Fear Free Practice With It You ll Thrive, Without It, You Might Not Survive Dr. Marty Becker

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1 Fear Free Practice With It You ll Thrive, Without It, You Might Not Survive Dr. Marty Becker I ve been a practicing veterinarian for over 35-years and I ve seen three previous transformations of significance: 1. Feline Medicine I grew up on a family farm/ranch in rural Southern Idaho. In that environment, cat and veterinarian didn t belong in the same sentence (would be as odd as smoking and healthy). By and large the vast majority of cats with barn cats, lived in the haystacks or were outside cats. Very few ever went to a veterinary hospital for treatment and even fewer for preventive care. Eventually veterinary medicine realized that cats, too, were beloved pets, weren t just small dogs, that they were a separate species that needed their own meds, dosages and treatment protocols. 2. Dentistry Circa my graduation in 1980, dentistry consisted of the occasional ultrasonic teeth cleaning and a lot of pulling rotten teeth. Talk of prevention was rare. Then came veterinary dentists and the blossoming of dental care with a focus on prevention (daily oral care), digital dental radiographs, dental suites and advanced therapy. 3. Pain management Have pity on this profession that for so long, we ignored the existence of and consequences from pain in pets. Thankfully, we started to focus on pain, developed multimodal pain management, and made the prevention or relief of animal pain or suffering a priority. Of course, feline medicine is limited to cats that receive veterinary care (still far to few). And although 80% of companion animals have dental disease by the age of three, the majority of pets suffer in silence with a mouth full of inflammation and infection. Pain management is widely offered, but this only helps with pets that have pain (trauma, joint or disc disease, post surgery). The most important transformation in the history of companion animal medicine is here now. And rather than just affecting a species or a condition, this initiative involves every pet, every veterinary visit, every practice, every day, forever. This make or break transformation is creating Fear Free veterinary visits. The polar opposite of a fad, Fear Free has become a practice imperative if you re going to thrive, or even survive. Too strong of a statement? Far from it. You should fear not being a Fear Free veterinarian, technician, hospital team member or facility. Why? Because pet owners can see, hear, feel if you re Fear Free and can measure success. Before Fear Free, companion animal practices largely competed on location, convenience, curb appeal, quality of medicine and price. Of these, the most subjective is quality of medicine. You ve heard it said a dozen ways, hundreds of times, but it s literally impossible for a pet owner to judge the quality of medicine. How do they know inside of the incision that did a better job of surgery than someone else. Or that another veterinarian could have removed that carnassial tooth with much less trauma, or done a much better job of cleaning out infected ears. Fear Free is different and a differentiator, because pet owners can easily tell at every moment-of-truth (outside the hospital front

2 door, in reception area, exam room, interaction with technician and veterinarian, getting preventive care) whether their pet is calm or anxious/stressed/fearful. Our profession, and increasingly pet owners, are coming to understand that maladaptive fear is the worst thing a social species can experience and that it causes permanent damage to the brain. And that going to a veterinary practice (or grooming or boarding) where the pet will experience fear, is causing repeat, severe psychological damage to the pet. Conversely, taking a pet to a facility that looks after both the pet s physical and emotional wellbeing, is better for both the pet and the pet owner. The Bayer Veterinary Healthcare Usage study showed conclusively that the #1 reason people weren t taking their pets to the vet as often was because of the stress to the pet. And #3 was stress to the pet owner taking the stressed pet to the veterinarian (#2 was money btw). So in providing a Fear Free experience for the pet, you can eliminate two of the top three reasons people aren t taking pets to the veterinarian. More pet owners visiting the veterinarian for their pet s accidents, illnesses and preventive care means everybody wins. The pet gets optimal care. The pet owner is doing the best job possible as the surrogate. The practitioner and hospital team member get to practice at a level that s rewarding (financial success and emotional wealth). The practice thrives. Not only can pet owners measure if their pet is fearful or Fear Free, there is going to be a big push in the very near future to education pet owners on how they can provide their pets with a more Fear Free home environment, how they must work with the veterinary team to deliver a calm pet to the practice, and where they can find veterinarians and veterinary hospitals that are certified Fear Free. For individuals and facilities that remain fearful, many will wither and some will die. For those that embrace the necessity of looking after the physical and emotional wellbeing of pets (plus pet owners and team members), they are going to thrive.

3 Apples & Oranges: Significant Differences between Fear Free and Fearful Veterinary Practices Dr. Marty Becker There are three things I can pretty much predict someone will say every time these situations arise: 1. Cute baby in sight. I ve always loved children and, like everyone else who sees a baby, I always say in a syrupy sweet voice, Ahhh.she s so cute! The baby could be wrinkled, bald, and spewing pablum, and we still say the same thing. 2. Pets lower blood pressure. Since veterinary school I ve been privy and partner to the human-animal health connection and wrote an award winning book on the subject called The Healing Power of Pets. When doing the initial book tour in 2001 and every time since then, when the book s subject title comes up, 7 out of 10 people say, I hear pets lower blood pressure. It s like that s the only benefit of pet companionship anyone has ever heard of. 3. Fear Free veterinary practice. I ve yet to speak on this subject without at least several members of the audience assuring me, We ve been doing Fear Free for years. In some ways, yes, they have, but in most of them, no, they haven t and here s why. Starting in the late 1980s, working with famed veterinary behaviorist and inventor (Gentle Leader) Dr. R.K. Anderson, we tried to become All Treat Veterinary Hospital vs. All Pain Veterinary Hospital by deploying treats at every moment of truth in a veterinary exam or procedure. Yes, this helped reduce anxiety and stress for pets, and is a component of a less-stress visit, but it wasn t Fear Free. Fear Free is a multimodal approach to removing or reducing anxiety/stress/fear triggers, mitigating these same factors when they arise, and always having the pet s emotional wellbeing in our hands (along with physical wellbeing). Let me contrast a Fear Free (FF) practice with one that remains fearful for pets, pet owners, and the hospital team: 1. Primary focus. The North Star for a FF practice is the emotional wellbeing of all stakeholders (pet, pet owner, practitioner, practice team). In a fearful practice, the focus can be medicine, money, or both. 2. Hiring. FF practices hire for attitude and genuine care and compassion for pets and people. They re looking for that special 1 out of 10. Fearful practices hire for performance above all, and pay little or no attention to attitudes of compassion in their team members.

4 3. Harmony. Fearful practices care more about getting the job done than the emotional environment of the business, out front and in back. Fear Free practices know both pets and people can easily detect, and are put off or made anxious by, stressful interactions among members of the hospital team. 4. Design. In the fearful hospital, design is all about curb appeal, efficiency, durability, safety and cost. The FF practice has colors that please pets and people, use high coefficient of friction floor coverings, use a lot of soundproofing, have species-specific exam rooms (some have species-specific treatment areas), and have the ability to isolate pets who are hospitalized for procedures or treatment from pets who are currently being treated or examined to minimize the viral spread of fear. 5. Where pets are parked. In the fearful hospital, appointments are booked without thought, and in doing so aggressive pets can be side-by-side with fearful ones, dogs with cats, or new puppies with hyperkinetic, emotionally damaged pets. Fearful hospitals pack the schedule and the waiting area with nervous pets and people. Fear Free practices utilize the exam rooms (with enough rooms and the technology) for checking pets in-and-out, bypassing that stewpot of stress called reception. If there aren t enough rooms or the technology, FF practices have pet owners check in (leaving the pet in the vehicle) and then go back outside and wait with their pet in the vehicle or outdoor area until it s their turn to be seen. 6. Pace. Fearful hospitals are all about auguring the pets through the system to help as many animals medically as possible. More pets = more money. FF facilities are all about smart scheduling (looking how to minimize stress for individual pets and people), being more relaxed, working to remove or reduce excessive noise, and not being afraid to delay or stop a procedure if fear flares. 7. Exam. In a fearful facility, almost every pet is put up on the exam room table for exams and procedures. In FF, the pet is given the choice of where to be examined and treated (on the table, floor or lap). 8. Hold still. To examine ears, eyes, wounds, or to draw blood or give vaccinations, fearful practices using restraint, which is designed to protect the healthcare provider. FF practices use Gentle Control or Stress Less handling, which are designed to protect both the pet and the person. 9. Sedation. In fearful practices, sedation is rarely used and is thought of as a last resort. Sedation is a resort reached for early and often in a Fear Free practice. FF practices have a saying, If you can t abate (as in anxiety/stress/fear) then you must abate (with sedation). 10. Records. It s all about the medical record in a fearful practice, whereas in the FF practice, there s a great medical record but it s bookend is a great emotional record. It includes things like the anxiety/stress/fear triggers for this unique pet and pet owner; where the pet likes to be examined; what Gentle Control method works best; what treat

5 the pet likes best, what tricks the pet knows, with cue words; what products (compression garments, chill pills, pheromones, sedatives) work best with this pet. So just as not every baby really is the cutest one every born, and pets do so much more than lower blood pressure, Fear Free is not about adding treats and a warm bedside manner to your get er done veterinary strategy. And you can take that to the bank, fearlessly guaranteed!

6 Top 10 Ways To Get Started With Fear Free Veterinary Visits Dr. Marty Becker Are you, your hospital team members or clients some of the millions of pet owners who ve seen recent Internet slide shows featuring frightened pets at the vet? Meant to be funny --- with images of huge dogs in people s laps, cats inside the exam room garbage can, canines trying to hide in a tiny toy box, felines hunkered down behind canisters of Q-Tips and gauze on the counter are actually so sad they make me, as a veteran veterinarian and lifetime pet lover, want to cry. Why? Pets that go to the veterinarian in a fearful state often end up with repeat, severe psychological damage. Like PTSD, these pets don t even have to suffer the stressful circumstances, such as being hoisted on the exam table, poked, pricked or restrained, to have fear. Just the sight of the carrier coming out or being loaded in the car can be enough to bring back the traumatic memories of a previous veterinary visit. Imagine the added stress of a pet that s been languishing in the shelter or just recently moved from the cage to your couch. And interestingly enough, once you know the signs of anxiety and fear, you will see it in most animals, even the ones pet owners think like going to the vet. But just as dentists changed from focusing just on oral health to looking after children s dental and emotional health (I hated to go to the dentist as a child and now my Granddaughter looks forward to it!), as a profession we re now embracing our obligation to look after both a pet s physical and emotional wellbeing. Can you imagine an environment where most dogs want to go to the vet and remain calm throughout the process of moving from the living room to the exam room and back home? A process through which cats find going to the veterinarian less stressful than having a stray cat wander through their yard, taking a bath or oral medications? You don t have to imagine because veterinarians, technicians and practices across the country are learning the techniques and protocols to provide for Fear Free veterinary visits for all pets. Stress less. Fear Free. Whatever you call it, it just means that pets won t hate going to the vet and pet owners won t cringe at the thought of taking them. Fear Free requires an extra effort, not just on the part of the veterinary healthcare team, but also the pet owner (compared to past veterinary appointments). Here are my Top 10 pet owner tactics and tips for a Fear Free veterinary visit: 1. Remove or reduce anxiety triggers Does your cat or small dog cringe when the carrier comes out? Then take it out several days before the wellness visit and feed high value food or treats in it. But don t force your pet- let it find the goodies on its own. Do you have pets that hate to be separated? Take them both to the vet. The one will get examined and treatment but both will get treats. 2. Make the carrier a little slice of heaven If you re one of those people whose carrier only comes out when it s time to go to the vet, you can make it more like a condo than a cage by a) leaving it out all the time, b) treat it like a safe room for the pet, c)

7 frequently put toys and treats inside of it. If you don t have the space or desire to leave it out, then at least take it out three days before the scheduled visit. 3. Magic carpet ride of pheromones Ask your veterinarian for a recommendation of a synthetic version of naturally occurring dog or cat pheromones, recommends Gary Landsberg, a boarded veterinary behaviorist and the author of Behavior Problems of the Dog & Cat. Landsberg warns that pet owners need a product that s clinically proven to work not just has Veterinary Recommended on the label which means nothing. By spritzing or wiping the pheromones onto surfaces like the pet s bedding, the door and walls of the carrier, the upholstery of the car you deliver a magic carpet ride that extends from carrier to car to clinic. 4. Just chill out Many pets require some chill pills, compression (calming) wraps, ear covers that reduce auditory stimuli and eye covers that reduce visual stimuli, some calming music (classical not heavy metal) or all of them. I recommend starting out with products you can get from your veterinarian that work in a natural way. One of my favorites is a green tea extract in a chewable tablet (has amazing palatability in both dogs and cats), another is a capsule containing milk proteins. The compression wraps act like the deep hugs you get when someone wants to comfort you, swaddling a baby or the tightening some autistic people find so relaxing. And if you know from previous experience that the visit will be stressful discuss in advance with your veterinarian whether anxiety reducing medications might be right for your pet. There are medications which in combination with supplements (such as melatonin or suntheanine) that are generally safe and may help decrease anxiety and fear in dogs and cats, says Dr. Alicia Karas, who teaches and practices anesthesia and pain medicine at Tufts University's Cummings School of Veterinary Medicine. These can be prescribed by your vet and given an hour or so prior to leaving for the clinic. Very strong sedatives are not suitable for pet owners to give, but if coordinated with the veterinary staff, can be given immediately upon arrival to permit examination and minor procedures such as radiographs or ultrasound or even suture removal. Realize that being sleepy or groggy is often preferable to recovering from a severely stressful experience and just let them safely sleep it off. Talk to your vet about this especially if you have had tough visits in the past. 5. Hungry will mean happy Withhold the bulk of your pet s food within 12 hours of the veterinary visit so that they enter the clinic very hungry and more likely to accept food rewards from the veterinary team. Landsberg warns, If your pet is a puppy, kitten, a miniature breed or has any health issues, check with your veterinarian on how long to withhold. A great thing to do is to bring your pet s most favorite treats to the clinic so that they are delighted when they flow copiously 6. Ready, steady, go Pet owners typically put the carrier containing the cat or small dog on the car seat. Problem is the cant of the seat bottom makes the carrier tilted which if discomforting for the pet. There are commercial products available for keeping pizzas flat on the car seat that can be used or you can just use rolled up towels. A seat belt can provide further restraint for the carrier. 7. See no evil Face the level carrier towards the front of the vehicle. Cover the carrier with a light sheet, leaving only the front door uncovered. This greatly reduces visual stimuli (such as dogs being walked, vehicles whizzing by) and increases chances for a state of calm.

8 8. Furget the baby talking We put GoPro cameras in pet owner s vehicles and watched and listened to what happened. What a hot mess! The problem was pet owners saw their pet s stressed or were stressed themselves, they baby talked the pet, the pet got more anxious, the pet owner got stressed and they kept feeding upon each other until both pet and pet owner were ready to boil-over by the time they pulled into the veterinary clinic parking lot. In short, what you say and do, will affect how your pet feels. Don t force the issue, raise your voice or get angry or upset. A better thing to do is to remain calm and quiet or upbeat (pretend it s a trip to the dog park or the pet store). Bringing along a favored toy may also help to keep your pet occupied and happy. 9. Don t just check in as usual For decades pet owners have followed the wellrehearsed route of stopping in the veterinary hospital parking lot, grabbing the carrier or the leash and taking the pet inside to check in at the receptionist desk, waiting in the reception area with other pets and pet owners for your turn, and then going into the exam room. The reception area is nothing short of a stewpot of stress. Ask your veterinarian if you can either a) be taken straight into an exam room to be checked in, or b) park the vehicle, call or text the front desk to let them know you have arrived, and wait with your pet until an exam room clears and it s your turn to be seen. NOTE: It worth reminding to keep AC on if it s hot outside. 10. Building on success Having a stress free, positive veterinary visit puts your pet on the road to success. After a negative experience future visits become increasingly more traumatic for the pet. But following positive visits, future visits become increasingly easier and more enjoyable for all.