Fear Me: Fear Free Practice and You

My resting blood pressure, I assure you, is completely normal. I have to state this fact again and again every time I wind up at the doctor’s office, when the nurse places the cuff and then pulls it off with a thoughtful wrinkle in her forehead. “It’s not normally 200/140!” I plead, hoping she doesn’t direct me to the closest ER. “I just get this way when I’m in the doctor’s office.” She nods, and we get on with our day. I have no idea why it happens, but apparently it’s A Thing. I blame it on the scale. I hate going to the doctor and avoid it as often as possible.

Sound familiar?

trip-to-the-vet-every-single-time

It happens at the vet, too. “The cat’s temperature is 103.8,” the tech will say, shrugging. “I think. She was trying to bite me most of the time, so I didn’t get a heart rate.” White coat syndrome in pets can be so significant that some behavior experts counsel the veterinarian to leave the coat in the back room, so as to trick the pet into thinking you aren’t the dreaded vet. We accept this as a reality of practice, our years of blood sweat and tears in service of our love of animals being reduced to this: told, on a daily basis, “Ha ha! My dog hates you.”

“Fear is the most damaging thing a social species can experience.”

I was talking to Dr. Marty Becker the other day (I know, right? I am so excited to actually say that I am a person who talked to Marty Becker the other day) and he was sharing a conversation he had with Dr. Karen Overall about the effect of stress hormones on physical health. It’s not some theoretical thing; fear causes permanent change to the brain. It is damaging in a profound and terrible way.

I think of my mother, who had such horrible experiences at the dentist as a child that she refused to go back for years until the advent of sedation dentistry. I think of my own memories of childbirth and hospitals and how simply seeing the maternity ward from the side of the freeway gets my heart pumping. Fear is an awful feeling. And what we do to pets in the hospital can only be described in many cases as a terror inducing, fear of death experience. Slapping a cat on a cold exam table, sticking needles in their neck like a predator sinking their teeth into prey, staring at them through the bars of the cage. It can take them days or weeks to recover from the stress of a hospitalization, and as soon as they get put in the carrier for a follow up, it starts all over again. No wonder cat visits to the vet are so infrequent. And we are supposed to be their health champions.

As vets, we often blame clients for not caring enough about their pets. “Don’t you know,” we ask sagely, “how important these visits are?” And we shake our heads at the pet owners, blaming them for not having their priorities straight, for not wanting to spend the money on visits. We have done this for years, without ever looking at ourselves and wondering what part of the blame we shoulder ourselves for making the vet hospital pretty much the worst environment possible for pets. “Shelters are so stressful and sad,” we say, ignoring the PTSD we are inducing in the cat with a urinary catheter in the back who has nowhere to escape the prying eyes of the Husky across the room.

When I really started to think about it, I was mortified.

It doesn’t have to be this way.

Some people get it. I worked with a technician who loved cats, like, in a self professed ‘cat lady’ sort of way. She was always sneaking into exam rooms to place a microwaved towel under a cat, or sprinkling catnip in their cage, making little hidey boxes out of recycled cardboard. It was tolerated. It should have been celebrated.

A lot of people in the profession, like that technician, are intuitively doing what they can to make things easier on pets. After hearing Dr. Margie Scherk lecture on this topic years ago,  I started keeping a yoga mat in the back for cats to sit on, on the table. Dr. Becker is taking it one step further: he wants vets to re-envision practice from the ground up, to change them from a vet-friendly hospital to a pet-friendly one. He calls it “Fear Free Practice,” and I love it.

When I was in school, veterinary behavior as a specialty was just getting off the ground. It was scoffed at. It’s not ‘real medicine’ was the prevailing attitude. They were wrong. It is, in my opinion, our biggest oversight as a profession. We blame backyard breeders and lack of affordable spay/neuter for pet overpopulation while neglecting to address behavior issues that eventually result in a pet being relinquished. We make the clinic so unpleasant people would rather let their pet suffer in pain at home than come see us and miss the chance for interventions that can save a life.  The consequences: less visits, more health issues, more behavior issues we never got the chance to address.

The veterinary community needs to do a better job, from start to finish, of addressing and incorporating behavior into practice.

Fear Free Practice: Real Life Implications

Anyone who has spoken to me in the past year or two knows I am passionate about encouraging our profession to take a more active role in maintaining a pet’s healthy role in the family. To me, preserving that relationship is just as important as maintaining a good weight. It is vital. As is, I think, this concept of fear-free practice.

While Dr. Becker and other like minded vets work on our colleagues, I encourage you to advocate for your pet’s mental well being at the clinic. Bring a mat or towel. Spray them with Feliway. Ask the vet to give your dog some of his favorite treats before jumping into the exam, or if they can take the heart rate while the cat stays in your lap. Making a visit less stressful doesn’t have to involve rebuilding the clinic from the ground up; it can start with these little steps. It’s a philosophy more than a set of prescriptives.

Has fear kept you and your pet from the vet? Had a vet that went out of their way to make you comfortable by embracing a fear free approach?

Filed: Be The Change, Blog, Health, Musings, Picks of the Litter Tagged: ,
  • http://boingydog.com/ BoingyDog

    This is a really great post! I love having a focus on the pet’s mental well being. I’m in the same school as your mother but I haven’t broken through it yet. I haven’t been to the dentists in 17 years. Yikes! I still happen to have pretty healthy teeth, thank goodness. When I saw a recent story about a dentist who brings in his dog for kids I thought “Now that’s a dentist I could go to!” It’s a great thing you’re doing!

    • Michelle Cotton

      I grew up with military dentists, who don’t believe in making it comfortable for the patient no matter what age you are. And I too, had a horrible fear of the dentist. However, I had to get over it to take my kids so that their teeth wouldn’t suffer. Eventually I made an appointment for myself and was pleasantly surprised. Things are way different. I’ve had several cavities filled and cleanings done since. I won’t lie and say I don’t still get nervous about going, but nothing like the fear I had before I tried. (Both of my best friends, same issue, also go to my dentist, so there is hope!)

      • http://boingydog.com/ BoingyDog

        Thank you for that! I’m a pretty tough cookie in every other area but once the fear started it just stuck! But I’ll need to face this at some time or another and it might as well be now before I have problems. Let’s see if I can break this 17-year streak!

  • kgseymour

    Once again, you’re SO on the mark. I’ve done this in a few, small ways with my dogs — I ask to be involved by feeding my dogs treats when we do a nail clipping, and I get right down on the floor with them during the rest of the exam to give them a little bit of extra comfort. But I wasn’t sure what to do for my cat. She doesn’t like to be held, period, and rarely sits on my lap, so the best I felt I could do was sort of hold her in place and try to distract her with chin and ear scratches while trying to give her treats that she was clearly too stressed out to take. From here on out, though, I’m packing a towel and will look at what I have for calming treats and sprays ahead of time. Thank you!

  • Amanda

    My vets encourage people to just bring their pets (usually) dogs by randomly just into the reception area for treats. They also keep a scale in the reception area and encourage owners to bring the dog by for weight cheks (if there hav ebeen issues) and treats. While this doesn’t reduce all the anxiety, it certainly makes getting through the front door easier. They also try to keep the exams as light as possible. Not sure about the kennel situation as I try to never leave my animals – but I am sure it could be better. Cardboard boxes in cages for cats is SUCH a good idea!

  • Michelle Cotton

    One of the reasons I adore our vet is because they both take extra steps to make sure my pets are comfortable. For example, I have 2 big dogs and our favorite vet always comes in and sits on the floor with them talking to them and petting them before she begins her exam. My big boy adores her, and he’s a big goofy wimp of a dog, LOL. My other dog associates the vet with doggie daycare, which I had her in for her first year so she could play with other dogs. So whenever I take her to the vet she runs for the door that leads back to the kennels. It’s actually funny. I am lucky that both my dogs love going to the vet.
    My cat, however. I take the route of not kenneling or crating him when I take him to the vet. To me that is an automatic response of stress and fear. I let him roam around the back of my van. I know, that’s dangerous, but we live 5 minutes from the vet and he’s a big cat. I am physically not able to carry a crate he could fit into (not fat, just the big boy of the litter). When we are in the exam room I let him roam around and sniff there too. Haven’t figured out how to make him less stressed during the exam, but he doesn’t fight or hiss and I think a large part of that goes to how calm and understanding our vet is.

  • Words With Wieners

    What a fantastic post! I think cats actually have it kind of lucky, because both vets and cat parents have the expectation that the cat is NOT going to like the vet visit and there could be maiming involved. Of the staff. Not the cat. :) But dogs, sigh… everyone seems to expect dogs to be these happy-go-lucky creatures and to be all wags and licks. And some of them are… some of them lay right down at their parents’ feet in the waiting room, relaxed as they could possibly be… even falling asleep. But my two aren’t, and neither was my previous who is at the Rainbow Bridge now. They are positively terrified of the vet and every visit is extremely stressful on everyone. Our most recent visit might’ve been the last straw, though. We’ve only switched vet practices once, and I’m afraid now we might have to switch again. I’m not going to describe the whole ordeal, but the staff at this practice just doesn’t seem to know or care how to deal with fearful pets. But I’m really not sure where to begin with finding a new/better practice. There are certainly many to choose from where we live, but I think I would feel strange calling some of them to ask if they’re experienced with fearful dogs and how they handle stressful visits. I wish I could just ask a vet how they would feel being asked something like that.
    And fear of dentist visits? Oh yes, that’s me. Can’t tell you how long it’s been since I’ve been to the dentist. I know sedation dentistry is offered now, but I’m kind of fearful about being sedated too… even though the couple experiences I’ve had with it went fine (once for a minor surgery and the other for wisdom teeth removal). It was: “Okay, goodnight.” Then what seemed like a minute later, “Okay, rise and shine… you’re all done.” I guess I just need to get over the fear and go back. Let them sedate me and have their way with my teeth.

    • http://www.pawcurious.com Dr. V

      You know, I think it is totally reasonable to ask about how they handle fearful dogs. If they have a good answer for you, you know they’re steps ahead- and if they don’t have an answer, maybe it would get them thinking about it, at the very least. I’ve had lots of clients make requests as to things I could do to ease their pet’s anxiety, and as long as it doesn’t compromise the safety of the pet or the staff, I’m happy to do so.

  • Heather Staas

    My 4 year old dog hasn’t been the vets since he was a year old, after getting choke-dragged across a slippery floor while being mobbed by loose staff dogs and terrified. The staff had been made aware that he had serious dog fear issues. They tried to slam the door on me yelling “he’s fine, he’s fine” while I barged in, picked him, and carried him back to the lobby away from the terrifiying situation, telling them “no, he isn’t, he needs HELP.” He’s never been back. We do rabies clinics and ask to go last and have the vet come out to the car so he doesn’t have to step more than 2 feet from his safe crate with no dogs in sight. That should never had happened and it will stay with him forever. “I am not safe from strange dogs at the vets” is branded into his brain now. It took me 4 months after adopting him to get him happily there and waiting in the lobby with other leashed dogs, so much progress, ripped out from under him. I have a reputation of being “overprotective” and no longer letting my pets be overwhelmed with too much restraint or unpleasant procedures in one visit, and for not letting them go out back without me, EVER anymore.

  • TonyaW

    I just visited the vet this week with a stray kitten who followed me home while I was walking my dog. My vet has a cat exam room with a feliway diffuser, and they brought in a warm blanket (from the dryer or microwave, I’m guessing) to put on the exam table so the kitten wouldn’t have to lie on the cold table. So I’m happy to say they are on the right track!
    I’m lucky with my dog, Clyde. He sees a visit to the vet as just another excuse to go for a ride in the car (which he LOVES!). Then the staff comes by to pet him and/or give him a treat while he’s waiting. What’s not to like about that?! And when it’s something unpleasant, like a shot or a nail trim, I bring a pocket full of kibble to stuff in his mouth during the process so he hardly notices what they are doing to him.

  • Tamara

    I feel really lucky to have found the vet my kitties goes to. They use the memory foam mats on their exam tables, specifically to make them for comfy for the animals. The doctor rarely wears a “white coat.” She’s usually in scrubs, and there are always lots of chin scratches and “quiet” moments during the exam itself. Our kitty doctor also does acupuncture in a quiet room with bamboo trees, a water fountain… My kitties may not notice, but it relaxes me, and I know they notice how stressed I am. Helping pets feel comfortable in the exam room/treatment area is important!

  • http://www.thedrakecenter.com/ The Drake Center

    Thank you for writing on this topic! Sometimes it is easy to forget that even the smallest effort can make a big difference for a fearful pet. Whenever possible, we use a special exam room for our feline patients, complete with a Feliway diffuser, soft carpeting, catnip and kitty treats. We also strongly encourage social visits to help pets disassociate the veterinarian with feelings of fear.

    • http://www.pawcurious.com Dr. V

      Why does it not surprise me the Drake Center is on top of the latest trends in the field? San Diego is lucky to have you. :)

      • http://www.thedrakecenter.com/ The Drake Center

        And you!

  • Mouse605

    we tend to take our patient’s well-being into mind at my clinic (i’m a veterinary technician)- I always put a towel down on the table prior to any exams that will happen on there. we use a separate room for cats (and small dogs of we need it for overflow). we keep feliway around for stressed out kitties. dogs over 40 pounds or who have long enough legs to make my holding them on a table get their exams on the floor- my doctor has no qualms with getting on the floor with our patients! we ALWAYS start and end our exams with cookies..LOTS OF COOKIES!! dogs AND cats! we have both crunchy cookies and soft cookies for both species, and we keep a bag of hypoallergenic cookies in the rooms too so nobody is excluded. i can’t tell you how many times i have just sat ont he floor against the wall before and after an exam on a fearful patient, just to let them see i’m not a threat. feed them enough cookies (I can break a milkbone into approximately 100 pieces, i swear!!) and talk to them sweet while you’re sitting, and they’ll come right over. i’ve made many a friend out of an extremely fearful dog by just spending the extra 10 minutes with them. cats are a different story- NEVER EVER EVER DRAG A CAT OUT OF THE FRONT OF A CARRIER. i love the lift-off crates! i ALWAYS remove the top of the carrier and lift the cats out…much less stressful, also, we never EVER scruff unless we absolutely MUST- if a cat is aggressive, we cover them with a towel. just cover them up. and then i hold their head with both hands and face them away from me, using my elbows to stabilize their bodies. I put my thumbs behind their ears and my pointer finger lines up with the bottom of their jawbone- kind of like how you’d hold a bird- and voila! safe vet, safe tech, much less angry cat!! many of those grumpy cats love treats, too…. I have to say, we (the rest of my techs and my doctor, too!) work in a fabulous environment. we have amazingly close relationships with most of our clients, and have a great word-of-mouth reputation. I’m a very lucky tech :)

    • mouse605

      **edit:
      dogs over 40 pounds, or whose legs are too long to allow me to comfortably hold them on a table, get their exams on the floor.

    • http://www.pawcurious.com Dr. V

      If there’s one thing I would encourage all cat owners to do: get an easy-off carrier (not one with rusty screws!). I have a cloth Sleepypod whose top unzips, and that one’s even better.

    • Words With Wieners

      Awesome to hear this! Wish we could find a clinic just like yours! (And a tech like you!)

  • Tricia

    I have to say that my dog’s vet tries really hard to ease my dog’s fear. My pup jumps out of the car all excited that she’s going somewhere… but the second I open the door and she smells the clinic, she’s extremely fearful. My vet talks calmly, gives her treats and doesn’t make her go up on the table. I don’t know what else we can do. I appreciate that he takes his time with us and tries to make my dog comfortable.
    ~Tricia

  • Megan Taliaferro

    Great post, as usual! One of my colleagues is a passionate believer of fear-free visits. I’ve learned some great tips from her and as a consequence I think my exams are becoming a little easier on everyone. Even with the dogs I’m amazed how something so simple, like giving treats while the puppy vacines are given, can change their whole experience at the vet office.

  • Crittersitter

    Good article! Changes need to be made in this direction and are long overdue. For too many vets, time/money issues are inhibitors to incorporating such change.
    Mouse605> Sounds like you have a great place to work!

  • Kateintex

    We’ve found calming music so helpful for cats by Lisa Spector of Through A Cat’s Ear that was released in June this year: http://throughadogsear.com/tace/ For a long time, we’ve been using http://throughadogsear.com/tade/ for dogs. The classical music is played about 1/3 slower than usual and calms pets and their nervous humans too!

  • Dr. B

    I would say nearly 95% of the patients I’ve seen labelled “aggressive” (by owners, other practices, staff, whatever) are just TERRIFIED!!! It’s incredible how much of an exam you can do- safely!- by just talking gently, offering treats, and using species-appropriate body language to reduce stress. I have called off wellness exams (especially on puppies, kittens and new patients) when a patient becomes too fearful and split it up, spending the rest of the time petting and giving treats. Takes an extra give minutes? Yes. Run behind on my schedule sometimes as a result? … Yes. But, once I explain to owners what I’m doing, I rarely have a problem, and even that slightly-later next appointment knows I’ll do my best to spend time with their pet too (I hope- I really do try!)

    Dr. Sophia Yin’s Low-Stress Handling book is a great addition to any clinic- it should also be required reading in every vet and tech school!

    On a related note, cat carriers with screwed-on tops- ESPECIALLY the ones that have been sitting in a garage for 40 years and the screws have rusted shut- should be loaded onto a rocket and shot into the sun. Along with any Flexi leads used in vet’s offices.

  • kerry photographer
  • Sarah Whitfield

    I have 2 rescued cats both of whom are three-legged. Their hatred with the vet’s office probably stems back to the trauma of their surgeries when they were found as strays and taken to the vet. One of my cats, Daisy is much better than Lily my other cat. We’ve tried Feliway, giving treats and even the thundershirt. Nothing works with Lily and it is an ordeal taking her for her shots but we go every year regardless. My vet has suggested sedation in the future. She’s such a sweet cat at home but dislikes the vet so much.

  • Live News India

    world cat day. one of the best cat blogs. http://www.clubpets.org

  • Alyssa

    It’s because of fear of vet offices that I now have a vet who does house-calls. It’s much more expensive, but the cats are far less stressed. One of mine was vicious at the vet’s office, biting and clawing (and she’d poop in the carrier, at the very least). At home, she’s still not overly happy, but it’s much better. And the vet does all the procedures in front of me, not taking them to the back and away like the vet’s office always did.