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Incorporating behavioral assessments into every examination

All veterinary visits should include a behavioral assessment. Such assessments encourage the client to talk to the veterinarian regarding any concerns or questions they may have about their pet’s behavior and allow the staff to better meet the behavioral needs of their patients during and after the evaluation. Assessments should include the use of a standardized behavioral history form that
becomes part of the patient’s permanent medical record. Using the same questionnaire at every visit, individual behavioral changes can be tracked and problems can be addressed early in development.

Behavioral evaluations on record are useful after patients have had surgery or emergency treatment. Convalescence is best evaluated with respect to the patient’s normal behaviors. 

Good behavioral evaluations are especially important in young animals. Studies show that 10 percent of puppies that were fearful during a physical exam at 8 wk of age were also fearful at 18 mo. 9,10 Patients do not outgrow pathologic fear. 

Veterinary staff should be able to recognize signs of fear and distress, understand when behaviors deviate from normal, and identify patients at risk for developing problematic behaviors. The behavioral history will identify whether such behaviors are exceptional and contextual (e.g., the dog is truly only afraid at the veterinariany practice) or more generalized (e.g., the cat is never seen upstairs
and must be trapped in the basement for a trip to the veterinary practice). Such assessments help clients monitor the patient’s behavior while educating them about risk.

The most commonly recognized signs of nonspecific anxiety and distress are listed in Table 1.11–22 Clients easily recognize trembling, shaking, and high-pitched vocalization as signs of distress but may not recognize less overt signs. Veterinary professionals are in an ideal position to educate clients about potential behavior problems and risk factors. Behavioral conditions are progressive. Early intervention is
essential to preserve quality of life for both the patient and client and to provide the best chance of treatment success.

TABLE 1

Most commonly recognized signs of nonspecific anxiety/distress in dogs and cats11–22

  • Urination
  • Defecation
  • Anal sac expression
  • Panting
  • Increased respiration and heart rate
  • Trembling, shaking
  • Muscle rigidity (usually with tremors)
  • Lip licking
  • Nose licking
  • Grimace (retraction of lips)
  • Head shaking
  • Smacking/popping lips or jaws together
  • Salivation/hypersalivation
  • Vocalization (excessive and/or out of context)
  • Frequently repetitive sounds, including high-pitched whines, like those associated with isolation
  • Yawning
  • Immobility, ‘‘freezing,’’ profoundly decreased activity
  • Pacing, profoundly increased activity
  • Hiding or attempted hiding
  • Escaping or attempted escaping
  • Body language of social disengagement (i.e., turning head or body away from signaler)
  • Lowering of head or neck
  • Inability to meet a direct gaze
  • Staring at some middle distance
  • Body posture lower than normal (in fear, the body is extremely lowered or tail tucked)
  • Ears lowered/possibly droopy because of changes in facial muscle tone
  • Mydriasis
  • Scanning (i.e., moving eyes and/or head across the environment to
    continually monitor all activity)
  • Hypervigilance/hyperalertness (may only be noticed when touched or interrupted, but pet may hyperreact to stimuli that otherwise would not elicit this reaction)
  • Shifting legs
  • Lifting paw in an intentional movement
  • Increased closeness to preferred associates
  • Decreased closeness to preferred associates
  • Profound alterations in eating/drinking (acute stress is usually associated with a decrease in appetite and thirst, whereas chronic stress is often associated with an increase)
  • Increased grooming, possibly with self-mutilation
  • Decreased grooming
  • Possible appearance of ritualized/repetitive activities
  • Changes in other behaviors, including increased reactivity or increased aggressiveness (may be nonspecific)