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Aggressive pets: Take away the fear factor
There are no bad patients-just fearful and stressed ones. By remembering that, watching for warning signs, and taking a less-is-more approach, you can help patients and keep yourself safe.
"You have a frightened feline that needs its toenails trimmed in exam room one and a raging rover in need of a blood draw in exam room two," your trusted receptionist informs you. "Muzzles are in both rooms, and assistants are standing by to help you wrestle the patients to the ground."
Hearing that—and many similar statements—you walk into the exam room ready for war, not peace. I want to challenge you to see a different perspective. Besides, if there is an easier way, wouldn't you want to take it—for your sake and for the pets you are trying to help?
Each animal has its own fears and anxieties. Just because you know an animal will be safe during its visit to your clinic, doesn't mean it understands this is the case or trusts you. And using force with frightened or reactive animals intensifies their stress, making your job more difficult and dangerous.
Effects of stress
The effects of stress and high arousal levels are well-documented. As soon as the body is placed under stress, various hormones are released. The hormone cortisol, which affects the immune system, is increasingly released under stress. Cortisol is the main culprit for adaptation diseases, and a permanently raised cortisol concentration in the blood weakens the immune system. Allergies, stomach ulcers, chronic diarrhea, and bladder issues can be signs of anxiety. Stress can cause the urge to defecate and urinate frequently. In other words, overly stressing an animal in your care doesn't lead to optimal healing, but it does lead to cleaning up a lot of messes.
Most of a dog's life is aimed at conflict resolution. If exposed to fear and other stress-inducing stimuli for long periods, the dog can chemically and behaviorally extend so far out of the normal range that it can't return to its normal emotional state. Long-term exposure to stress and fear is frequently the root of behavior patterns that present as aggression.
Cats have a fear imprint period from 2 to 7 weeks of age. For dogs, the first fear imprint period occurs from 8 to 11 weeks of age, and the second fear imprint period is from 6 to 14 months of age.1 Be cautious if you are dealing with an animal during a fear period. If you push the animal too far during this period, you could spend the rest of its life overcoming its fear, forcefully restraining it through simple procedures, or sedating it at every visit.
Reading the warning signs
We expect animals to come into our world and learn our language, but how much effort do we put into learning theirs? Almost all patients use body language to warn us that they are not comfortable, that they want out of the situation, and that if you don't stop, they will react.
The more you note an animal's body language and watch for clusters of signals, the better you can read the animal. Some signals to note in dogs are a lowered head or body, curving (twisting the body into a C shape), pulled back ears, whale eyes (the white portion of the eye showing at the corner or rim), body stiffening, a tucked tail, uneven weight distribution (back vs. front), averted eyes or head, a softening of eyes (almost squinting), yawning, panting, and lip licking. Signs to look for in cats include dilated eyes, ears pressed backward, an open mouth with retracted lips, and a tucked, puffed, or frantically twitching tail.2 Entire books are dedicated to learning animal body language, such as On Talking Terms with Dogs: Calming Signals by Turgid Rugass, Canine Body Language: A Photographic Guide Interpreting the Native Language of the Domestic Dog by Brenda Aloff, What is My Cat Thinking? by Gwen Bailey. I highly recommend having a few of these books available to everyone working in the veterinary clinic.
Another important detail to note: There is an escalation ladder to body language. Something stressful happens, and the animal will give one or two warning signals. If the situation continues, you will see a clustering of signals. You should never punish animals for showing these signals—you need them to warn you before they bite.
Why patients attack: Going from the green to the red zone
If a pet feels stress, it may give one or two warning signals. At this point, it is in the green zone. If the pet continues to feel stressed and show multiple warning signals, at some point the situation will overwhelm the pet and it will enter the yellow zone. At the apex of the yellow zone, the stress signals will stop. This is often when the owners say something like, "See, I told you Fluffy was OK!" On the contrary, the patient is getting ready to do something about the stressful situation. It's experiencing the fight-or-flight response, and since it is locked in the exam room, it can't flee. With dogs, you will start to see defense growling, lunging, or barking, and the dog will stop taking treats. Once in the red zone, the dog will bite. In cats, you will see full-out lunging and growling—and then batting and biting during the red zone.
Calming these patients
All too often, we play it safe with aggressive or fearful patients by using muzzles, rabies poles, or force to restrain them. Most of the time, you can use much less intense efforts with these patients. While safety—your own and that of your patients—is of the utmost importance, by using a less-is-more method, you can actually decrease bites to staff members and help calm stressed patients. Here are some easy strategies to implement:
- Be patient. Give the cat or dog time to adjust to the environment. For example, allow anxious pets into the exam room as soon as possible, and give them four or five minutes to adjust. Encourage the owners to walk the pet around the room to take in the smells. The quieter the room, the better. And the more efficient you are, the quicker the visit, and the less time to stress.
- Let the pet come to you.
- Never pull a cat out of its carrier. Instead, take the top off screw-top carriers and coax the cat out with treats. Or open the door to the carrier and allow the cat to come out on its own, giving it a few minutes to acclimate to the environment. Only remove the cat when necessary.
- If you're facing a pet, change your body language by turning your entire body to the side so the patient understands that you are trying to be less threatening.
- Don't stare.
- Don't hover.
- Pet with your hand open, palm facing up and under the chin or on the chest area, rather than going at the animal straight on with your hand over its head.
- Don't smile, because it looks like a tension-filled grimace to dogs and cats.
- Spray or diffuse pheromones in the exam room. Vision-restricting headgear or pressure wraps may help, too.
- Use a lift table instead of picking up the animal.
Although not a quick-fix solution, some simple training can reduce a patient's stress in the exam room. For example, owners can teach their dogs to sit or make eye contact with them, called attention, instead of watching the exam. (Visit dvm360.com/fearfulpets to download a client handout on teaching attention in puppies.) You can teach dogs and cats to target (touch an object with their nose), which can countercondition and desensitize animals to the situation. (For more on changing associations through conditioning, see dvm360.com/fearfulpets.) Or you can teach the animal to have a positive association with your exam room through classical conditioning and high-value treats such as chicken, steak, peanut butter, or cheese.
If restraint is needed, place an Elizabethan collar so the animal doesn't feel closed in and restrain normally. When an E-collar isn't enough, use a basket muzzle, which is not as tight on the dog's muzzle as a nylon muzzle. With a basket muzzle, a dog can still open its mouth, so you can feed it treats, possibly changing the dog's outlook on the situation. Sometimes the restraint itself is stressful for the animal, so less is generally better in those situations.
Finally, administering a sedative (or anesthesia in extreme cases) typically doesn't save the clinic time, and it costs the owners more money. It may be a necessary tool at times, but it shouldn't be the first choice when dealing with fearful patients.
As you and your fellow team members implement these techniques, you'll gain confidence handling aggressive and fearful patients. A positive cycle should follow: Your less-is-more approach will mean you'll face fewer incidents with aggressive patients and you'll continue to gain even more confidence handling them. While you'll undoubtedly still face fear-aggressive pets from time to time, the fear factor on both sides—patients' and yours—will continue to diminish.
Katie Costello, RVT, CPDT-KA, is co-owner of The Learning Dog Training and Enrichment Center in Hubbard, Ohio, and the founder of the therapy-animal group K-9's for Compassion. Costello is also a Society of Veterinary Behavior Technicians board member.
1. Developmental stages and socialization. Available at: http://www.diamondsintheruff.com/DevelopmentalStages.html.
2. Dodman N. What is your cat saying? Reading your cat's body language. Available at: http://www.petplace.com/cats/what-is-your-cat-saying-reading-your-cat-s-body-language/page1.aspx.