Fear and aggression during veterinary examinations and procedures are relatively common. Patients may try to escape or show defensive aggression throughout the visit or during certain procedures. Aggression may be directed only at certain team members (eg, male vs female).
Dogs that are uncomfortable around strangers are more likely to develop fear aggression at the practice because they are being handled by strangers who may inflict discomfort during certain procedures. Some dogs show apprehension in response to any kind of restraint or medical treatment, even when administered by owners; in the author’s experience, these dogs are at a particularly high risk for developing aggression during veterinary procedures, even as young puppies.
The severity of a dog’s reaction is determined by its individual temperament (eg, level of anxiety trait), its early socialization and training, its level of pain sensitivity, and the number of previous unpleasant experiences the dog has had at the practice. The intensity of the aggression is also affected by how the owner handles husbandry tasks (eg, positively and patiently vs combatively) at home and the type of training the owner uses, as some types of interactions (eg, force restraint, alpha rolls) can erode the animal’s trust in the owner and promote defensive reactions.
The initial treatment goal for dogs with severe fear and/or aggression at the practice is to prepare the dog for full sedation at the next examination or for sick visits using muzzle training at home, testing of previsit pharmaceuticals at home and at the practice prior to the appointment, and counterconditioning for injections at home and at the practice. The long-term goal is to train the dog to voluntarily cooperate with various aspects of an examination, as well as injections and venipuncture. The patient should be sedated for any procedure that it has not yet been trained to tolerate.
Dogs with mild-to-moderate defensive aggression may respond rapidly to good preparation and appropriate previsit pharmaceuticals (eg, trazodone, clonidine, benzodiazepines, gabapentin [used alone or in combination]). Some patients may require previsit pharmaceuticals for life, whereas others may be gradually weaned off if the patient is handled correctly at each examination. Procedures, even simple ones (eg, nail trims), that may or will push the patient above its tolerance threshold should always be performed with the patient under sedation.1 Although nail trims are generally short and uncomplicated, they can be traumatizing to many patients. Of important note, the duration of the procedure should not be a determining factor in whether a patient is given sedation to reduce its distress.
During each visit, every effort should be made to reduce the patient’s distress and fear to the lowest level possible (see Take-Home Messages). If the patient’s behavior worsens over multiple visits to the practice, careful evaluation of practice protocols is warranted to determine where modification is needed to promote positive changes. Medical advances and expansion of knowledge must include attention to the mental well-being of the patient, as psychologic status is inseparable from physiologic health.2