Tips Handling Fractious Patients
Working with a fractious animal is stressful and potentially dangerous for patient, client, and staff. Naturally, prevention is the best solution and can often be accomplished by creating safe, secure, and pleasant visits for puppies and kittens. Going slowly and using food rewards at the beginning, middle, and end of the examinations can often smooth over any bumps in the road for puppies, kittens, and adult dogs and cats alike. Keep in mind that resistance is usually a sign of fear, so calm and quiet responses-not harsh discipline-are needed.
Many pets only travel in the car on a limited basis, and the destination is often unpleasant, so car travel itself can induce anxiety. Therefore, the pet may be on edge even before it arrives at the clinic. Keeping the reception area calm and quiet may help. Pets known to become agitated can be allowed to wait in the car, scheduled for the first appointment of the day or after a lunch break, or taken directly into the examination room. Separate waiting rooms for dogs and cats may be helpful.
In the Examination RoomThe examination table should be covered with a nonslip rug or pad, which will make the animal more comfortable. An alternative is to examine a dog on the floor. The initial greeting can set the tone for the entire examination. Avoid rushing into the room in a hurried, loud fashion-take time to enter slowly; avoid eye contact with dogs or reaching for cats. This allows the animal time to assess body language. If you approach too quickly, it may react defensively because it has no time to determine whether another response would be more appropriate. Turning sideways is considered a less imposing body posture and can decrease canine anxiety. You might consider changing the way you greet the owner; that is, do not approach the owner to shake hands as this could be viewed by the dog as a threatening gesture. Dropping or gently tossing a food treat can also help ease the tension.
Owners should be advised to avoid "calming" the pet by using a soothing tone of voice and body contact because the animal will perceive from this that its behavior is acceptable; they should be counseled that it is more useful to be calm, firm, and relaxed when handling their pets. Punishment is contraindicated because it is likely to increase rather than decrease fear and anxiety: the animal may associate the stimulus (the veterinarian) with aversive consequences.
The Case with CatsWhile cats are usually in a carrier, keeping the environment calm and quiet is useful. Various techniques can facilitate removing a cat from the carrier. Avoid tipping the carrier and "shaking" the cat out. Instead, if time permits, have the owner set the carrier on the floor and open the door so the cat can come out on its own. Otherwise it may be more prudent to remove the top of the carrier. Slowly sliding a towel over the opening as you remove the top can provide a sense of security for some cats. The towel can then be used to gently surround and lift the cat onto the table for examination. If the cat is extremely scared, the examination can be done within the carrier. Advise the owner to purchase a soft-sided carrier as it will be easier to get the cat into and out of the zippered opening at the top.
Consistently Difficult DogsFor dogs that are consistently difficult to handle, planning ahead is helpful. For some, a head halter is calming and increases control. Training the dog at home to wear a basket muzzle can be useful if it has a history of being aggressive and difficult to handle. Using food rewards, the owner can train the dog to wear the muzzle when it is not frightened or anxious and gradually increase the wearing time. The muzzle should be placed on the dog before it enters the veterinary clinic.
In some situations, a dog may be more tractable when removed from the owner. Over the long term, a counterconditioning and desensitization program can be instituted to teach the dog new responses to veterinary visits. This would entail short, fun visits to the clinic in which no examination is done but the animal receives food rewards and praise.
Recognizing increasing agitation, fear, anxiety, and aggression in both dogs and cats is important. If the pet becomes more difficult to handle, it may be best to stop the examination for a few minutes, allowing the pet to settle down before continuing. If this doesn't work, consider either having the pet return another day or pharmacologic restraint. Continuing to struggle with the pet only increases anxiety and fear, which will affect its behavior on subsequent visits. For routine visits and vaccinations, patients can be given a tranquilizer or anxiolytic before the appointment. Short-acting anesthetics can be used when the animal must be examined at the time of presentation. Propofol or tiletamine plus zolazepam are common anesthetic choices; dosages can be found in several sources.
A commonly used tranquilizer is acepromazine, a phenothiazine tranquilizer that causes sedation and ataxia but usually does not appreciably decrease anxiety or fear. It should be used with caution in animals that are prone to seizures. Moreover, animals can actually become more agitated and more difficult to restrain when medicated with acepromazine.
With planning and preparation, most fractious patients can be managed and handled. The use of calm restraint and medication when necessary can aid in controlling these patients. Shortening the visit time will decrease stress on the owner, pet, and staff; so have all necessary medications, vaccinations, and supplies drawn up and ready when the pet is restrained.
What to Do• Avoid rushing into the examination room in a hurried and loud fashion; food treats can help ease the tension.• Using a towel to help remove a cat from a carrier can be helpful.• Some dogs may need to be trained to wear a muzzle.• In some situations, sedation may be necessary.• Creating a pleasant environment for puppies and kittens is the best way to preclude creating a fractious patient for the future.