plan to achieve a Fear Free approach.

This can be stressful because you can’t predict the client’s reaction. Will they be open? Angry? Frustrated? Shocked and skeptical, because “They always do great at the vet!” and “No one’s ever mentioned anything before.” As discussed in Fear Free level 2 module 4¹⁵, understanding the client’s needs and finding ways to meet those needs will help the pet parent get on board with your recommendations. For clients with time constraints, offer a drop-off slot or reschedule with PVPs on a day that works for them. For clients with budget concerns, consider invoicing a lower, “brief exam” fee for the follow up and setting in-hospital PVPs/sedation fees at a price that improves compliance. For clients who feel embarrassed or upset about their pet’s FAS, normalizing signs of FAS and using success stories of your own pets can help clients relate.

Think creatively and have some flexibility when making a plan for a client. I recently saw a dog for acute, non-weight-bearing lameness in a rear leg. While I suspected a torn CCL, on examination the dog was so tense and anxious that I couldn’t be sure. I recommended sending the dog home with pain medications and returning them for sedated rads and a repeat orthopedic exam, but the client had budget concerns, time constraints, and concerns about sedation. We made a plan to administer gabapentin at drop off, wait a couple of hours, and then give an opioid injection about 20 minutes before trying the rads, with the agreement that we would not continue if the dog was still painful or stressed. The tech informed me that she was unable to administer gabapentin because the dog was trying to bite. I asked the client to return to the clinic to help us give the medication, and when the client offered the meds in a treat, the dog took them immediately. After an hour, he was lying down sternally in his kennel, had stopped whining, and was coming to the front of the kennel for petting. When it was time for his rads, we still placed a basket muzzle as a precaution, but the dog was an FAS of 1, semi-sedate, eating treats, and much more amenable to the ortho exam and imaging. It wasn’t my initial plan, but it still worked for the client and the pet, who did have a torn CCL.

According to the AVMA Language of Veterinary Care Initiative¹⁶, “Clients want a strong relationship with their veterinarian. To clients, the word ‘relationship’ signals that the veterinarian is trustworthy, will make their pet feel comfortable, and goes out of the way to provide personalized service.” Focusing on long-term thinking and relationship-building can also help with client communication and Fear Free, especially for high FAS pets. We’re not just thinking about how to get through this visit, we’re thinking ahead to the next 5 or 10 years of vet visits. If we push your pet now when he’s already so stressed, the next visit is going to be that much harder for him. We want to build a relationship with you and your pet, and provide them with a lifetime of humane veterinary

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for fear free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

Continue learning about managing patients with high FAS through Part One, Part Two & Part Four of this series.

Want to learn more about Fear Free? Sign up for our newsletter to stay in the loop on upcoming events, specials, courses, and more by clicking here.

Resources

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Managing Patients with High Fear, Anxiety, and Stress: Navigating Roadblocks

Jack Meyer — Tue, 09 Jan 2024 08:01:43 +0000

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.

This is Part Two of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

You see a historically high FAS dog on your schedule for planned sedation and feel confident in your plan. The client has done a great job with positive basket muzzle training and administering PVPs as directed, and while the PVPs don’t really seem to have had much of an effect, surely the sedation you just gave will help her feel calmer. So, you wait. And wait. No effect. Did you miscalculate your doses?

Unfortunately, despite all your careful planning, you will encounter some hurdles when managing high FAS patients, particularly during procedures that are more painful or aversive. Here are some tips on circumventing roadblocks during Fear Free care:

Re-evaluate wants vs. needs. It’s easy to lose sight of this Fear Free fundamental when you’re in the middle of handling a pet, especially since vet professionals tend to be very goal-oriented. When a patient’s FAS escalates, take a mental step back and ask yourself whether your current task is truly medically necessary for that pet at that moment. With a Fear Free approach, much of what we do in general practice is considered a want, not a need. Making the ethical call to stop before you cause further emotional damage to that pet can be difficult, but it’s amazing how much further you get when non-urgent concerns are deferred for a follow-up visit.
Reassess your analgesia and decide if sedation or anesthesia is more appropriate. Sometimes we underestimate the level of pain caused by procedures we want to accomplish. When a high FAS pet escalates from pain, upgrading to stronger analgesics such as a full mu opioid or engaging multimodal pain relief can help bring FAS back down. However, in some pets this will be inadequate, and stepping up to sedation or even general anesthesia may be needed. One high FAS dog I saw would take treats readily during the initial visit, but would try to bite whenever I tried to examine the area of matted hair on his rear leg. He was rescheduled to come back the next day, but PVPs, analgesics, initial sedation attempts, and adding on more sedation medications didn’t touch him. He finally ended up needing general anesthesia, and what I thought was a matted hotspot was actually a several cm region of semi-necrotic tissue that was much more painful and inflamed than I ever could have guessed.
Teamwork makes the dream work! When interacting with a high FAS pet, think of your team outside of the vet clinic as well, particularly if you encounter a roadblock. I’m eternally grateful for the veterinary behaviorists, in-home providers, positive trainers, behavior consultants, groomers, and pet sitters in my area. Establishing a referral network of ethically aligned pet and vet professionals will help that pet receive the care they deserve throughout their life, while also making your job easier. For example, since most vet clinics don’t have trainers on staff, I routinely refer to reward-based trainers to help with skills that can reduce FAS during vet visits such as reducing arousal around other dogs: desensitization and counterconditioning to restraint, basket muzzles, nail trims, injections, Elizabethan collars, going into carriers; and training for veterinary cooperative care. And if you aren’t lucky enough to have veterinary behaviorists in your area for direct patient referral, many provide virtual behavior consulting with other vets to help manage challenging patients.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Continue learning about managing patients with high FAS through Part One, Part Three & Part Four of this series.

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Managing Patients with High Fear, Anxiety, and Stress: A Guide to Effective Handling

Jack Meyer — Tue, 02 Jan 2024 08:01:43 +0000

A four-part “from the trenches” series, written by a Fear Free veterinarian for Fear Free veterinary professionals.

This is Part One of a four-part series on helping Fear Free Certified Veterinary Professionals handle patients with high levels of FAS and communicate with their owners.

By Julie Liu, DVM

At least once a day, I see a high FAS patient. While I don’t always know their detailed backstory, the alerts on their patient files are like a roadmap to how they got there, as a “wiggly” puppy transforms into an adolescent that “may urinate” to a 3-year-old who’s a “CAUTION, WILL BITE!!!” Some days it seems like every pet has an FAS score of 4 or 5, and for Fear Free Certified Professionals, those days can be both emotionally and physically exhausting. It’s even more disheartening when we encounter ethical quandaries such as a pet parent who’s not on board with our Fear Free plan for their highly stressed pet. These situations are common, and according to psychotherapist and compassion fatigue expert Dr. Elizabeth Strand, moral stress is the number-one contributor to compassion fatigue in vet med¹.

So what do we do with these high FAS patients? How do we care for their emotional and physical wellness, while also caring for our own wellbeing and balancing the needs of the pet parent? Flexibility, communication, and supporting the Fear Free team culture are key to approaching these challenging cases.

After becoming Fear Free certified, I started realizing that a patient would be a lot less stressed if I approached the interaction like jazz–with a general sense of where it might go, but incorporating improvisation and responding to what the pet was communicating at that moment. This may mean giving the pet a brief break during handling to allow de-escalation, or even backing off completely on what I was originally trying to accomplish. Fear Free handling is a dialogue, not a monologue. When handling a patient with high FAS, a few other guiding principles can help:

Location, location, location. When handling any pet, try to choose the area where the pet prefers to be and is most comfortable. There are multiple places where a pet can be handled other than an exam table, such as the floor, on a lap, on the bench, or in the bottom of their cat carrier. In general, many pets with high FAS also do better with the owner present.
Give every pet a sense of choice and control where possible. Encourage voluntary movement by calling the pet using a happy voice, asking the owner to call them over, or luring them to move of their own free will with a treat or toy. Many dogs also know cues for sit and down, so instead of pushing a dog’s rear end down and pulling their legs out to get them sternal, ask or lure the dog to a sit and down. Respect the cat’s choice to stay in the carrier and access them by removing the top of the carrier and covering them with a towel to facilitate hiding. When restraining a pet, especially a high FAS pet, allowing them to stay in the position they prefer goes miles toward keeping them calm, whether it’s allowing a dog to stand instead of sit for a jugular draw or allowing a cat’s front end to remain sternal instead of forcing them into full lateral to reach the medial saphenous.
Less is more. Use the minimum number of people needed and the least amount of restraint needed while staying safe. The more hands on a pet and the more people crowded around them, the more likely they are to become stressed.
Prevent and treat for pain. Pain contributes to FAS and vice versa, and as mentioned in a 2022 Fear Free roundtable³, pain and fear are “two sides of the same coin.” Dull needles also hurt more, so try to make it common practice during sample collection to not reuse needles. During unsuccessful blood draws, I often see people pulling the needle out of a pet’s skin, re-palpating the vein, and then pushing that same, microscopically shredded needle back into that pet’s skin for a second or third attempt as the pet gets more and more stressed.
Sedate early, not as a last resort. With many high FAS pets, you will often reach a limit for what PVPs can accomplish. Injectable sedation may be the best way to help minimize FAS. Sedating earlier when the patient is calmer will be safer for the pet and likely allow you to use lower doses of anesthetic drugs. Familiarizing yourself with Fear Free in-clinic sedation protocols, lowering the charge for sedation to get client buy-in ($70 is more palatable than $140), and getting staff members comfortable with sedation/monitoring will also prove invaluable. Another way to approach stressful procedures for high FAS pets is to tack them onto an already-scheduled procedure involving general anesthesia. Depending on the patient’s needs, these could include shaving a matted cat, microchipping, trimming or dremeling nails, performing a cystocentesis, aspirating a growth in a sensitive location, expressing anal glands, or performing an orthopedic exam/radiographs. For more info on Fear Free in-clinic sedation, check out Fear Free Level 1 module 7b⁸, Fear Free Level 3 module 1⁹, and these other Fear Free resources^{10, 11, 12, 13}.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Continue learning about managing patients with high FAS through Part Two, Part Three & Part Four of this series.

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Resources

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Help Your Clients Protect Their Pup From Noise Aversion This Holiday Season

Jack Meyer — Fri, 15 Dec 2023 08:01:43 +0000

New Year’s Eve is a time of celebration and hope for many people, but it can also be a source of stress and anxiety for our furry companions. The loud noises, unfamiliar smells, and changes in routine during New Year’s Eve celebrations can trigger fear and panic in some dogs, affecting their wellbeing and behavior. Noise aversion is a serious concern affecting one in three dogs in the United States. As veterinarians, we have a vital role in assisting our clients and their pets in coping with this challenge by providing proactive advice and effective solutions.

Unlike other unpredictable noise events, such as thunderstorms, we can anticipate the noise associated with New Year’s Eve celebrations. Educating our clients about the signs of noise aversion in dogs, including hiding, panting, pacing, trembling, or even self-injury or property damage, is crucial. We should also inform them about the possibility of social transmission, where one dog’s fear can influence other pets in the household. By identifying the problem early, we can intervene before it escalates.

One of the most effective ways to help dogs with noise aversion is to establish a calm and secure environment for them during the noisy festivities. This should be a comfortable, familiar, and quiet space where the dog can retreat voluntarily. Provide their favorite toys, blankets, and treats to offer comfort and distraction. Importantly, dogs should not be forced into this space or punished for displaying fear. Instead, they should be praised and rewarded for staying calm and relaxed.

Reducing the impact of noise is essential. This can be achieved by closing windows and curtains and playing soothing music or white noise. These measures can help mask the sounds and sights of fireworks and other loud noises. For some dogs, wearing ear muffs or wraps that cover their ears and apply gentle pressure can help muffle the sounds.

In some cases, environmental and behavioral strategies may not be sufficient to alleviate a dog’s anxiety. In such situations, veterinarians can consider prescribing medications that can help reduce the dog’s fear response and make them more comfortable. Several options are available, depending on the severity of the condition and the client’s preferences. Always discuss the benefits and risks of each option with your clients and monitor the dog’s response to treatment.

As veterinary professionals, we can offer various ways to support our clients. A downloadable noise aversion checklist can serve as a starting point for the conversation. We can also discuss the potential use of compression garments, supplements, or medications to tailor our approach to each patient with noise aversion.

By providing our clients with proactive advice and effective solutions for noise aversion in dogs, we can help them enjoy New Year’s Eve with their pets without compromising their welfare or safety. In doing so, we strengthen our relationship with our clients and their pets, showing that we genuinely care about their wellbeing and happiness.

To learn more about Sileo® (dexmedetomidine oromucosal gel), the first FDA-approved treatment for noise aversion in dogs, visit www.noiseaversion.com.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Tracey Diess is a Fear Free Certified Veterinarian with special interests in ultrasonography, soft tissue surgery, and pain management. Dr. Deiss joined Zoetis as the professional services veterinarian for the Houston and surrounding areas in 2018 and is the current medical lead for Core Therapeutics.

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Brought to you by our friends at Zoetis.

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Improve Wound Healing and Patient Recovery

Jack Meyer — Tue, 24 Oct 2023 07:01:43 +0000

By Dr. Natalie Marks, DVM, CVJ, Elite FFCP

As a practicing veterinarian and previous practice owner for more than two decades, I’ve witnessed quite a bit of evolution within our industry. There continue to be advances in diagnostic technologies, telemedicine, novel therapeutics for dermatology and osteoarthritis, and a dramatic shift from independent practice ownership to corporatization. However, one of the most important discoveries and initiatives has been the concept of Fear Free, the initiative dedicated to the physical and emotional health of our patients and clients through the reduction of fear, anxiety, and stress.

However, Fear Free is, and can be, more. It is a lifestyle and guide on how to practice and manage and educate. Client trust and compliance is key to a successful veterinary-client-patient relationship, and that’s difficult to achieve when fear, anxiety, and stress surround exam room interactions and associated communications. This is never more evident than when trying to manage wound care. The aftercare associated with an incision, a laceration repair, a skin lesion, or a superficial burn can be extensive and complicated, often with multiple medications, bandage care, an Elizabethan collar, and an incredibly stressed patient and pet parent. This negatively affects patient care and the veterinary team as frustrated pet parents call and email frequently, taking veterinary professionals away from patient care in hospital.

There’s now a single solution for improved wound healing for patients, reduction of the home care burden for pet parents, and preservation of emotional health for patient, pet parent, and the veterinary health care team. KeraVet® Gel is a first-of-its-kind wound care product. As a scientist, safety and efficacy of any new product is top of mind. I’ve been impressed with the initial studies with this product, which has a keratin-based patent-protected technology to promote a moist wound environment and barrier to the environment as well as a bitterant to deter licking behavior, enabling us to send a patient home without that collar that so often leads to increased stress for both the patient and our client. That said, it is important to note that there can be a risk to the human-animal bond when we frequently apply something to our pets that tastes unpleasant, and for some pets that can be more stressful than protective clothing, bandages, or an Elizabethan collar. Each animal is an individual and their needs should be taken into account when deciding on the best solution for wound healing.

In the right circumstances, though, this product can be a game changer. One of the tenets I lived by as a practice owner was “best medicine leads to best business.” Our clients want to see the value in the care they are investing in, that it’s convenient and safe, and that it addresses their family member’s physical and emotional health. When we choose to use KeraVet® gel, we give our clients a single effective solution addressing both of their needs, thus building trust and compliance, and strengthening the human-animal bond. These are the clients who return and refer and stay lifelong members of our hospitals.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Natalie Marks is a veterinarian, consultant, educator, media expert, an advisor for KeraVet Bio, on the Executive Committee of VANE (Veterinary Angel Network), and an Elite Fear Free Certified Professional. She is passionate about working with colleagues and mentees and moving the needle forward with innovation with companies like KeraVet Bio. Learn more about Dr. Marks at marksdvmconsulting.com and KeraVet Bio at https://keravetbio.com/

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Addressing High FAS About Switching to Cloud-Based Veterinary Software

Jack Meyer — Tue, 24 Oct 2023 07:01:43 +0000

By Shepherd Veterinary Software

Fear, anxiety, and stress (FAS) are not exclusive to our veterinary patients. For some practice owners, the mere thought of switching to a cloud-based software triggers a similar negative spiral. Fear of change can prevent them from appreciating how a serverless system could optimize their workflow and support future practice growth.

Like any fear, apprehension about changing software is best conquered with knowledge. Let Shepherd Veterinary Software address the most common fears and stressors. Learn about the comfort and peace of mind that comes with being in the cloud.

Fear: Data migration will be an enormous hassle

This is perhaps the biggest concern among veterinary practice owners and managers—for good reason. In the past, transferring inventory and patient records was painstakingly inefficient, not only because of data loss during the transfer, but also due to the financial loss from closing the practice during the process.

Reality: Modern cloud-based veterinary practice management systems (PIMS) such as Shepherd Veterinary Software provide step-by-step assistance that streamlines the data migration process. Shepherd’s experienced team understands the implications of switching from server to cloud-based software and provides a wealth of resources and advice to ease the transition and help you anticipate and minimize potential challenges.

Anxiety: My team will struggle to learn the new system and be less productive

No matter how inefficient or frustrating your current PIMS, most team members will find switching to a new, entirely unfamiliar software daunting.

Reality: Modern software options have intuitive, user-friendly designs that reduce errors and increase productivity for all skill levels. With the help of self-paced training modules, ongoing software support, and skill-building resources, most veterinary staff can feel confident using a new PIMS like Shepherd in as little as a few hours. And, if the team hits a snag during the learning process, Shepherd’s support team is only a call or click away.

Stress: My practice data will not be secure stored in the cloud

When it comes to practice data, on-site servers can provide practice owners with false peace of mind. A physical unit in your clinic or hospital may feel well protected, but server-based PIMS are often more vulnerable to cyber attacks and malware, not to mention physical threats such as fire and water damage.

Reality: Remote cloud-based storage safeguards your practice’s data through expert monitoring that will identify and address any threat. Automatic security updates and patches keep the system one step ahead of hackers and cyber threats, and automatic syncing ensures access to the latest patient and practice information. There’s also no costly downtime waiting for IT or the release of a system-wide update.

Fear: The benefits won’t be worth the effort

Cloud-based veterinary software is a significant investment of a practice’s finances and resources. It’s only natural to question its proposed benefits and value.

Reality: As veterinary teams quickly discover, serverless software delivers powerful, game-changing advantages that extend beyond practice management to elevate patient care, enhance the client experience, and shape future growth.

Improved accuracy — Automated charge capture ensures consistency across all documents, including the patient chart, estimate, and invoice.
Increased revenue — Smooth workflows and quick-fill SOAPs mean you can fit in more appointments and care for more patients without staying late.
Easier oversight and case management — Remote access allows you to view the practice dashboard, inventory, and patient records from any location with an internet connection.
More time to spend with patients and clients — Automated features and powerful integrations eliminate the need for time-consuming repetitive tasks so you can focus on patient care.
Stronger client relationships — Enhanced communication tools, such as messaging and pet portals, help develop the veterinarian-client-patient bond.
Better job satisfaction — Increased efficiency and smooth workflow put the joy back in veterinary medicine, resulting in a healthier practice culture.

Anxiety: Team members fear that remote access will blur the work-home boundary

Many professionals have discovered that working remotely has an unexpected downside—an “always available” mentality that erodes the work-home life boundary. As a result, some practice owners and veterinary team members may hesitate to embrace remotely accessible cloud-based PIMS. They fear that because of the flexible software, they will be pressured to always be available.

Reality: Remote access can re-envision rather than add to the workload. It allows veterinarians and practice leaders to check in on daily operations, review the schedule, answer questions about a specific case, and take much-needed breaks without losing touch—or control—of the practice.

Stress: Clients won’t understand the change, especially if service is disrupted

Successful software transitions rely on careful planning. It’s important to notify clients as early as possible about anticipated schedule changes or closures. Instead of explaining that your practice is “changing software,” talk in terms of client benefits (e.g., better communication, reduced wait times, simplified check-in).

Reality: This change can build excitement! Upgrading your software demonstrates your practice’s commitment to exceptional client and patient service. With the right approach, you can help anxious clients understand that the temporary inconvenience will result in long-term gain.

Change is never easy, but the transition to cloud-based software is nothing to fear. Discover how veterinarian-designed Shepherd Veterinary Software can elevate your practice’s performance, increase efficiency, and help you rediscover the joy of veterinary medicine. Contact the Shepherd team to schedule a personalized demo and let your software-switching fears float away in the cloud.

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How to Make Exam Rooms Fear Free and Friendly for Cats

Kim Thornton — Mon, 07 Aug 2023 07:00:33 +0000

Julie Liu, DVM

Several years ago, when I was still a staff vet, I would routinely walk into the doctors’ office in the morning to see one of my associate-mates typing away at her computer with the overhead light turned off. The exterior wall to the office was a large window that faced east so there was always some early morning light coming through, but still, I didn’t get it. Wasn’t it always better to have more light? Why toil away in the dark like a cave creature?

After a few mornings, I started getting used to only having natural light in the office and noticed that I felt a lot calmer. If another doctor turned the light on, it felt way too bright and jarring. I realized that something as simple as decreasing the intensity of the light source in my environment could magically decrease my stress levels without me even noticing.

When it comes to our feline patients, many of the surroundings in a vet hospital can seem similarly disruptive, and may even lead to fear, anxiety, and stress (FAS). By reimagining the veterinary environment and catering to the feline senses, we can promote relaxation and a less stressful experience for both cats and humans. Here are some simple, budget-friendly tips for creating Fear Free feline exam rooms.

Provide a Safe Place

In 2022, the AAFP/ ISFM released an update of their guidelines for a Cat Friendly Veterinary Environment, in which they reference the 5 Pillars of a Healthy Feline Environment. While you may not be able to achieve all 5 Pillars in every exam room, being mindful of them will go a long way towards keeping your feline patients calm.

Pillar 1, “Provide a Safe Place”, is paramount. So what makes cats feel safe? When cats are experiencing FAS, hiding becomes a major way in which they cope. Think of all of those patients you’ve seen hiding under their bedding or overturned litterbox in the treatment area, or hiding under a chair in the exam room–they’re trying to cope with the stress of being in a scary place. Ensuring that every exam room is stocked with towels and a cat bed with high sides will facilitate hiding and comfort during the visit. You can even go next level and place a towel warmer outside the exam rooms. The thermoneutral zone for cats is 86-100.4℉ (30-38°C), so grabbing a warm towel as you’re heading in will allow your feline patient to feel even cozier.

Cats also feel safer when they can be elevated. If the cat chooses to explore the exam room, non-slip cat shelves, perches, and cat cubby holes mounted onto the wall will allow them to survey their surroundings from a height while also remaining hidden. Just ensure that any cubby can be opened easily to access the patient for their exam, as removing a cat from their “safe” place will increase FAS. Along the same lines, if budget allows, replace any exam room chairs with a bench that extends to the floor so cats don’t have to be pulled out from their hiding spot when it’s time for handling.

It can also take several minutes for cats to acclimate to a new area, so if you’re taking all feline appointments to “the back” where it’s noisy and full of dogs to collect samples, expect their FAS levels to escalate. Instead, treat each exam room like a private, “safe” treatment area for that kitty and stock it appropriately with everything you might need for samples: tubes, syringes, smaller gauge needles, butterfly catheters, slides, and EMLA cream to reduce the pain of needle pokes. If your team members aren’t comfortable collecting samples in front of the cat parent, I’ve found that most clients are more than willing to hang out in the waiting area and drink a coffee or play on their phones until you’re done.

Considerate Approach

As Fear Free professionals, we should always use Considerate Approach with our patients, which means we want to consider how our felines are experiencing their environment during care.

Touch. Exam tables are slippery, cold, and uncomfortable. To provide stability and extra warmth, ensure all exam tables have a non-slip surface such as a yoga mat to act as a base under your warm towel. Every room should also have a non-tippable cat scale with a non-slip surface, which could be a Feliway-sprayed towel that you “tare” prior to weighing the cat.
Taste. Does your clinic have treats for dogs, but not cats? While many cats will be too fearful to eat treats, others can readily be distracted by catnip, Temptations, Churu, squeeze cheese, tuna, whipped cream, and other delicious snacks during interactions. Also be mindful of taste the next time you’re dousing your feline patients with alcohol to collect samples–unless you wipe the alcohol off of their fur with a damp washcloth, you’re contributing to their negative experience when they groom themselves after the visit. Consider using water instead of alcohol.
Visual. Photorealistic depictions of cats or other animals may cause cats to react, so abstract art often works best. If you’re lucky enough to have a quiet exam room with a window, consider making that a feline-only room. Many cats will explore the room and gaze outside during a visit, which works great as a distractor. Cats are also better able to see in lower light than people, so try installing a dimmer switch to decrease the light intensity.
Auditory. Vet clinics are loud. Dental scalers, cage doors slamming, and dogs barking can significantly increase FAS during a feline visit. Installing soft closers on cabinets and doors and hanging a “Shhh….feline appointment in progress!” sign on the treatment area side of the door will remind team members to use their inside voices and keep environmental noises low. You can also hook a speaker up to the exam room computer and play soft, cat-specific music. A 2019 study published by the Journal of Feline Medicine and Surgery found that cats listening to cat-specific music in a veterinary clinical setting had lower cat stress scores and lower mean handling scale scores than cats that were exposed to silence or classical music.
Olfactory. Pets leave behind lots of scents during visits, and smelling them may increase FAS, particularly if a dog was just in that room. Having a cat-specific exam room helps prevent olfactory stressors, and Rescue will allow you to disinfect and remove traces of the previous patient while minimizing harsh smells from scented cleaners.
Pheromonal. When your cat rubs their cheek against your leg or the furniture, they’re depositing the feline facial pheromone that marks an area as “safe”. Feliway Classic mimics this pheromone and comes in user-friendly diffusers that can be plugged into every exam room. You can also pre-spritz your scrubs at the beginning and middle of each shift and room towels with Feliway spray at least 15 minutes before your first appointment, then reload for afternoon kitties since it wears off in four to five hours. Don’t forget to label your diffuser with some client education so cat parents see the Fear Free value.

The exam room can be a scary place for many cats, causing them to experience FAS even before handling. Adding some Fear Free tools and considering the feline senses will help turn your exam rooms into kitty havens.

Resources

https://fearfreepets.com/cat-friendly-exam-room/#:~:text=Avoid%20chairs%20cats%20can%20get,Choose%20light%20colors

https://fearfreepets.com/top-10-treats/

https://fearfreepets.com/helping-our-feline-friends-feel-fear-free-with-dr-tony-buffington/

https://fearfreepets.com/providing-the-optimum-environment-for-cats/

https://fearfreepets.com/creating-a-comfortable-environment-in-the-clinic/

JFMS: https://journals.sagepub.com/doi/full/10.1177/1098612X221128763

JFMS: https://journals.sagepub.com/doi/10.1177/1098612X19828131

Cat music: https://www.youtube.com/watch?v=vGyElqvALbY

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

Julie Liu is a veterinarian and freelance writer based in Austin, Texas. In addition to advocating for Fear Free handling, she is passionate about felines and senior pet care. Learn more about Dr. Liu and her work at www.drjulieliu.com.

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