It’s no surprise that many dogs and cats suffer behavioral and physiologic stress during veterinary appointments. The damage, however, can go deeper, affecting their well-being and overall health, reducing a client’s compliance with your recommendations and inhibiting a correct diagnosis and treatment. In addition, a pet with a negative veterinary experience will likely be fearful and anxious during the next visit.
Reston, Virginia, veterinarian Dr. Amanda Smith has seen how fear and stress manifest in four significant ways:
- No more visits. A client trying to avoid triggering a pet’s fear and stress stops seeking veterinary care.
- Medical concerns. “The body’s stress response causes an increase in heart rate and breathing rate, among other things. If a pet has underlying heart or respiratory disease, fear and anxiety can push them into a medical crisis,” Dr. Smith warned.
- Unreliable numbers. High stress can cause abnormalities in a patient’s diagnostic test results, making them challenging to interpret.
- Unwilling patients. Intense fear causes a fight-or-flight response, “which can greatly impact the veterinary team’s ability to examine a patient, perform diagnostics and administer treatments fully,” Dr. Smith said.
The solution in some cases, and an untapped opportunity for many veterinary teams, is pre-visit sedation.
EDITOR’S NOTE
This is the first in a three-part series on using sedation and analgesics to improve veterinary care and boost the bottom line. This Clinic Consult series is brought to you by Dechra.
“For many pets, a simple pre-visit medication is all they need to relax and allow for a smooth and successful veterinary visit for all involved,” Dr. Smith said.
The Benefits of Sedation
Minimizing stress using pre-visit sedation supports:
- Patients: Sedation delivers better mental well-being, quicker recovery from a stressful event and a favorable attitude about future visits.
- Clients: Some forgo veterinary care, especially preventive care, to prevent stressing pets. Providing pre-visit pet sedation can improve client compliance and follow-up care. In addition, clients will have more positive interactions with the veterinary team.
- Veterinary teams: Pre-visit pet sedation can increase a team’s efficiency, decrease the workload, improve employee morale, and reduce injury risk and workers’ compensation claims.
- Clinics: Clients who feel good about a pet’s visits are more likely to remain loyal to the practice and provide word-of-mouth advertising. As a result, revenue increases.
Pre-Visit Sedation Options
Several medications can calm a stressed patient. Veterinarians may prescribe any of the following sedatives and anxiolytics before a visit:
- Gabapentin: It decreases stress during transport, diminishes a loud-noise fear response, and reduces stress and aggression in cats. The drug also has analgesic effects in cats.
- Trazodone: It reduces behavioral stress and lowers confinement stress.
- Alprazolam: It reduces fear and panic in dogs.
- Oral dexmedetomidine: The alpha-2 agonist reduces fear.
It’s important to note that veterinarians should choose pre-visit medications based on a patient’s specific needs. The medicines might be contraindicated if the animal’s health status is unknown or the cardiac or respiratory system is compromised.
Educating Clients
When you recommend pre-visit sedation, remember to tell clients how the medications facilitate examinations of the pet and minor surgical procedures.
“When talking to clients about the need for pre-visit intervention or the use of sedation, focus on how the medication will benefit their pet while also addressing their concerns,” said Dr. Jennifer Merlo, the director of veterinary affairs for the Fear Free organization.
“Pet owners don’t want to see their pet anxious or stressed,” Dr. Merlo said. “However, oftentimes the mention of medication or sedation can cause clients to worry.”
She recommends reassuring clients about the safety of pre-visit sedation.
“Talking to clients about the impact of fear, anxiety and stress on their pet can help them understand your recommendations,” Dr. Merlo said.
Administering Medications
When prescribing pre-visit sedation, ensure the client is comfortable giving the medication. Considerations include:
- A trial dose: Recommend that the client give a trial dose beforehand so you can adjust it as necessary.
- Administration route: Confirm that the client can administer the medication properly.
- Timing: Advise the client when to administer a dose to ensure maximum effects.
- Monitoring: Ensure the client monitors the sedated pet to prevent mishaps arising from ataxia.
Preparing for the Visit
Other tips for reducing a pet’s pre-visit anxiety include:
- Acclimating the pet: Instruct clients to place the carrier in a conspicuous place so the pet gets used to going in and out. Clients should consider feeding the pet inside the carrier to support a positive association.
- Making the carrier comfortable: Soft, squeezable carriers or those with clip tops facilitate low-stress handling. Urge clients to provide a carrier large enough for the pet to turn around in comfortably. Advise them to place the pet’s bedding inside so that familiar scents comfort the anxious patient.
- Withholding food: Instruct clients not to feed a sedated pet for several hours before the visit to prevent car sickness, which can increase anxiety.
- Scheduling an early appointment: Ask owners of particularly anxious pets to take the day’s first appointment. That way, a busy day doesn’t delay their arrival.
- Covering the carrier: Feline patients might feel more relaxed and secure when the owner covers the carrier with a towel sprayed with feline pheromones.
The veterinary team should prioritize reducing patient stress. Prescribing pre-visit sedation, properly educating clients about anxiety and medication choices, and using Fear Free techniques can reduce or eliminate patient stress and benefit everyone involved.
FEAR FREE TECHNIQUES
Knowing how to reduce a patient’s fear, anxiety and stress can significantly improve the veterinary visit for a client and pet. The Fear Free organization promotes these concepts:
- Environment: Minimize sights, sounds and smells that can trigger fear, anxiety and stress.
- Observation: De-escalate stress by responding to a pet’s body language.
- Human behavior: Avoid direct eye contact with a fearful or anxious pet, turn sideways when approaching a patient to appear less threatening, move smoothly and calmly around a patient, and give treats to encourage cooperation.
- Gentle control: Use minimal restraint when administering veterinary care, creating a positive and pleasant experience for the patient.
- Touch gradient: Performing a thorough veterinary exam requires handling the patient. Fear Free’s touch gradient consists of maintaining continuous hands-on contact throughout the procedure or examination when possible and acclimating patients to increasing touch intensity while continuously measuring their acceptance and comfort.
“For most pets, medications are only a portion of the answer,” said Dr. Jennifer Merlo, Fear Free’s director of veterinary affairs.