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Handling anxious or reactive patients

The following items are suitable for creating a less stressful hospital environment for canine patients:

  • Nonskid mats, rubber shelf liners, or yoga mats on horizontal surfaces.
    • Blue is a preferred color because it can be readily seen by dogs.
    • Dogs have greater control and feel safe from falling when they stand on nonslip mats, which also warm the exam table.
  • Towels for wraps and bolsters.
    • Clean towel wraps provide safe containment of limbs and heads. 53 They are easy to use, not offensive to owners, provide better control and surface area coverage without human contact, and may induce a sense of security and muscle relaxation.
    • If the occasional patient finds being wrapped in a towel stressful, simply do not use the wrap.
    • Practice using towels and wraps on calm animals before attempting them on distressed patients.
  • Treats.
    • Treats can include fish-flavored snacks (e.g., dried/tinned shrimp/anchovies), flavored hair ball preparations, yeast spreads, cream cheese, cheese spreads, and shredded cooked chicken. Treats must be palatable, have an olfactory component at room temperature, and be small enough so that dogs and cats can have several without appreciable caloric intake.
    • Treats can be used for distraction, redirection, counterconditioning, and reward techniques. 
    • Caution is urged for patients/handlers with food allergies (e.g., peanut butter) and for dogs that become more aggressive in the presence of any food.
  • Toys.
    • Toys can be used for distraction, redirection, counterconditioning, and lowering a patient’s fear and stress.
    • Toys should either be kept clean and washed
      between patients or sent home with the patient.
  • Basket muzzles.
    • Well-fitted basket muzzles prevent bites to staff and clients that handle anxious animals. Other forms of muzzles may not prevent bites.
    • Staff members may be less fearful and use less restraint if a difficult patient is muzzled and is accustomed to the muzzle.
    • Basket muzzles pose less of a health risk for dogs compared with nonbasket muzzles (e.g., vomiting), can be put on easily, and allow dogs to accept treats and drink.
    • To minimize risk, dogs must be taught to voluntarily put their face into the muzzle using reward based training.
    • Muzzles can become weapons that cause injury to humans and other animals if the muzzled dog is distressed. Cautious, calm handling still applies to muzzled dogs.
    • For the safety of the staff and the patient, all fractious animals under chemical restraint or sedation should wear a well-fitted basket muzzle throughout the procedure if not medically contraindicated.
  • Remote-controlled treat dispensers.
    • Treat dispensers can be used with techniques involving distraction, redirection, and counterconditioning and can lower fear and stress.
    • Treat dispensers located some distance from personnel will direct the dog’s attention away from handlers.
    • Dogs that are aggressive in the presence of food or treats may either guard dispensing devices or become aggressive in their presence.
    • Some treat dispensers may require a specific type of treat that may not be palatable to all dogs.
  • Spreadable treats and squeezable food.
    • Spreadable treats (e.g., cream cheese, spray cheeses, pâtés, yeast spreads, some tinned foods) can be delivered at a distance rather than by hand.
    • A treat can be placed on tables, walkways, long spoons, toys with long handles, or pizza boards, encouraging the dog to move away from handler to get the treat.
    • Treats can be distributed over a large area, creating a wide area of focus and interest for the patient.
  • Spreadable treats can be used in distraction, redirection, counterconditioning, and to reduce fear and stress.
    • Spreadable treats and squeezable foods should not be used with dogs that become reactive or aggressive around food.
    • When food treats are used, veterinary personnel and clients should be screened or cautioned about possible food allergies.
  • Head collars and halters.
    • Head collars and halters provide better control than standard collars, allowing the handler to turn the dog’s head or close its mouth without force.
    • Head collars and halters should be well-fitted.
    • Dogs must become accustomed to these devices.
    • Immediately stop using a head collar or halter if the dog feels trapped or panics.
    • Because of the risk of injury or strangulation, leads, collars, head collars, harnesses, and halters should not be left on unsupervised dogs.

The following equipment is useful for minimizing in-clinic stress for feline patients:

  • Cat squeeze boxes and cat bags. 53
    • Intramuscular sedation of fractious cats is an ideal use for a cat squeeze box.Squeeze boxes may have a calming effect on a cat.
    • The squeeze box allows for the application of less restraint and is best used by a skilled handler. 
    • Some cats may become anxious or freeze when their movement is restricted; therefore, the use of squeeze boxes or cat bags are not suitable for such cats.
    • Injury to the handler or cat is still possible with cat bags.
  • Box, basket, or carrier for cats to hide in.
    • Cats hide as a normal coping behavior in response to a stressful situation.
    • Providing feline patients with a box, basket, or carrier as a place to hide has a calming effect for many cats.