As I have lectured about less stressful veterinary care, and participated in various Facebook groups and forums, I often hear opinions that only serve to keep discussions about Low Stress Handling® polarized within the veterinary and animal behavior industries. Some believe that Low Stress Handling® techniques take too long to be usable in an emergency care setting. Some feel there is more risk for staff injury when using less restrictive handling techniques. While others are concerned that a full exam must be completed before using sedatives or pain relief medication and that sedation is just a chemical restraint.
As a private small animal practitioner myself, I occasionally provide emergency care for the companion animals in my community. I also refer patients to our local emergency clinics and have collaborated with those clinics on how to provide less stressful emergency care. Many of the Low Stress Handling® techniques are useful, safe, and effective. As in any discipline of medicine, one can modify techniques used in another discipline. In this article I will address what techniques help reduce stress in emergency care, how you can achieve patient cooperation when you do not have the ability to use food rewards, address staff safety, and why the experience in an emergency setting affects an animal for all veterinary care.
The first comment I will typically hear from emergency staff is that “we don’t have the time to use Low Stress Handling®.” Granted, learning the body language of fear or some of the various holds and positioning techniques does take time, but doesn’t all of our continuing education take time? As for the actual exam time, an emergency setting can save time in providing a low stress experience. Here are five ways that Low Stress Handling can and will save time in exams and reduce stress:
- Get a weight room floor pad that is vulcanized to cover your stainless-steel exam tables. This can be wiped and sanitized between each exam, and is warm, soft, and quiet. I have them on all my exam tables and floor scale. They have stood up to 5 plus years of daily use and are still smooth, easy to clean and the clients love them. No time needs to be spent getting towels or yoga pads put on tables. You are always ready to go.
- Keep a stack of bath towels, pillow cases, and a baby blanket or two, pre-sprayed with Adaptil (dogs) and Feliway (cats), on a shelf in the exam room. Pheromones are species specific — the animal will be helped by the pheromone that works for them. Spray them twice daily and keep the spray out on the counter for staff use. Since this could be part of the room set up that is restocked daily, you don’t have to spend time looking for these items. Pheromone diffusers are also helpful in the exam room and kennel area.
- Learn to use the cowl technique from the Low Stress Handling, Restraint and Behavior Modification of Dogs & Cats textbook by Sophia Yin, DVM. This towel wrap technique will substitute for scruffing cats, helps reduce the struggle many brachiocephalic breeds have with head holds, and it reduces bite risk for staff and the DVM. Head movement is limited with the thick towel and pheromones are easily inhaled from the pre-sprayed towels and blankets.
- Pain relief and sedation before examination on an aggressive patient improves welfare and is less of a health risk than escalating stress. The increased stress hormones and excitatory neurotransmitters released in a patient in pain can harm the heart and respiratory system, and will decrease the effectiveness of medication. It is important to run the blood work and urinalysis before continuing some medications, which can be collected on the sedated exam. If an animal is aggressive with acute pain, transmucosal buprenorphine is effective quickly for both dogs and cats. Topical anesthetic sprays and creams also reduce pain quickly. If an animal is aggressive, provide the pain relief before or at the time of sedation. Think of stress and pain as an agent that increases risk for sedation.
- Keep the hospital environment, exam room, and treatment areas as low stimulus as possible. Take the cats to an exam room or empty area, not the busy treatment area for care. I know many emergency clinics are designed with a large centralized treatment room where a lot goes on; this was designed with the human’s ease in mind, not the animal’s. Clipping a towel over the cage of a barking dog will help decrease the barking and stress on that dog and others in the treatment area. Consider how you can allow an article of the client’s clothing to stay with this animal in the hospital. Remind your staff to keep their voices down during care. Muffle beepers on monitors or set them to a lower volume. All of this can be done in emergency care.
Patients cooperate for care when they are less fearful. Having pheromones in the exam and treatment areas ready for immediate use, using Elizabethan collars to block the animal’s view of the DVM or handler, a floor exam rather than on the table, and licking a frozen Dixie cup of broth can help a patient be cooperative during care. I suggest keeping the freezer stocked with broth cups so that you’ll have them handy when they are needed. None of these techniques requires much time.
In all of the Low Stress Handling® Certified hospitals surveyed, using the Low Stress Handling® techniques significantly reduced staff injury from bites and scratches. We see far less injury when a technician and DVM know how to read the animal’s body language, how to change their approach, and how to utilize the proper techniques focused on comfort while keeping the staff’s face and hands away from the teeth. By following the specific techniques in the Low Stress Handling, Restraint and Behavior Modification of Dogs & Cats textbook, the DVDs, and modules of the Low Stress Handling® Certification courses, you will have less injury.
Whatever the animal experiences during care, creates the memory of veterinary care. If they were in pain, stressed by people walking by, or experienced multiple handlers restraining them, this becomes their memory of all veterinary care. Even if they had positive, low stress, free of fear exams at their general veterinarian in the past, they now generalize the emergency visit experience to all veterinary practices. Why? We all look the same to the pet – reception desk, exam tables, exam rooms, stethoscopes and syringes. If this animal was easy to bring to the regular vet, one may see them now shaking, drooling, yowling, or panting. This animal can be reconditioned to being less stressed but it will require work. It may also be perplexing to the general practice to see this change in a patient, especially if they did not know the pet was in for emergency care. Taking a few steps to reduce stress will help prevent this effect. If the pet was difficult to manage in order to reduce stress and pain, please inform your general practitioner. They can reset this animal by providing some short positive, low stress exams.
It is not easy to provide emergency care. You have to provide care now, not later. The animals, owners, and staff are often stressed. I accept and acknowledge that stress cannot be eliminated. But any stress reduction is an improvement on the patient’s welfare, the staff’s safety, and improves patient outcomes. Low Stress Handling is not an all or nothing concept. It is a concept that can be applied to all care situations and modified according to the patient and situation at hand. If you always think of reducing stress every day, every way, with every animal, you are providing a low stress, positive care experience.
** This is Dr. Foote’s personal recommendation and does not reflect any professional endorsement by CattleDog Publishing.
Dr. Sally J. Foote
For Further Reading:
- Are You in a North/South Workplace?
- Tactile Learning & Low Stress Handling: The Step From Learning to Doing
- Ready to Learn, the Low Stress Handling Way
- Help! My Vet is Scaring My Dog!