A tale of four paws, two veterinary practices

Dealing with fear, anxiety and stress in the veterinary clinic

You probably remember one of the defining moments of the O.J. Simpson trial, when during closing arguments, in reference to the infamous glove found at the scene, Johnnie Cochran said, “If it doesn’t fit, you must acquit.”

Wait … what does that have to do with veterinary medicine?

The story I’m about to tell isn’t about a decades-old criminal trial but about something Gary Landsberg, BSc, DVM, DACVB, DECAWBM, coauthor of Behavior Problems for the Dog & Cat, has been telling packed veterinary audiences for years. Echoing Cochran’s famous remark and speaking about fear, anxiety, and stress, he’d tell them, “If you can’t abate, you must medicate.” (Or, humorously, “All we are saying is give drugs a chance!”)

Still confused? Let me share a story about Clyde

Not long ago, I received an email from Nancy Williams, RVT, an associated certified applied behaviorist and a trainer who used to work at the National Institutes of Health and now owns a business called Dogs with Issues in Manchester, Md.

Nancy knows my daughter, Mikkel Becker, who is also a trainer, and thought we might be interested in learning about a horrific sequence of events that happened at a hospital in her area. I will identify the pet, the pet owner, and the pet’s new veterinarian by their real names but will use a fictitious name for the offending clinic, which I’ll call “Rodeo, Judo Throw, Pile-‘O-Techs Veterinary Hospital” in Bruticaine, Pa.

Nancy was working with Jennifer Binder, a former police officer retired with full disability who had adopted Clyde, a 48-pound mountain cur dog from a local shelter. Clyde, who was going to be euthanized because of overcrowding in a South Carolina animal organization, was brought north on the UnderHound Railroad.

Clyde underwent intensive training to become Jennifer’s assistance dog and was taught to help her with specific tasks of daily living such as picking items up off of the floor.

Clyde was so amazing that Jennifer felt guilty keeping him all to herself. The pair went through Pet Partners training, and Clyde became a certified animal-assisted therapy (AAT) dog. Part of the requirement of the program is a clean coat and trimmed nails.

At first, Jennifer could trim Clyde’s nails easily, but as it became more difficult, she got a neighbor to help. Eventually the two of them could no longer do it, and she took him to a local pet store chain for pedicures. Those didn’t go well, so finally faced with getting Clyde’s nails trimmed or not and perhaps not being able to do the AAT that they both loved, Jennifer took Clyde into her regular veterinarian of many years.

The receptionist cheerfully told Jennifer that they trimmed dogs’ nails all the time, and because they’re in the hospital and scared, it’s often much easier to do.

Jennifer took a seat in the waiting area, along with another pet owner. Suddenly, she heard her beloved Clyde screaming at the top of his lungs with a desperate cry.

“That doesn’t sound good!” said the other pet owner.

Jennifer replied only with a shake of her head. What was going on in there?

A minute or two later, a shell-shocked, flush-faced veterinary nurse came out with sweat pouring off her brow.

“Your dog does not like to have his nails trimmed,” she said with a trembling voice. “We think you need to work with a trainer.”

Jennifer put a trembling Clyde in her car. He was covered with his own feces, urine, and anal gland secretions, plus the sweat of the pile-‘o-techs that had restrained him as he struggled for what he thought was his life. She immediately contacted Nancy, who, based on Jennifer’s account and her own evaluation, wrote up an amazing report that Mikkel and I got to read.

From terrorized to tremendous

Nancy began working with Jennifer on counterconditioning with Clyde. As Jennifer had been with her current practice for a decade and wanted to give them a second chance, together she and Nancy worked out a script of what she should say to the veterinarian the next time she brought Clyde in for a nail trim, including asking if they would consider using sedation.

As you well know, most people with a dog screaming from a procedure probably would just never go back, but loyal Jennifer spoke directly to Clyde’s vet about using sedation. The response? He was taken aback and truly perplexed at the suggestion in the first place. It wasn’t something he did, he said, leaving Jennifer feeling it was an over-the-top suggestion.

Crestfallen, Jennifer left, never to return. This practice just lost an A+ pet owner who would spend any amount of money on her beloved Clyde, an amazing animal who didn’t just make her feel good, but who was good for her.

Nancy suggested she consider going to another local veterinary practice, Airpark Animal Hospital in Westminster, Md., where veterinarians and veterinary nurses there were working to achieve Fear Free certification.

Jennifer called Airpark to discuss sedation for a nail trim. Staff were extremely friendly, relaxed, and engaged, and made Jennifer feel that sedation was always an allied part of therapy/treatment at Airpark and would be handled competently, confidently, and, most importantly, compassionately. Airpark didn’t know it yet, but it was going to become Jennifer’s new, forever veterinary practice.

At Airpark, John Kable, DVM, saw Jennifer and Clyde; Nancy was there, as well. Clyde was evaluated and then given the gift of a previsit pharmaceutical. When they arrived the day of the procedure, they were ushered straight into an exam room without having to wait in that crockpot of stress we call the waiting area.

Clyde was on a nonskid surface, and while the veterinary nurse was distracting him with Easy Cheese Cheddar ‘n Bacon, Dr. Kable confidently and competently injected an IV sedative.

“Nighty-night, Clyde,” he said as the dog drifted off to a place free from the terrors of past nail trims stuck in his amygdala. The team trimmed his nails without a hint of emotional and physical trauma, and reversed the sedative before he went home.

Clyde loves to visit his new veterinary practice, and Jennifer loves taking him there. Never again will she feel bad about trying to do something she knew was good for Clyde but in reality harmed him.

Why not do it this way?

“There are very few, if any, reasons not to sedate anxious or fearful patients even for minor procedures,” said Tamara Grubb, DVM, Ph.D., DACVAA, associate professor of anesthesia and analgesia at the Washington State University College of Veterinary Medicine. “The decision to sedate or not should be based just as much on the patient’s demeanor as on the type of procedure. We have safe, effective, reversible drugs that are likely to have less physiologic adverse effects than the stress, fear, and physical activity of a struggling patient.”

So here’s the question: In this tale of two veterinary practices, which one is yours? Which one do you want it to be?

I’ll let Ralph Harvey, DVM, MS, DACVAA, associate professor of anesthesiology at the University of Tennessee College of Veterinary Medicine, have the final words.

“Together we celebrate the human-animal bond in respect and admiration of the many roles of nonhuman animals in our lives, of our profound familiar relationships with them, and of our shared genuine love for many of them,” he said. “We would never wish to frighten, stress, or harm those we so admire, respect, and love.

“And so as the veterinary profession works with animals, we embrace our opportunities to skillfully, compassionately, and gently apply the many useful anxiolytics, sedatives, and analgesics to best maintain and improve our relationships. We consider this to be an important part of our sacred duty in a world that we are so privileged to temporarily share with them.

“To do this work and to educate and encourage others in this work is our shared mission. It is what I do and it is who I am. Nothing is more important or significant by way of introduction or identification.”

Dr. Marty Becker writes every other month for Veterinary Practice News. He is a Sandpoint, Idaho, practitioner and founder of the Fear Free initiative. For more information about Fear Free or to register for certification, go to fearfreepets.com.

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3 thoughts on “A tale of four paws, two veterinary practices

  1. I wish more veterinarians would seriously consider plans to become “fear free” clinics. This IS the future! Why must I be separated from my dog for a veterinarian or tech to examine or treat my pet? Whats going on back there that you dont want me to see?! All you do by separating us from one and other is needlessly worry and increase the anxiety for both owner AND pet. This does not foster a colaborative doctor patient relationship and is a complete and utter turn off. You will never gain me as a client this way. And my wallet is open and never closes when it comes to the needs of my dogs & horse.

  2. We are in process of implementing the fear free program at Marshall Veterinary Clinic in Marshall, Virginia. I wholly support the information in this article and recognize more harm than good comes from the bruticaine philosophy. It takes a long time to train an excellent dog and one bad experience can undo it in short order.