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Tips for reducing patient fear in the veterinary clinic

  1. Reduce stress by having separate waiting areas for dogs and cats with separate air-handling systems, if possible.
  2. Ensure that all dogs can have at least 1–1.5 body lengths between themselves and other dogs. Barriers can help keep animals separated.
  3. Invest in nonslip floors that are back friendly and provide secure footing for dogs and cats.
  4. Create a protocol for reactive patients. That may include either calling or texting clients when they can walk directly to the exam room, having the veterinarian already in the exam room, using a blind or bringing a reactive dog into the hospital through either a side or back door. Reactive dogs may do best as the first or last patient of the day. They generally do worse in a busy practice in which appointment delays are common. Giving preanesthetic medication with the client present may facilitate care.
  5. Move at the animal’s pace. Rushing may cause delays or intractability at a later visit.
  6. Teach staff to use standardized questionnaires to evaluate stress at the hospital and invest in ensuring that everyone can accurately read canine and feline normal and stress-related behaviors and body language (Tables 1, 4).
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)
TABLE 4

Key Behaviors Used in Clinical Settings to Identify Fearful Dogs and Cats

Behavior patterns associated with normal development

Behavior patterns associated with problematic development

Approaches unfamiliar people Will not approach/actively avoids unfamiliar people
Approaches and/or plays with other friendly and/or solicitous animals Doesn’t interact or play with other solicitous animals, avoids them or responds aggressively to their solicitations for play
Not fearful of most noises and recovers quickly from exposure to loud noises Fearful of many noises and does not immediately recover from exposure to loud noises
Takes treats and explores exam room Doesn’t take treats, hides, freezes, or panics in the exam room
Uses litter box/eliminates outside when taken out and does not soil the house if otherwise given reasonable access House/litter box training is either not progressing or regressing