Your skills as a technician, combined with empathy that allows you to understand what fearful patients and clients are going through, can help calm and heal them on both an emotional and mental level.
Will you give me that rabies pole thing to hold my dog down so you can do his exam?” asks the nervous owner the first time she sets up a house call appointment for her dog. “My dog is really bad at the vet, and we’ve been told we can’t take him there again unless we sedate him first. But he’s really great with us at home. He’s just scared, and each year he gets worse.”
I explain that I do not have a rabies pole and have never felt the need for one. In my house call practice, owners will often say their dogs are terrible at the veterinarian’s office, using descriptions that range from “purely terrified” to “absolutely psychotic”. Some have been asked to wait outside the clinic with their dogs. A few have been told not to return. Most of these dogs are fearful, and will only bite if they are cornered. In many of these cases, the anxiety from the owners is sensed by the dogs, which further contributes to the behavior.
As veterinarians, technicians and staff, we can use a variety of methods to calm these animals, including the art of deception – most of my own patients don’t even realize they are getting an exam. The techniques I use in my house call practice can be easily modified in the veterinary clinic by starting with one simple concept…empathy.
Empathy is the ability to relate to someone, to put ourselves in another’s shoes, so to speak. In this case, let’s see if we can walk a mile in our patients’ paws. We’ll begin by taking an average day at a veterinary clinic with an anxious dog or cat. It’s busy, the doctor is running behind (again!) and you need vitals on the dog in room two. He is lying between his owner’s legs, tail tucked beneath him and trembling. How do you handle this patient? The easiest, fastest thing is to pull the dog by the leash into the center of the room and lift him onto the table. If he growls or snaps, a second assistant may be brought in with a muzzle to handle him firmly while he is assessed. Sound familiar?
As integrative practitioners, we are held to a higher standard because we do not simply treat an animal’s physical symptoms, but consider their emotional and mental states as well. In the Summer 2013 issue of IVC, Dr. Sophia Yin covered ways to recognize fear in our patients. It is important to realize that just as the veterinarian can cure physical illness, your skills as a technician combined with your ability to empathize with these patients can heal them on an emotional and mental level. Here are a few tricks that allow you to put your empathy to good use in the veterinary clinic.
Into the room and introduce yourself to the owner, but do not immediately approach her pet. This gives the dog a chance to greet you on his terms, sniff and get to know you before you reach for him. Speak with the owner while avoiding direct eye contact with the dog, as this may be intimidating to him. After a moment, you may also kneel down, speak softly and let the dog sniff you, but don’t pet him yet. During this time, while it looks like you are simply introducing yourself to the owner, you are assessing this dog’s behavior: is he nervous, outgoing, shy, aggressive or timid? This helps you create a plan for the visit so that everyone is comfortable. If the animal acts aggressive, calmly inquire about any previous bites, and whether or not he has good bite inhibition (if there was a bite, was the skin broken?).
Softly and slowly to a nervous dog. If treats are okay with the owner, each time he shows interest in you, softly say “yes” or “good” and offer him a treat. While food rewards are not always possible because the patient may be sick or injured, praise is always a good idea. For cats, you can snap your fingers and imitate the sounds a cat makes when he is curious or chatty: usually a soft inquisitive purr, followed by a single scratch of the ears or chin is enough to engage them. Remember that these calm interactions are not just soothing the patient, they are helping you gain the trust of the owner too.
On the floor. Patients and owners absolutely love it. This is one of the best ways to win them both over. Not only are the pets less fearful when all four paws are on the ground, but you can observe their movements more accurately; you are much more likely to identify the cause of lameness or pain if the animal is allowed to move freely in the room. He is also less likely to act fearful while on the floor, since many pets have negative memories of events that happened once they were placed on an exam table.
Calm even when the owner and the pet are stressed or fearful – they are looking to you for guidance. Most owners and pets who have had prior negative experiences at clinics are anxious. They will often say their dog or cat should be immediately muzzled or reach to hold them tightly for the exam. I think we’ve all been bitten badly enough once or twice to be very, very careful, but unless a pet is showing clear signs of aggression, it’s always nice to give him a chance, even with a history of bad behavior. Part of the challenge of our job is to create a new, positive experience for the patient and his human, and we have to establish a bit of trust before this can happen.
The patient gently, calming him with massage and using pressure no stronger than the weight of a quarter. TTouch is one form of massage therapy that can be easily learned and applied to nervous or injured patients to help relieve pain and fear. Avoid scruffing and over-restraining cats; often wrapping them in a towel is enough. When you give injections, scratch the area of the skin for several seconds before inserting the needle; this will often keep the pet from noticing the pin prick. If you have to muzzle an animal, try to hold him as gently as possible. Have a second person stroke his ears, over his eyes, or on the top of his muzzle during IV catheter placement or a blood draw, speaking slowly and softly as you give him praise for being so brave. This approach is soothing and distracting enough to lower the animal’s fear and reduce the need for excessive restraint. A side effect of this technique is that your energy sends a message to those around you, reminding them to be as gentle and kind to these animals as if they were their own.
For telltale triggers that heighten or diminish a pet’s anxiety. For example, Harley is a four-year-old Saint Bernard in my house call practice who is being treated homeopathically for anxiety and digestive issues. Harley’s behavior is fear-based, and he has never bitten anyone, always opting to run away when approached. While Harley is very anxious in the presence of his owners and will pace, bark and snarl at visitors, he becomes almost completely relaxed in their absence. At his most recent visit in June, his owners watched through a small window as Harley allowed me to enter their porch and perform a full examination with no growling or barking. His posture and eyes were softer, and his overall demeanor was much more relaxed than just a few minutes earlier in the presence of his owners. At the end of the exam, we even engaged in a short game of play, and he gave me a friendly lick when we finished. When I brought him back inside to his owners, however, he went right back to growling and barking at me again. Identifying and removing the triggers that heightened Harley’s anxiety allowed for a veterinary visit that was minimally stressful for everyone involved.
Your patient emotionally and mentally, and create a positive experience for the pet and his human. In addition to minimizing the fear during the visit by adjusting your behavior, there are other forms of therapy that can help with a pet’s anxiety as well. For example, homeopathic treatment is improving Harley’s behavior issues. At the end of my visit, he was given a single dose of a homeopathic medicine that matched all his symptoms of illness, including his anxiety. Within five minutes of his treatment, he settled down on the floor behind his owner’s chair and fell asleep only a few feet from me. This type of pacifying response is commonly seen in patients within minutes of receiving a homeopathic remedy for their symptoms. Another option to calm a nervous animal is to spray a small amount of Rescue Remedy on your hands or clothing before entering the room.
As practitioners of integrative medicine, we will always be more successful in healing our patients if we understand the full extent of their illnesses. Empathizing with their emotional and mental state as well as their physical symptoms is a holistic approach that will have clients and their pets looking forward to their next veterinary visit.
Put yourself in the patient’s place
Imagine you go to your own doctor for flu-like symptoms. You are feverish and irritable, and your doctor is running behind (again!). As you wait, shivering in a plastic chair because the table with the paper cover is so uncomfortable in your thin disposable gown, a nurse rushes into the room, mumbles a greeting, and pushes a thermometer into your mouth. When you protest at her abruptness, she calls security. A person in uniform enters the room, lifts you onto the table, and holds you there while your vitals are taken. When you try to push them away, they seem irritated that you are not more cooperative.
It is unlikely you would choose to go back to this office, because you have the free will to make that decision. But what if you had no choice and were taken back to that office, year after year, with the same unpleasant experience? How would you react? Wouldn’t you become more fearful and perhaps even more defensive at the next visit?
Once you translate this experience to dogs and cats at the veterinary clinic, you may have a greater empathy for the anxiety and resultant behaviors that often occur in the exam room.