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Behavior medicine: Easing patient fear
A behavioral method of curbing patient anxiety in the hospital


Reducing anxiety in the fearful pet

Patients displaying subtle signs of fear may be improved with patience, food treats, toys and the use of a pheromone (DAP®) in the examination room. Offer high value food rewards. Try cheese spread or peanut butter (if there are no owner allergies) on a wooden spoon. These are highly palatable, occupy the pet longer than single treats, and keep staff and family further away for safety. Be sure to identify even mildly fearful dogs in your medical records. For further visits, fasting the pet before the visit and having the owner bring along favored food treats or toys may distract the pet and make the visit enjoyable if the anxiety is not too intense. Giving a benzodiazepine one to two hours prior to a visit and placing DAP spray on a blanket during the car ride may reduce anxiety and increase the pet's interest in taking treats.

Tools and techniques

Use handling and restraint techniques which minimize stress for the patient while providing optimal safety for your staff. Preparation, a calm attitude and proper tools can turn a potentially negative situation into one that is positive and safe. For dogs that are difficult to restrain and potentially aggressive, the primary goals are to ensure safety and to minimize fear and anxiety for the pet. If the dog is trained to wear a head halter or a basket muzzle prior to the visit, often the procedures can be accomplished with a minimum of fear or anxiety for all. The Not only does a head halter allow for a safe and calm examination, dogs that are food motivated can be distracted with favored treats while gently restraining the head. This technique is displayed on the Web site by Dr. Gary Landsberg. Similarly the muzzle can be used to ensure safety while remaining safe and calm. In fact, if the dog will take them, food rewards can even be given through the openings in a basket muzzle. Basket muzzles provide many advantages over traditional nylon, mesh muzzles: they allow panting and normal respiration, the dog may be fed soft, small treats, and normal canine communication signals such as lip curling, growling or snapping can be monitored. If the dog is not trained to accept a basket style muzzle before coming into the hospital, this might be accomplished on site, by generously applying peanut butter, squeeze cheese or even can cat food on the inside of the basket muzzle. Another product that covers the eyes to reduce the visual stimuli that might aggravate the dog's fear is a Calming Cap® by Premier Pet Products.

Pharmaceutical management

Avoid waiting too long for pharmacological intervention; stress, elevated heart rate and fear are detrimental to the pet and may alter the efficacy and doses needed for sedation. Benzodiazepines (e.g., diazepam, alprazolam, lorazepam) given in advance of the visit may provide anxiety relief, reduce arousal and provide a desirable amnesia effect. For increased sedation, acepromazine or phenobarbital can be added. However, for the more fearful patients intramuscular sedation is likely to be most practical either for minor procedures or as a premedication for anesthesia. Use of a head halter or basket muzzle should allow for safe administration. A combination of a narcotic such as morphine or hydromorphone, a low dose of medetomidine or dexmedetomidine (if there is no cardiac contraindication), plus the use of midazolam (which might have both an anxiolytic and amnesic effect) will usually be effective. Each of these components can be reversed should the need arise. Buprenorphine or butorphanol can be used as an alternative to the narcotic but cannot be reversed. For more difficult dogs additional dexmedetomidine can be used or Telazol (teletamine/zolazapam) can be added. Quiet environments promote successful induction with lower, safer doses. For details and doses, see the VIN FAQ on Handling and Restraint of Difficult Pets by Dr. Robert Stein, the chapter by Dr. Moffat in the September 2008 issue of Veterinary Clinics of North America, or by visiting

Triage for long-term behavioral health

Include both medical and behavioral triage in your treatment plan. Assess your patient, the urgency of medical procedures and the likelihood of a fearful outcome. If the procedure is not necessary (e.g. nail trim), it may be best postponed. However, if the procedure is necessary and likely to cause fear or discomfort (e.g. ocular examination, anal-sac expression), then develop a medical and behavioral plan, using management tools and drugs where necessary. Negative experiences are likely to have a lasting impact for future visits. By promoting gentle and positive handling and avoiding negative experiences, the result may be a patient that enjoys coming to the veterinary hospital.

by Gary Landsberg, BSc, DVM, Dipl. ACVB, Dipl. ECVBM-CA Dr. Landsberg practices at North Toronto Animal Clinic, Thornhill, Ont., Canada.

For a complete list of articles by Dr. Landsberg, visit

by Theresa DePorter, DVM Dr. DePorter has been providing consultations for behavior problems in the Southeastern Michigan area since 1995. She has spent more than 14 years independently studying the interaction of animal health, pet behavior and the human-animal bond. She received her DVM degree from Purdue University in 1992.


Source: DVM360 MAGAZINE,
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