Fear at the Vet's Office - Using Low Stress Handling for Dogs

By: Dr. Susan Barrett

Does your dog love the vet? Do you love taking your dog to the vet? If you both answer yes, great! Prevention of fear and stress in the vet hospital is always the best, and you can use many of the tips in this article to help keep you both less stressed. If either of you don't care for the vet, you are not alone. According to the Bayer Veterinary Care Usage Study1, 38% of dog owners feel their dog "hates going to the vet", and 26% of dog owners get stressed just thinking about taking their dog to the vet. Although these numbers are not as high as for cats, this still means a lot of you don't look forward to your dog's vet visits.

The veterinary profession is recognizing the anxiety that our pets do feel at the vet and the subsequent stress felt by their owners, and is in the process of developing principles and standards for low-stress handling for all pets during their vet visits. The American Veterinary Medical Association's Physical Restraint of Animals Policy states: "The method [of restraint] used should provide the least restraint required to allow the specific procedure(s) to be performed properly, should minimize fear, pain, stress and suffering for the animal, and should protect both the animal and personnel from harm. Every effort should be made to ensure adequate and ongoing training in animal handling and behavior by all parties involved, so that distress and physical restraint are minimized. In some situations, [sedation] may be the preferred method. Whenever possible, restraint should be planned, formulated, and communicated prior to its application."

What this means for you and your dog is that many veterinary practices are in the process of developing "low stress handling" techniques to help reduce your dog's fear and hopefully your stress level.

Signs of fear at the vet's office

How do you know your dog is fearful or anxious at the vet? Some dogs tremble, hide under your chair, or even growl, snap and bite. These are the easier signs to see. The following categories can help you identify signs of fear in your dog.

  Fidget – This is the dog that just can't seem to hold still. This is a sign of anxiety that may be read as "rambunctious" or "playful" behavior. He may be pacing, wagging his tail rapidly, or have his tail tucked. He may be panting heavily, and his body will be stiff. He probably won't take treats. When pushed, he often will try to avoid the veterinary staff or may start to struggle.

  Freeze – This is the dog that often is described being "so good" at the vet because he just sits there and lets the vet do whatever is needed. Signs of a dog that is freezing versus really not minding what is happening: he is not wagging his tail (often the tail is down or tucked under his belly), he does not look relaxed, his body is not soft, and often you will noticed his pupils are dilated. He probably will actually have a 'worried look' on his face with his mouth held tightly shut. He won't take treats. His eyes will be scanning the room. When pushed, he may try to get away. He often looks like he is saying "just get it over with, would you?" You may also see a brief freeze when a dog is shifting from comfortable to flight or fight.

  Flight – This is the dog who is already trying to get away from the veterinary staff as they enter the room. He retreats when they approach, often under the owner's chair, or as far away as possible from the staff. He may start to struggle when restrained, or may simply freeze depending on his fear level and overall demeanor. This dog is often trying to tell the vet to back off and he may be easily pushed into fight.

  Fight – This dog has escalated and is now telling the staff or vet to STOP. He may be growling, snapping, pawing, rolling over, etc. He often needs a muzzle for safety. He is highly distressed (he doesn't want to fight). In the past, you may have heard these dog labeled as "mean" or "bad". We now know they are not mean or bad, they really are just afraid, they don't understand what we want, they may be painful or all of the above.

A dog may start in fidget but escalate rapidly to fight. Or he may freeze and stay frozen for the whole visit. It is important to read all of his body language to get a real picture of what he is saying. If he is telling us to stop and we do not, we may teach him to give harsher signals the next time. In other words, we could teach him to be offensively aggressive instead of defensive. A dog that starts off at offensive aggression (fight) may be mislabeled as dominant in the exam room. He is really fearful, but has learned in previous visits that softer warnings don't stop the unwanted encounters.

Desensitization and counterconditioning

How can you help your dog during his vet visits? First, read his body language and ask your vet for help in doing this. If he is even mildly fearful, we then want to develop an approach to help him early on, so his fear does not escalate with every visit. The dog who freezes in one visit may turn into a fighter at a later visit.

An important thing to remember about any pet's fear at the vet hospital (or any other situation) is that his emotional state is rooted in how he feels about the hospital and what is happening to him. He can't help being afraid, just as you cannot help being afraid when you are about to crash your car at high speed. The longer we expose him to the fearful stimulus, the more likely his fear will escalate, meaning he could go quickly from a freezer to a biter.

A primary way we approach helping pets at the vet's office by desensitization and counterconditioning (DS/CC). DS/CC is a common treatment developed by psychologists to help people and animals overcome fears and phobias. Desensitization means exposing your dog to small doses of the situation or thing that causes him fear (e.g. maybe just going into the parking lot of the vet hospital).

Counterconditioning means teaching him to have a positive feeling associated with the feared situation. So when we drive our fearful patient into the vet's parking lot, we give a delicious treat. We do this in small steps, pairing each step with a treat that he finds especially wonderful. After we are successful in the parking lot, we then go to the entrance, feeding all the way. In short sessions over days, weeks or months, we gradually work our way to the exam room, and exams. If at any point he stops eating, his tail drops, he 'looks worried', we stop and start over where we were last successful. Some dogs go much faster than others – it's dog dependent. Your vet can help you with this process. More and more veterinary offices are offering "happy visits' to help owners DS/CC their dogs to the vet hospital environment. Many positive reinforcement dog training centers have classes to help you DS/CC your dog to veterinary handling. 

Most DS/CC is done with favorite treats (canned food, moist treats, pieces of hot dogs, chicken baby food, braunschweiger, etc.). The act of eating will automatically change his emotional state to a less stressed one. Rare dogs respond more consistently to favorite toys. Many times DS/CC is paired with clicker training. An important note when using DS/CC to fearful conditions – watch his body language. When he starts acting less than completely comfortable, stops eating or stops following simple commands, he is telling you he is too aroused! Stop and go back to where you were successful.

The very best time to do DS/CC to the vet's office is the first visit, before he knows to be fearful and when he is healthy and able to eat. Then if he becomes ill or needs a procedure where he is not allowed food, he has already been conditioned that the vet is not a terrible place.

Feeding should happen before, during and after exams and procedures. One common misconception is that feeding 'rewards his behavior'. As mentioned above, fear is not something he has control over. He feels it and we can't tell him not to. We can try to decrease his fearful feeling if he will eat.

Start as young as possible

If you obtain your dog as a puppy, this is the best time to start all his socialization so he has less anxiety in new situations, including the vet. The American Veterinary Society of Animal Behavior's Puppy Socialization Position Statement (http://avsabonline.org/uploads/position_statements/puppy_socialization1-25-13.pdf) states that during the first three months of life, "puppies should be exposed to as many new people, animals, stimuli and environments as can be achieved safely and without causing over- stimulation manifested as excessive fear, withdrawal or avoidance behavior." This includes the veterinary hospital. The tips in this article can help minimize his fear at the very first visit (e.g. feeding before, during and after exams and vaccines).

Other tips

Here are some other ideas that can help you help your dog at the vet:

  Be present – Many dogs are more comfortable with their owners in the room with them. If you can, try to be present for your dog's exam, blood draws or anything that does not require sedation or anesthesia, or specialized equipment that cannot be brought into the exam room. Of course, if you prefer not to watch such procedures, you can leave the room and return and feed as soon as you can. Ask your vet to have someone continue feeding while you are out of the room. Rarely dogs actually do better away from their owners. If this is the case, you and your vet can make adjustments to his handling plan.

  Avoid the lobby – some dogs become aroused with the presence of other dogs, too many people, etc. If you see your dog become anxious (stiff posture, heavy panting, hiding, tail tucked, growling, staring at other dogs), then ask to be put directly in an exam room. If necessary, wait in a quiet area of the parking lot until a room is free. Many patients start becoming aroused and overly excited in the lobby, and this can spill over into increased arousal in the exam room

  Use pheromones – Adaptil® (formerly D.A.P®) is an appeasing pheromone mimicking the properties of a pheromone released by lactating female dogs. This pheromone gives the nursing puppies a sense of well-being, has been found to reduce stress in puppies and dogs of all ages. It comes as a spray, a diffuser and a collar. The collar is very convenient because it goes everywhere with your dog, including the vet hospital or boarding kennel.

  Try the ThunderShirt. Anxiety experts believe that constant gentle pressure on the torso has a calming effect on the nervous system and may release calming hormones such as endorphins and oxytocin. Some dogs relax at the vet with their Thundershirt. Be sure to carefully test the shirt at home and also use favorite food treats while introducing him to it.

  Use a no-pull harness or collar – These will allow you to have more control during the visit.

  Don't punish – The AVSAB Position Statement on the Use of Punishment for Behavior Modification in Animals (http://avsabonline.org/uploads/position_statements/Combined_Punishment_Statements.pdf) states that punishment may result in increased fear-related and aggressive behaviors.

  Use a no slip mat or work on the floor – Ask your vet for a no slip mat, or take one with you.

Make handling plans with your vet

Some dogs will never be comfortable at the vet, just like some people are never comfortable at the dentist. In this case, ask your vet to work with you to formulate a plan. The plan may include all of the above components, in addition to the following:

  Oral Sedation – very often, especially for dogs with unknown history, you and your vet may wish to add in sedation to help with the handling. Oral sedation prior to vet visits (even happy visits) is often used as a component of the plan during DS/CC. Oral sedatives generally need to be tested at home first, as some dogs may actually become a little more agitated with some of these medications. Your vet can instruct you on how to do an at-home test of a sedative medication.

  Injectable sedation at the vet's office – Some dogs are still very fearful despite all the above preparations. Or they may not be allowed to eat due to a medical condition or upcoming test or procedure. Ask your vet for sedation to be administered via injection immediately upon arrival to the office to reduce your dog's stress and possibly help him not remember his scary experience.

  Stop the visit if able – If at any point his fear has escalated to where you feel his fear is getting worse or he cannot be safely handled for sedation administration without undue stress, it's ok to stop the visit and make a better plan for the next time with your vet. The more his fear escalates, the harder each subsequent visit will be. If he is sick or injured and the visit must continue, you may have to do more work to decrease his fear over the following visits.

  Practice at home – talk to your vet about things you might be able to practice at home, like touching the mouth or ears, touching near his tail, touching his paws. Only practice this on the advice of your vet if your pet has shown any resistance, such as pulling back, growling, snapping, hiding, etc... at home.

  Muzzle training – for some pets who are fearful at the vet or other situations, especially those who resist restraint of any kind, it can be a good idea to teach them to wear a muzzle comfortably and for longer periods of time. We use DS/CC for this training as well, usually pairing food with the muzzle – ask your vet for more specific instructions. The muzzle allows your vet to use the least restraint possible. Muzzle training can come in handy at home for things like nail trims, and especially if your pet is injured and needs to be transported quickly but may be trying to bite in response to pain or fear.